. Author manuscript; available in PMC: 2013 Sep 1.

Published in final edited form as: Clin Perinatol. 2012 Sep;39(3):655–683. doi: 10.1016/j.clp.2012.06.006

Table 1.

Differential diagnosis of hypoxemia in neonates based on the direction of shunt at atrial and ductal levels on echocardiography

Diagnosis	Ductal Shunt	Atrial Shunt	Management
Parenchymal lung disease and V/Q mismatch and intrapulmonary shunt	L →R	L →R	Lung recruitment, specific therapy (antibiotics for pneumonia) NO may be beneficial
PPHN	R →L	R →L	Oxygenation, correction of acidosis and inhaled NO
Left ventricular dysfunction (common in diaphragmatic hernia, asphyxia, and sepsis)^59,60	R →L	L →R	Inotropes and vasodilators (Milrinone)
Tricuspid atresia/stenosis or pulmonic atresia/stenosis	L →R	R →L	Prostaglandin E1 + surgery
Total anomalous pulmonary venous return¹⁵⁵	R →L (large PA)	R →L (small LA and no tricuspid regurgitation)	Surgery

From Lakshminrusimha S, Kumar VH. Diseases of pulmonary circulation. In: Fuhrman PP, Zimmerman JJ, editors. Pediatric critical care. Mosby; 2011. p. 641; with permission.