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a Directorate of Neonatology South Cleveland
Hospital Middlesbrough TS4 3BW, b Department of Paediatric
Cardiology Freeman Hospital Newcastle upon Tyne
Correspondence to: Dr J P Wyllie.
Accepted 26 June 1998
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.
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