Major congenital heart defects are rarely diagnosed after newborns' hospital discharge with modern screening

Abstract

AimOur aim was to assess undiagnosed congenital heart defects (CHD) after newborns' hospital discharge in patients with a murmur or CHD suspicion, to find out the signs that predict CHDs and to estimate the costs of the examinations.MethodsWe reviewed retrospective medical records of patients (n = 490) referred for the evaluation of CHD suspicion during 2017–2018.ResultsThe median age of the patients was 2.5 (IQR 0.5–7.4) years. Sixty‐three (13%) patients had an abnormal echocardiography. Neither ductal‐dependent nor cyanotic CHDs were found. Cardiac interventions were performed for 14 out of 63 (22%) patients. Clinical signs indicating CHDs were murmur grade ≥3 (10/11 [91%] vs. 53/479 [11%], p < 0.001) and harsh murmur (15/44 [34%] vs. 48/446 [11%], p < 0.001). Abnormal electrocardiography did not indicate CHD (8/40 [20%] vs. 55/447 [12%], p = 0.165). The total cost of the examinations was 259 700€. The share of the cost of studies assessed as benign was 59%.ConclusionOnly a few CHDs were found after newborn hospital discharge among patients who received foetal and newborn screening and were examined due to CHD suspicion. The high number of benign murmurs in children leads to many referrals, resulting in unnecessary healthcare costs.

Automated Analysis of Heart Sound Signals in Screening for Structural Heart Disease in Children

“…In Finland, most referrals due to murmurs or suspicion of CHD come from primary health care, so our algorithm could be most useful in screening for murmurs in that context 7 . The high prevalence of innocent murmurs detected in primary health care strains the limited resources of specialised care.…”

“…Although a murmur is the most common nding that raises suspicion of CHD, most of the children referred to paediatric cardiologists have an innocent murmur. According to some estimates, up to 90% of initial visits to paediatric cardiology clinics were due to an innocent murmur and thus unnecessary 5,7 .…”

Issue highlights

“…4 Meanwhile, Papinen et al report that only a few CHDs were confirmed after discharge in infants with suspected CHD when examined by foetal and newborn screening. 5 The authors point out that the high number of benign murmurs in children leads to numerous referrals and unnecessary healthcare costs.…”