Dear Editor

The recent article about the role of Senior House Officers to assess neonatal cardiac murmurs was very well presented.

There are a few issues worth considering in this context. The authors have excluded babies who had abnormal antenatal scans.This would extend to abnormal fetal cardiac scans as well. An area with a strong fetal cardiology input will have extremely small number of undiagnosed major congenital heart problems ( as hypoplastic left heart syndrome or atrioventricular septal defects) compared to areas without the facility. It would be worthwhile to know the fetal cardiology input in the hospital concerned.

Clinical skills are acquired over time. Any neonatal unit usually has a good mix of SHOs in terms of experience and clinical skill. Moreover, the level of skill in the same group of SHOs is remarkably different in the beginning and at the end of their tenures. In the two year study period ,it would probably be more informative to know if level of clinical skills of the SHOs( e.g. initial 3 months versus last 3 months of each batch) were associated to any difference in the outcome of the assessments.