The neonate with circulatory failure and cardiogenic shock is a difficult management problem. However, the initial approach is that of resuscitation with exact diagnosis of secondary concern. Once the infant has been stabilized and septic and hypovolemic shock have been excluded, attention should be directed to the four most likely causes of cardiogenic shock: structural heart disease with left heart obstruction being the most common, cardiac muscle disorders, cardiac dysrhythmias, and cardiac metabolic disorders.