Congenital heart disease presenting in the newborn — branching viva

Station opening

Examiner: "Tell me the single bedside decision that frames every newborn with suspected congenital heart disease, and why it matters." [6]

Strong candidate (must-hit)

• The decision is whether the lesion is duct-dependent: whether systemic or pulmonary blood flow can only occur through an open ductus arteriosus. It matters because the ductus closes functionally over 24 to 48 hours, so a duct-dependent baby who looks well initially will collapse — with shock (left obstruction) or cyanosis (right obstruction) — as the duct closes. Making that call early and starting prostaglandin before the echo is the difference between a planned transfer and an arrest. [6]

Weak candidate

• "We look for a murmur and do an echocardiogram." [6]