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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: [email protected]
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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
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Copyright
© Cambridge University Press 2015 

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