HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in ADC Online Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Farrer, K F M Articles by Rennie, J M Search for Related Content PubMed PubMed Citation Articles by Farrer, K F M Articles by Rennie, J M Topic Collections Relevant Article

Neonatal murmurs: are senior house officers good enough?

¹ Neonatal Intensive Care Unit, St George’s Hospital, Tooting, London SW17 0QT, UK
² Neonatal Intensive Care Unit, Kings College Hospital, Denmark Hill, London SE5 9RS, UK

Correspondence to:
Correspondence to:
Dr Farrer, Neonatal Intensive Care Unit, St George’s Hospital, Tooting, London SW17 0QT, UK;
kate.farrer{at}stgeorges.nhs.uk

ABSTRACT
Aim: To show that, given appropriate guidelines, senior house officers (SHOs) have the clinical skills required to assess neonatal murmurs.

Methods: Neonatal SHOs identified babies with a cardiac murmur at routine neonatal examination. The SHOs assessed whether the murmur was significant or innocent and decided between immediate further assessment or echocardiogram as an outpatient.

Results: A total of 112 babies had murmurs at routine neonatal examination. The incidence of cardiac murmurs was 13.8 per 1000. Twelve babies were referred for immediate further assessment. Eleven had structurally abnormal hearts. One had a normal heart with pulmonary hypoplasia. One hundred babies were referred, and 78 attended for outpatient follow up. Of these, the SHO assessed nine babies as having a significant murmur and 69 as having an innocent murmur. Twenty two babies failed to attend for follow up; all were thought to have innocent murmurs. Of the nine murmurs assessed as significant, four were confirmed as such and five were found to be innocent. Of the 91 murmurs assessed as innocent, 63 were proven to be innocent, six had abnormalities on echocardiogram, and 22 defaulted to follow up. Five of the serious murmurs were small ventricular septal defects, which had resolved by 6 months of age; the other had mild pulmonary stenosis. None of these babies were clinically symptomatic at outpatient review.

Conclusion: Given appropriate guidelines, SHOs have the skills to assess the significance of, and decide on appropriate management for, neonatal murmurs. Electrocardiograms and chest radiographs are not necessary.

Keywords: heart; cardiac; murmur; assessment; senior house officers

Abbreviations: ECG, electrocardiogram; CXR, chest radiograph; CHD, congenital heart disease; SHO, senior house officer; VSD, ventricular septal defect; PDA, patent ductus arteriosus; "PBS", mild pulmonary branch stenosis

Relevant Article

Fantoms

Ben Stenson
Arch. Dis. Child. Fetal Neonatal Ed. 2003 88: F80. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				C Patton and E Hey How effectively can clinical examination pick up congenital heart disease at birth? Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2006; 91(4): F263 - F267. [Abstract] [Full Text] [PDF]

eLetters: