How effectively can clinical examination pick up congenital heart disease at birth?

Abstract

Aims:To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians. Methods: A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. Results: 1.2% of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography) within a year of birth. The number not suspected before discharge declined over time, and only 6% were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8, but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2% requiring cardiac referral; 54% of these babies still had a murmur when assessed one to two weeks later, and 33% had a structural defect. Parents said in independent, retrospectively conducted, interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. Conclusions: Effective screening requires experience and a clear, structured, referral pathway, but can work much better than most previous reports suggest. Whether staff bring a medical or nursing background to the task may well be of less importance.

It Is Time for Routine Neonatal Screening by Pulse Oximetry

“…In their study, follow-up of neonates with and without positive oximetry screens was incomplete, and the study is continuing. Patton and Hey [48] in Northumberland observed that no CCHD was undetected after 1998, based on clinical examination and careful follow-up.…”

The value of the postnatal examination in improving child health

“…Arguably if only one examination is being performed, this should be after 24 h to allow maximal time for the ductus to close and pulmonary vascular resistance to start to fall, thus increasing the chances of revealing previously occult congenital heart disease 7. Paediatricians also hold that earlier examination may itself mandate earlier discharge, leading to congenital anomalies and feeding problems presenting in the community 8.…”

“…The excess is mostly small ventricular septal defects 7 17 18. Defects whose early detection would make a dramatic difference to babies outcome occur very rarely (see table 1) with individuals and even units having limited exposure to each condition.…”

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP

“…52 Heart murmurs have a prevalence of between 0.6% and 4.2% in newborns and are mistakenly considered a hallmark of heart disease. 53,54 They often do not accompany critical heart defects, particularly those with valve atresia and transposition. Flow murmurs of the transitional circulation, transient tricuspid regurgitation, and small ventricular septal defects are common and of no clinical importance in newborns.…”