How effectively can clinical examination pick up congenital heart disease at birth?

To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians.

A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003.

1.2% of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography) within a year of birth. The number not suspected before discharge declined over time, and only 6% were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8, but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2% requiring cardiac referral; 54% of these babies still had a murmur when assessed one to two weeks later, and 33% had a structural defect. Parents said in independent, retrospectively conducted, interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained.

Effective screening requires experience and a clear, structured, referral pathway, but can work much better than most previous reports suggest. Whether staff bring a medical or nursing background to the task may well be of less importance.