Closing the Gap in Neonatal Congenital Heart Disease Care: The Role of the NICVD Network

Critical congenital heart disease (CCHD) is a major contributor to neonatal morbidity and mortality, particularly in low- and middle-income countries (LMICs), where delays in diagnosis and treatment can be fatal. In Pakistan, limited access to specialist services, referral delays and financial barriers complicate timely care. Role of the National Institute of Cardiovascular Diseases (NICVD) network: Improving neonatal CCHD outcomes requires a coordinated continuum of care, not cardiac surgery alone. Clinical assessment and pulse-oximetry screening should support early recognition and prompt echocardiographic evaluation. Neonates with suspected duct-dependent lesions require urgent stabilization, specialist consultation and safe transfer. The NICVD network could link screening, diagnosis, stabilization, neonatal transport, catheter-based or surgical treatment, intensive care and follow-up. Future priorities: Standardized referral and stabilization protocols, specialist neonatal transport, prostaglandin therapy when indicated, neonatal cardiac intensive care and systematic outcome audits are essential. Prospective neonatal-specific data are needed to evaluate implementation and outcomes. By connecting early detection with timely specialist intervention, an integrated NICVD network could help reduce avoidable deaths associated with neonatal CCHD in Pakistan.