TY - CHAP M1 - Book, Section TI - Suspecting Congenital Heart Disease* A1 - Siassi, Bijan A1 - Ebrahimi, Mahmood A1 - Acherman, Ruben J. A2 - Siassi, Bijan A2 - Noori, Shahab A2 - Acherman, Ruben J. A2 - Wong, Pierre C. PY - 2018 T2 - Practical Neonatal Echocardiography AB - Although prenatal detection of congenital heart defects (CHDs) is attempted during routine fetal ultrasonography, it is estimated that, at present, only 36% of CHDs are detected antenatally, with a wide variation among different localities and states.1 Since the incidence of CHDs is approximately 8 per 1000 live births, and only a third are detected prior to birth, the proposition to perform echocardiography in all neonates for detecting CHDs2 is a huge and costly undertaking in absence of appropriate infrastructure and adequate funding. However, the initial echocardiogram obtained in any neonate (for any indication) should be as complete as possible and interpreted by a pediatric cardiologist who is competent in the interpretation of echocardiograms, or alternately, if it is performed by a non-cardiologist physician, the physician should have enough training to at least suspect the presence of a CHD, which will then require referral to the pediatric cardiology service for further evaluation and management. Understanding fetal and transitional circulatory physiology, as it is affected by a CHD, is essential in anticipating the presentation of a CHD in the neonate. It is important to remember that CHDs that would have significantly affected fetal systemic or placental circulation would likely have led to a fetal demise. Therefore, almost all critical congenital cardiac defects (CCHDs) that present at the time of birth were compatible with a fetal circulation that had adjusted to provide normal or near normal fetal systemic and placental circulation in utero; in the few instances in which fetal circulation is compromised, it is not to such degree as to cause fetal demise prior to birth. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1161425121 ER -