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Archives of Disease in Childhood - Fetal and Neonatal Edition 1999;80:F43-F45; doi:10.1136/fn.80.1.F43
Copyright © 1999 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child Fetal Neonatal Ed 1999;80:F43-F45 ( January )

Prevalence and clinical significance of cardiac murmurs in neonates

Sean B Ainsworth,a Jonathan P Wyllie,a Christopher Wrenb

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.

Key messages

  • The prevalence of murmurs detected at routine examination of neonates is less than 1%.
  • About half of murmurs are due to an underlying cardiovascular malformation
  • Early referral of all newborn babies with murmurs for definitive diagnosis is recommended
  • The absence of a murmur does not exclude serious heart disease



Keywords: congenital heart disease; neonatal examination; cardiac murmur; screening


© 1999 by Archives of Disease in Childhood

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