title: Significance of a cardiac murmur as the sole clinical sign in the newborn.
abstract: A cardiac murmur is a very common finding in the first few days of life. It is traditionally believed that lesions creating left-to-right shunts do not present so early. This study was aimed to define and to classify the causes of a murmur in a newborn with an otherwise normal examination. All echocardiograms performed on newborns aged 1-5 days who were referred for evaluation of a murmur in a 3-year period were reviewed. Newborns with additional clinical signs or antenatal diagnosis of a cardiac disease were excluded. Of 20,323 live births, there were 170 newborns referred for echocardiogram solely because of a murmur. Of these, 147 (86%) were found to have structural heart defects. The most common lesions found were those creating left-to-right shunts (66%). Ventricular septal defect was the most common single lesion (54/147, 37%), followed by patent ductus arteriosus (34 newborns, 23%). The combination of both was found in 10 newborns (7%). Six newborns (4%) had pulmonary valve stenosis and three (2%) aortic valve stenosis. Seven newborns (5%) had unforeseen complex heart disease. For five of them, delayed diagnosis would have resulted in potentially life-threatening conditions. There was no correlation between the category of lesion and the age of presentation. The audible threshold of a murmur correlated with a maximum instantaneous gradient of 25 mm Hg (range 11-46 mm Hg). Thirteen percent of newborns with isolated heart murmur had no identifiable structural heart disease. These data suggest that most asymptomatic newborns presenting with a murmur in the first days of life have structural heart disease. Some of the more serious defects would not have been diagnosed without early echocardiography. A left-to-right shunt, particularly a ventricular septal defect, may cause a murmur even the first day of life and is probably more common that has been acknowledged.
authors.affiliation: Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: A J
authors.initials: AJ
authors.lastname: Rein
authors.forename: S I
authors.initials: SI
authors.lastname: Omokhodion
authors.forename: A
authors.initials: A
authors.lastname: Nir
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis; D003937:Diagnosis, Differential; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006337:Heart Murmurs / Q000209:etiology*; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis*; D007557:Israel / Q000453:epidemiology; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis; D012189:Retrospective Studies; D012720:Severity of Illness Index