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Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes &gt;4000\u00a0m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4150\u00a0m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with\/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland\u2010origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born &gt;4000\u00a0m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence\u2010based tools optimized for use in low\u2010resource, high\u2010altitude settings.<\/jats:p>","DOI":"10.1113\/ep092215","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T18:47:43Z","timestamp":1741718863000},"page":"1060-1070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prolonged postnatal adaptation and enhanced prevalence of congenital heart diseases due to altitude may contribute to newborn mortality in Bolivia"],"prefix":"10.1113","volume":"110","author":[{"given":"Alexandra","family":"Heath","sequence":"first","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"von Alvensleben","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas Ardiles","family":"Spielvogel","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Freudenthal","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"},{"name":"School of Medicine, Faculty of Health Witten\/Herdecke University  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Trapp","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivanna","family":"Noya","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"G\u00e1lvez","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanny","family":"Mendiz\u00e1bal","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Kardiozentrum  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Department of Mathematics School of Computation, Information and Technology, Technical University of Munich  Garching Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceylan","family":"Apaza","sequence":"additional","affiliation":[{"name":"Department for Pediatric Cardiology Hospital \u2018Arco Iris\u2019  La Paz Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leibniz","family":"Sanga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Hospital Municipal Boliviano Holand\u00e9s  El Alto Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Mc Cann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati  Cincinnati Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen G.","family":"Julian","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnatti  Cincinnatti USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1745181"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330560302"},{"key":"e_1_2_9_4_1","first-page":"L370","article-title":"Alveolar size, number, and surface area: Developmentally dependent response to 13% O2","volume":"261","author":"Blanco L. 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