An audit of the management of heart murmurs on the postnatal wards

Area of Science:

• Neonatal cardiology
• Pediatric cardiovascular health
• Clinical guideline implementation

Background:

• Management of neonatal heart murmurs lacks standardization, varying by local resources.
• A hospital-specific guideline was implemented to standardize care, focusing on clinical examination and selective cardiology review.

Purpose of the Study:

• Assess adherence to and safety of the new guideline.
• Evaluate the guideline's impact on workload.
• Determine the prevalence and causes of neonatal heart murmurs in the study population.

Main Methods:

• Prospective identification of 89 neonates with heart murmurs over two years (August 2006 - July 2008).
• Review of case notes, including examination findings, investigations, follow-up, and diagnoses.

Main Results:

• Guideline adherence was generally good; 57% of infants were referred for cardiology assessment, with 40 undergoing echocardiography.
• 34% (30 infants) had an underlying cardiac malformation, with 25 identified before discharge.
• 50% of infants with cardiac malformations required cardiology follow-up at one year; no discharged infants without review presented with cardiac issues.

Conclusions:

• A significant proportion of neonatal heart murmurs are associated with underlying cardiac malformations.
• The implemented guideline effectively facilitates timely identification of these critical cases.
• The guideline optimizes the utilization of specialist cardiology services for neonates.