Congenital heart disease in newborns - Advances in early detection, management and outcomes: A narrative review

Congenital heart defects (CHDs) are among the most common congenital abnormalities and range from lesions that remain clinically silent in the neonatal period to critical defects that cause severe hypoxaemia, circulatory failure or death. Outcomes depend not only on lesion severity but also on timely recognition and access to specialist cardiac services. These challenges are particularly consequential in low- and middle-income countries, including Nigeria. To synthesise contemporary evidence on the spectrum, epidemiology, aetiology, clinical recognition, diagnosis, management, outcomes and prevention of cardiac anomalies in newborns, with emphasis on implications for Nigeria and sub-Saharan Africa. A targeted narrative literature update was undertaken for publications dated January 1, 2024 to August 31, 2026, supplemented by earlier landmark studies and Nigerian/African reports relevant to epidemiology and health-service context. PubMed-indexed literature and bibliographic records identified during the update were considered using combinations of terms for congenital heart disease, newborns, critical CHD, prenatal diagnosis, fetal echocardiography, pulse oximetry, management, outcomes, Nigeria and Africa. Relevant reviews, meta-analyses, epidemiological studies, clinical reports and guidance documents were synthesised thematically. This was not a systematic review; no pooled analysis or formal risk-of-bias scoring was undertaken. CHD prevalence estimates vary by population, diagnostic methods and setting. A 2025 African meta-analysis reported pooled estimates of 5.12 per 1000 in population-based studies and 12.63 per 1000 in hospital-based studies among children and adolescents, underscoring the effects of referral patterns and incomplete case ascertainment; these are not neonatal birth-prevalence estimates. Ventricular septal defect is commonly reported, and tetralogy of Fallot is a major cyanotic lesion. Prenatal assessment, newborn examination and pulse-oximetry screening can improve recognition, but no single screening approach detects every critical lesion. Echocardiography remains central to anatomical and haemodynamic diagnosis. Duct-dependent lesions require prompt stabilisation, consideration of prostaglandin E1 and urgent referral. Access to cardiac surgery, catheter intervention, intensive care and longitudinal follow-up remains unequal. Improving neonatal outcomes requires a coordinated pathway linking maternal care, prenatal detection, newborn screening, timely echocardiography, stabilisation, referral and definitive treatment. In Nigeria and comparable settings, screening programmes must be supported by diagnostic capacity, transport systems, specialist services and reliable surveillance.