Critical Congenital Heart Disease

Clinical assessment of Coarctation of Aorta (COA) in neonates
We can assess by palpating femoral pulses, in Coarctation of AortaCOA, these are either very weakly felt or not felt at all. Also there will be no pulse trace while assessing saturation in lower limbs. We should not rely on saturations until we get a good trace on monitor. In severe Coarctation of Aorta COA, saturation number we may get but trace will not be there. Severe Coarctation of Aorta COA is a medical emergency and needs to address on priority basis.
Critical Congential Cyanotic Heart Disease (Screening in Newborn)

In first 48 hours, many of cyanotic congenital heart disease can be easily missed. To avoid that, we shall assess saturation before discharge (at least in one upper and one lower limb). In cyanotic heart disease, saturation will always be less than 95%. If difference in spo2 of upper and lower limbs is more than 5%, then we should get an echo done before discharging the newborn.

Neonates presented with shock after 48 hours of life
Whenever a neonates (especially after 48 hours) comes with shock ,suspect duct (PDA) dependent lesion newborn may need Prostaglandin infusion to keep the duct open.