Fifteen-minute consultation: A neonate with suspected critical congenital heart disease

A focused, practical guide for general paediatricians and resident doctors managing neonates with suspected critical congenital heart disease (CHD), a spectrum of life-threatening cardiac defects requiring intervention. Through detailed case examples, we simulate real-world scenarios that highlight the diagnostic challenges and importance of early recognition. The article reviews essential clinical signs-including differential preductal and postductal oxygen saturations, persistent cyanosis unresponsive to oxygen, poor perfusion and weak femoral pulses-that should raise suspicion for critical CHD. It outlines a stepwise approach to initial management, encompassing immediate stabilisation with cautious fluid administration, and the early use of prostaglandin E1 infusions to maintain and increase ductal patency in duct-dependent lesions. Guidance is provided on prostaglandin, escalation, monitoring for side effects and the need for early discussion with tertiary cardiac centres. The article also addresses the careful titration of oxygen therapy to avoid potential risks unique to certain cardiac physiologies. Emphasis is placed on the limitations of prenatal screening programmes and the need for vigilance in postnatal care. Supplementary quiz questions reinforce key learning objectives and ensure knowledge retention. In summary, this article serves as an educational resource for prompt recognition, stabilisation and referral of neonates with critical CHD.