The sick neonate with cardiac disease

The approach to the infant with a cardiac emergency begins with identification of the unstable or critically ill child and proceeds rapidly into stabilization and provision of immediate therapies. Support of oxygenation, ventilation, and circulation will precede identification of specific cardiac lesions. The emergency clinician can use clinical findings, chest x-ray, and electrocardiographic information to plan emergent intervention. Infants in the first days of life who present with circulatory collapse secondary to obstruction of pulmonary or systemic blood flow (ductus dependent) conditions can be stabilized with prostaglandin E infusion. The more common presentation of cardiac disease in the first month of life is congestive heart failure. Infants with congestive heart failure require respiratory support, careful fluid management, and inotropic support.