Evaluation of suspected congenital heart disease in the neonatal period

Congenital heart disease (CHD) is the most common group of significant congenital abnormalities. It may present in the neonatal period with an asymptomatic murmur detected on the routine neonatal examination or when an infant becomes symptomatic. In assessing an infant with possible CHD, key features in history and examination need to be considered. The investigations appropriate to consider outside the tertiary paediatric cardiology setting will be discussed. We highlight the importance of a thorough assessment of the neonate presenting with an asymptomatic heart murmur to ensure that, where possible, infants with duct-dependent CHD are not discharged home inappropriately. The symptomatic presentation of CHD in the neonatal period is described, considering groups related by physiology rather than concentrating on the details of individual lesions. Important points in the initial stabilisation of a symptomatic infant are outlined.