Is pre-discharge echocardiography indicated for asymptomatic neonates with a heart murmur? A retrospective analysis.
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.
1Department of Pediatrics, Faculty of Medicine,Section of Cardiology,The University of Jordan,Amman,Jordan.
Iyad
I
Al-Ammouri
2Department of pediatrics, Faculty of Medicine,The University of Jordan,Amman,Jordan.
Fares
http://orcid.org/0000-0001-8559-5477
F
Ayoub
3Department of Pediatrics,Jordan University Hospital,The University of Jordan,Amman,Jordan.
Rima
R
Dababneh
D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006337:Heart Murmurs / Q000209:etiology*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007597:Jordan; D008297:Male; D010351:Patient Discharge; D012189:Retrospective Studies
Cardiac murmur; congenital cardiac anomaly; neonatal examination; neonatal heart disease; neonates