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Prevalence and clinical significance of cardiac murmurs in neonates
S Ainsworth1, J P Wyllie, C Wren
1South Cleveland Hospital, Middlesbrough.
Insights
Routine neonatal examinations detect less than half of congenital heart defects. A heart murmur in newborns indicates a 54% chance of underlying cardiac malformation, necessitating further pediatric cardiology evaluation.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Diagnostics
Background:
- Congenital heart disease (CHD) is a significant concern in newborns.
- Early detection of cardiac anomalies is crucial for timely intervention and improved outcomes.
- The role of routine neonatal physical examination in identifying CHD requires further clarification.
Purpose of the Study:
- To assess the prevalence of heart murmurs during routine neonatal examinations.
- To determine the clinical significance and diagnostic yield of these murmurs.
- To evaluate the effectiveness of neonatal screening in detecting all cases of CHD presenting in infancy.
Main Methods:
- A prospective study involving 7204 newborns over two years.
- Routine neonatal examinations conducted by senior house officers.
- Echocardiography performed on all infants with detected murmurs.
- Follow-up to identify CHD cases presenting later in infancy.
Main Results:
- Heart murmurs were detected in 0.6% (46/7204) of neonates.
- 25 out of 46 neonates with murmurs (54%) had a confirmed cardiac malformation, most commonly ventricular septal defect.
- An additional 32 infants (0.44%) from the same cohort were diagnosed with CHD before 12 months despite a normal neonatal exam.
Conclusions:
- Routine neonatal examination identifies only 44% of cardiac malformations presenting in infancy.
- A significant proportion of neonates with murmurs have underlying cardiac malformations.
- A normal neonatal examination does not rule out clinically significant CHD, emphasizing the need for vigilance and prompt referral if murmurs are present.
Aim:
To determine the prevalence and clinical significance of murmurs detected during routine neonatal examination.
Methods:
In a two year prospective study, 7204 newborn babies underwent routine examination by senior house officers. All those with murmurs underwent echocardiographic examination. All babies presenting later in infancy were also identified, to ascertain the total prevalence of congenital heart disease in infancy.
Results:
Murmurs were detected in 46 babies (0.6%) of whom 25 had a cardiac malformation. The most common diagnosis was a ventricular septal defect, although four babies had asymptomatic left heart outflow obstruction. A further 32 infants from the same birth cohort had a normal neonatal examination but were found to have a cardiac malformation before 12 months of age.
Conclusions:
The neonatal examination detects only 44% of cardiac malformations which present in infancy. If a murmur is heard there is a 54% chance of there being an underlying cardiac malformation. Parents and professionals should be aware that a normal neonatal examination does not preclude a clinically significant cardiac malformation. The detection of a murmur should prompt early referral to a paediatric cardiologist for diagnosis or appropriate reassurance.