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Management of Asymptomatic Cardiac Murmurs in Term Neonates

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Abstract

Approximately 2 % of newborn infants are noted to have cardiac murmur on routine postnatal examination. Our aim was to look at current evidence and practice in the management of asymptomatic cardiac murmur in term neonates. We performed a systematic literature review and a telephone survey of all neonatal units in the United Kingdom (UK). The systematic review of the literature did not support the routine practice of four-limb blood pressure (BP), chest X-ray (CXR), and electrocardiogram (ECG) in the assessment of asymptomatic cardiac murmur in term neonates. The survey had participation from 132 (68 %) of 193 neonatal units in the UK. In an asymptomatic term neonate with cardiac murmur, 124 (94 %) units perform pulse oximetry, 100 units (76 %) measure four-limb BP, 36 units (27 %) perform a CXR, and 52 units (39 %) perform an ECG. Eight-six units (65 %) have availability of in-house echocardiography services provided mainly by paediatricians with cardiology interest in special care units and neonatologists in neonatal intensive care units. Currently there is wide variation in practice in the management of asymptomatic cardiac murmur in term neonates. There is no evidence to support the routine use of four-limb BP, CXR, and ECG in the assessment of asymptomatic cardiac murmur in term neonates. Based on the evidence available, both structured clinical examination (including determining presence and quality of bilateral femoral pulses) and universal use of pulse oximetry are most important in identifying CHD in asymptomatic term neonates with cardiac murmur before discharge home.

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Acknowledgments

The authors are indebted to all of the medical staff in neonatal units in the United Kingdom who took the time to respond to this survey.

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Authors and Affiliations

  1. Department of Neonatology, Birmingham Women’s Hospital NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK

    Asha Shenvi, Jyoti Kapur & Shree Vishna Rasiah

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  1. Asha Shenvi
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  2. Jyoti Kapur
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  3. Shree Vishna Rasiah
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Correspondence to Asha Shenvi.

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Shenvi, A., Kapur, J. & Rasiah, S.V. Management of Asymptomatic Cardiac Murmurs in Term Neonates. Pediatr Cardiol 34, 1438–1446 (2013). https://doi.org/10.1007/s00246-013-0668-6

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  • DOI: https://doi.org/10.1007/s00246-013-0668-6

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