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Accuracy of cardiac auscultation in detection of neonatal congenital heart disease by general paediatricians

Published online by Cambridge University Press:  23 April 2019

Qu-ming Zhao ,
Conway Niu ,
Fang Liu ,
Lin Wu Open the ORCID record for Lin Wu [Opens in a new window] ,
Xiao-jing Ma  and
Guo-ying Huang
Qu-ming Zhao
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Conway Niu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Fang Liu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Lin Wu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Xiao-jing Ma
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China Shanghai Key Laboratory of Birth Defects, 399 Wan Yuan Road, Shanghai, China
Guo-ying Huang*
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China Shanghai Key Laboratory of Birth Defects, 399 Wan Yuan Road, Shanghai, China
*
Author for correspondence: Guo-ying Huang, MD, Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102, People’s Republic of China. Tel: +86 21 64931928; Fax: +86 21 64931002; E-mail: gyhuang@shmu.edu.cn
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Abstract

Background:

Challenges remain in the judgement of pathological murmurs in newborns at maternity hospitals, and there are still many simple major CHD patients in developing countries who are not diagnosed in a timely fashion. This study aimed to evaluate the accuracy of cardiac auscultation on neonatal CHD by general paediatricians.

Methods:

We conducted a prospective study at three hospitals. All asymptomatic newborns underwent auscultation, pulse oximetry monitoring, and echocardiography. Major CHD was classified and confirmed through follow-up. We evaluated the accuracy of various degrees of murmurs for detecting major CHD to determine the most appropriate standards and time of auscultation.

Results:

A total of 6750 newborns were included. The median age of auscultation was 43 hours. Cardiac murmurs were identified in 6.6% of newborns. For all CHD, 44.4% had varying degrees of murmurs. A murmur of grade ≥2 used as a reference standard for major CHD had a sensitivity of 89.58%. The false positive rate of murmurs of grade ≥2 for detecting major CHD was significantly negatively related to auscultation time, with 84.4% of false positives requiring follow-up for non-major CHD cardiac issues. Auscultation after 27 hours of life could reduce the false positive rate of major CHD from 2.7 to 0.9%.

Conclusions:

With appropriate training, maternity hospital’s paediatricians can detect major CHD with high detection rates with an acceptable false positive rate.

Keywords

Congenital heart diseasenewborn screeningcardiac auscultationechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 679 - 683
Copyright
© Cambridge University Press 2019 

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References

Hu, XJ, Ma, XJ, Zhao, QM, et al. Pulse oximetry and auscultation for congenital heart disease detection. Pediatrics 2017; 140: e20171154.CrossRefGoogle ScholarPubMed
Zhao, QM, Ma, XJ, Ge, XL, et al. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 2014; 384: 747–754.CrossRefGoogle ScholarPubMed
Ewer, AK, Middleton, LJ, Furmston, AT, et al. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet 2011; 378: 785–794.CrossRefGoogle ScholarPubMed
de-Wahl, Granelli A, Wennergren, M, Sandberg, K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39, 821 newborns. BMJ 2009; 338: a3037.CrossRefGoogle Scholar
de-Wahl, Granelli A, Meberg, A, Ojala, T, Steensberg, J, Oskarsson, G, Mellander, M. Nordic pulse oximetry screening--implementation status and proposal for uniform guidelines. Acta Paediatr 2014; 103: 1136–1142.CrossRefGoogle Scholar
Singh, A, Ewer, AK. Pulse oximetry screening for critical congenital heart defects: a UK national survey. Lancet 2013; 381: 535.CrossRefGoogle ScholarPubMed
Saxena, A. Pediatric cardiac care in India: current status and the way forward. Future Cardiol 2018; 14: 1–4.CrossRefGoogle ScholarPubMed
Reichert, HA, Rath, TE. Cardiac surgery in developing countries. J Extra Corpor Technol 2017; 49: 98–106.Google ScholarPubMed
Iyer, PU, Moreno, GE, Fernando, Caneo L, Faiz, T, Shekerdemian, LS, Lyer, KS. Management of late presentation congenital heart disease. Cardiol Young 2017; 27: S31–S39.CrossRefGoogle ScholarPubMed
Ho, TC, Ouyang, H, Lu, Y, Young, AH, Chintala, K, Detrano, RC. Postprocedural outcomes of rural children undergoing correction of congenital heart lesions in Yunnan Province, China. Pediatr Cardiol 2011; 32: 811–814.CrossRefGoogle ScholarPubMed
Saxena, A. Congenital cardiac surgery in the less privileged regions of the world. Expert Rev Cardiovasc Ther 2009; 7: 1621–1629.CrossRefGoogle Scholar
Shenvi, A, Kapur, J, Rasiah, SV. Management of asymptomatic cardiac murmurs in term neonates. Pediatr Cardiol 2013; 34: 1438–1446.CrossRefGoogle ScholarPubMed
Mackie, AS, Jutras, LC, Dancea, AB, Rohicek, CV, Platt, R, Beland, MJ. Can cardiologists distinguish innocent from pathologic murmurs in neonates? J Pediatr 2009; 154: 50–4 e1.CrossRefGoogle ScholarPubMed
Karatza, AA, Fouzas, S, Tzifas, S, Mermiga, A, Dimitriou, G, Mantagos, S. Accuracy of cardiac auscultation in asymptomatic neonates with heart murmurs: comparison between pediatric trainees and neonatologists. Pediatr Cardiol 2011;32: 473–477.Google ScholarPubMed
Gokmen, Z, Tunaoglu, FS, Kula, S, Ergenekon, E, Ozkiraz, S, Olgunturk, R. Comparison of initial evaluation of neonatal heart murmurs by pediatrician and pediatric cardiologist. J Matern Fetal Neonatal Med 2009; 22: 1086–1091.CrossRefGoogle ScholarPubMed
Azhar, AS, Habib, HS. Accuracy of the initial evaluation of heart murmurs in neonates: do we need an echocardiogram? Pediatr Cardiol 2006; 27: 234–237.CrossRefGoogle ScholarPubMed
Brunetti, ND, Rosania, S, D’Antuono, C, et al. Diagnostic accuracy of heart murmur in newborns with suspected congenital heart disease. J Cardiovasc Med 2015; 16: 556–561.CrossRefGoogle ScholarPubMed
Hu, Z, Yuan, X, Rao, K, Zheng, Z, Hu, S. National trend in congenital heart disease mortality in China during 2003 to 2010: a population-based study. J Thorac Cardiovasc Surg 2014; 148: 596–602 e1.CrossRefGoogle ScholarPubMed
Ainsworth, S, Wyllie, JP, Wren, C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed 1999; 80: F43–F45.CrossRefGoogle ScholarPubMed
Du, ZD, Roguin, N, Barak, M. Clinical and echocardiographic evaluation of neonates with heart murmurs. Acta Paediatr 1997; 86: 752–756.CrossRefGoogle ScholarPubMed
Singh, A, Desai, T, Miller, P, Rasiah, SV. Benefits of predischarge echocardiography service for postnatal heart murmurs. Acta Paediatr 2012; 101: e333–e336.CrossRefGoogle ScholarPubMed
O’Reilly, KM, Hall, FM, Richens, T, Cunningham, C, Simpson, JH. An audit of the management of heart murmurs on the postnatal wards. Scott Med J 2013; 58: e11–e14.CrossRefGoogle ScholarPubMed
Xu, W, Zhang, SC. Chinese pediatricians face a crisis: should they stay or leave? Pediatrics 2014; 134: 1045–1047.CrossRefGoogle ScholarPubMed