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Clinical Approach to a Neonate with Cyanosis. Cyanosis is always pathological and demands detailed evaluation. Combined use of clinical findings, electrocardiogram and chest radiograph permits determination of underlying cause in vast majority. Stepwise approach allows hemodynamic classification of the cardiac lesion and directs immediate management. Accurate anatomic diagnosis of the cardiac malformation is seldom essential for preliminary management and therefore, emphasis must be on clinical classification rather than on obtaining echocardiographic diagnosis.