Difficulties in distinguishing cardiac from pulmonary disease in the neonate

Since a clear cut differentiation between cardiac and pulmonary disease may be impossible in some situations, additional diagnostic studies, including heart catheterization and angiocardiography, may be required to precisely define the underlying state. Hemodynamic study of the newborn infant carries a small, but distinct, risk. As a general rule, cardiac catheterization is not performed unless the information than one is seeking will be central to the management of the infant. Infants with serious heart disease often require therapeutic intervention, and thus catheterization should be performed only when surgical support is readily available. In sophisticated cardiac centers, it is decidedly unusual for a hemodynamic and angiographic study to be performed in a neonate without structural heart disease. The only important exception to this statement concerns the study of infants with persistence of the fetal circulation in whom a precatheter diagnosis may not be made definitively. The recognition of congenital cardiovascular anomalies in the immediate newborn period constitutes a challenge, both to the pediatrician and to the pediatric cardiologist. Because of the normal hemodynamic changes that are occurring at this time in development, diagnosis is more difficult than at any other age.