Introduction: Congenital heart diseases (CHDs) represent some of the most common birth defects worldwide. The success of timely diagnosis of CHDs using medical equipment such as pulse oximetry largely depends on the awareness and vigilance of physicians during neonatal examinations. Considering the severe consequences associated with missed, delayed, or inaccurate diagnoses, the use of segmental pulse oximetry (upper and lower extremities) for monitoring arterial oxygen saturation (SaO₂) is regarded as a reliable and precise method. This approach reduces the need for arterial blood gas analysis by approximately ۵۰%. Although varying reports exist regarding its accuracy in cases of chronic hypoxemia, in certain clinical settings such as intensive care units, angiography, surgery, and anesthesia, accurate measurement of arterial oxygen saturation remains critical for physicians. Methods: A comprehensive search was conducted across scientific databases and search engines including Direct Science, Scopus, PubMed, Google Scholar, and Medline. Keywords used included congenital and structural anomalies, cardiovascular disorders, and pulse oximetry, in both Persian and English languages. Studies published between ۲۰۱۴ and ۲۰۲۴ were reviewed. Results: The search yielded ۵۸ articles, of which ۱۲ were selected for final analysis. Findings indicated that congenital heart diseases in neonates are often asymptomatic at birth. Routine clinical examinations and the identification of signs such as murmurs and cyanosis may raise suspicion of CHDs. Segmental pulse oximetry, due to its accessibility, safety, and cost-effectiveness, can be utilized as a screening tool for neonates. Pediatricians and neonatologists are therefore recommended to incorporate thorough clinical examinations and arterial oxygen saturation measurement via pulse oximetry in neonatal screening protocols. Abnormal findings should be confirmed with echocardiography and radiographic imaging. Conclusion: Physicians, particularly pediatricians and neonatologists, serve as the frontline providers of neonatal and pediatric healthcare. Timely diagnosis and referral of suspected CHD cases are of paramount importance. Clinical presentations such as tachypnea, cyanosis, arrhythmia, respiratory distress, cardiac murmurs, or abnormal arterial oxygen saturation can serve as sensitive indicators for CHD screening in neonates. Among clinical signs, cyanosis and respiratory distress hold greater diagnostic value. Variations in diagnostic outcomes may arise due to differences in the clinical skills of examining physicians and the expertise of pediatric cardiologists in identifying congenital heart diseases in neonates.
