Neonatal Cardiac Emergencies

Congenital heart disease is a relatively common birth defect that can be associated with significant morbidity and mortality. Although many emergency department visits have potential cardiac complaints, some of these signify critical cardiac disease (ie, cardiac emergencies) requiring urgent triage and management. Neonatal cardiac emergencies represent a unique subset of cardiac emergencies that can be difficult to distinguish from other critical neonatal pathologies such as sepsis and metabolic crisis. In this article, we review current approaches to the neonate with a potential cardiac emergency, highlighting common modes of presentation and providing strategies to distinguish cardiac from noncardiac etiologies. Rapid identification of a potential neonatal cardiac emergency allows for the most efficient and appropriate use of resources in this patient population while ensuring that life-threatening cardiac disease is aggressively managed to ensure the best possible outcome. Unique to the neonate is the “ductal dependent circulation” and a common feature of the cardiac lesions reviewed below. Although there is overlap, other lesions that can result in shock (and are not ductal dependent) are reviewed elsewhere in this issue of Clinical Pediatric Emergency Medicine.