Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T07:10:45.914Z Has data issue: false hasContentIssue false
  • English
  • Français

Is pre-discharge echocardiography indicated for asymptomatic neonates with a heart murmur? A retrospective analysis

Published online by Cambridge University Press:  10 September 2015

Iyad Al-Ammouri ,
Fares Ayoub Open the ORCID record for Fares Ayoub [Opens in a new window]  and
Rima Dababneh
Iyad Al-Ammouri*
Affiliation:
Department of Pediatrics, Faculty of Medicine, Section of Cardiology, The University of Jordan, Amman, Jordan
Fares Ayoub
Affiliation:
Department of pediatrics, Faculty of Medicine, The University of Jordan, Amman, Jordan
Rima Dababneh
Affiliation:
Department of Pediatrics, Jordan University Hospital, The University of Jordan, Amman, Jordan
*
Correspondence to: I. AL-Ammouri, Department of Pediatric Cardiology, Faculty of Medicine, Section of Pediatric Cardiology, The University of Jordan, Amman 11942, Jordan. Tel: +0096265353666, ext. 2767; Fax: +0096265300820; E-mail: Iyad72@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The purpose of this study was to determine whether a murmur detected on routine pre-discharge examination of asymptomatic newborn children in the first 48 hours of life warrants further investigation with echocardiography.

Methods

We conducted a retrospective review of all echocardiography studies of neonates born at Jordan University Hospital between August, 2007 and June, 2014. Findings on physical examination as well as the indication of the echocardiographic studies were reviewed. We included asymptomatic neonates for whom echocardiographic studies were carried out due to the sole indication of a heart murmur on routine pre-discharge neonatal physical examination.

Results

Of 309 asymptomatic newborns with murmurs on pre-discharge examination, echocardiography revealed 68 (22%) cases of CHD, with 18 (6%) designated as significant heart disease with anticipated intervention during infancy or childhood. The most common abnormality was ventricular septal defect occurring in 36 cases. Critical heart diseases detected included hypoplastic left heart syndrome in two and aortic valve stenosis in four newborns.

Conclusions

Although most asymptomatic neonates with heart murmurs have normal hearts, a small percentage may have significant heart disease. The decision to refer an asymptomatic newborn with a murmur for echocardiography before discharge from the hospital remains controversial and must be supported by other evidence such as murmur characteristics and local trends in parental compliance with follow-up well-baby visits.

Keywords

Cardiac murmurcongenital cardiac anomalyneonatal examinationneonatal heart diseaseneonates
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1056 - 1059
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoffman, JIE, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
2. Van der Linde, D, Konings, EEM, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.CrossRefGoogle ScholarPubMed
3. Singh, A, Desai, T, Miller, P, et al. Benefits of predischarge echocardiography service for postnatal heart murmurs. Acta Paediatr 2012; 101: e333–e336.Google Scholar
4. Committee on Fetus and Newborn. Policy statement: hospital stay for healthy term newborns. Pediatrics 2010; 125: 405–409.Google Scholar
5. Ainsworth, SB, Wyllie, JP, Wren, C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child – Fetal and Neonatal Edition 1999; 80: F43–F45.Google Scholar
6. Taksande, A. Neonatal heart murmur: is it useful for the diagnosis of congenital heart diseases? World J Pediatr 2014; 10: 91.CrossRefGoogle ScholarPubMed
7. Rein, AJ, Omokhodion, SI, Nir, A. Significance of a cardiac murmur as the sole clinical sign in the newborn. Clin Pediatr 2000; 39: 511–520.Google Scholar
8. 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.Google Scholar
9. Hagan, JF, Shaw, JS, Duncan, PM, et al. Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, 3rd edn. American Academy of Pediatrics, Elk Grove Village, IL, 2008.Google Scholar
10. Mahle, WT, Newburger, JW, Matherne, GP, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120: 447–458.CrossRefGoogle ScholarPubMed
11. 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
12. Ailes, EC, Gilboa, SM, Honein, MA, et al. Estimated number of infants detected and missed by critical congenital heart disease screening. Pediatrics 2015; 135: 1000–1008.Google Scholar