Fifteen-minute consultation: Cardiac murmurs in the Newborn Infant Physical Examination (NIPE)

Area of Science:

• Pediatrics
• Cardiology
• Neonatology

Background:

• Cardiac murmurs are frequently detected during newborn physical exams.
• Distinguishing benign murmurs from those indicating critical congenital heart defects (CHDs) can cause practitioner anxiety.
• Early identification of CHDs is crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To provide a structured approach for evaluating cardiac murmurs in newborns.
• To review the evidence supporting historical, physical examination, and non-specialist investigation features associated with CHDs.
• To enhance clinician confidence in managing this common neonatal finding and identifying at-risk infants.

Main Methods:

• Systematic review of the literature on neonatal cardiac murmurs and CHDs.
• Analysis of historical factors, clinical examination findings, and non-specialist investigations.
• Evidence-based assessment of features predictive of CHDs.

Main Results:

• Specific historical elements and examination findings can increase the suspicion of CHDs.
• Certain non-specialist investigations aid in risk stratification.
• A structured approach can effectively differentiate benign murmurs from those requiring further cardiac evaluation.

Conclusions:

• Clinicians can confidently manage neonatal cardiac murmurs using an evidence-based framework.
• Identifying infants with critical CHDs is achievable through careful assessment of key clinical indicators.
• This approach aims to reduce unnecessary anxiety and ensure prompt diagnosis for infants with serious cardiac conditions.