Presentation of congenital heart disease in infancy: implications for routine examination

Abstract

Aim-To investigate the performance of routine neonatal and 6 week examinations for detecting congenital heart disease. Methods-A retrospective review of findings on clinical examination was conducted of a cohort of live born infants with congenital heart disease in one health region in 1987-94 Results-Of 1590 babies with congenital heart disease, 523 (33%) presented before neonatal examination because of symptoms or non-cardiac abnormalities. 1061 underwent routine neonatal examination which was abnormal in 476 (45%), but only 170 were referred directly for diagnosis. Of 876 discharged with no diagnosis, 306 presented or died undiagnosed before 6 weeks. At 6 weeks 252 of 569 babies underwent a second routine examination which was abnormal in 164 (65%). Conclusions-Routine neonatal examination fails to detect more than half of babies with heart disease; examination at 6 weeks misses one third. A normal examination does not exclude heart disease. Babies with murmurs at neonatal or 6 week examinations should be referred for early paediatric cardiological evaluation which will result either in a definitive diagnosis of congenital heart disease or in authoritative reassurance of normal cardiac anatomy and function. (Arch Dis Child Fetal Neonatal Ed 1999;80:F49-F53)

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article

“…Two new Class I recommendations and one Class III recommendation have been added. [177][178][179][180][181][182][183][184][185][186][187][188][189][190][191][192][193][194] One recommendation has moved from Class IIb to Class IIa. Class I recommendations have been renumbered for clarity.…”

Profile of Congenital Heart Disease in Children: A Hospital Based Study

“…Other presentations can range from cyanosis, clubbing of fingers, fatigue to full blown congestive cardiac failure (7,9). CHD has not been studied thoroughly in India, as in western countries.…”

“…Despite advanced diagnostic facilities and improved medical care, CHD is considered one of the leading causes of infant mortality (7). According to a status report on CHD in India, 10% of the present infant mortality may be accounted by CHD (8).…”

“…According to a status report on CHD in India, 10% of the present infant mortality may be accounted by CHD (8). CHD may present at different ages from birth to adolescence (7). Many cases are asymptomatic and discovered incidentally during routine health check-up (9).…”

The quality of routine examinations of the newborn performed by midwives and SHOs; an evaluation using video recordings

“…14 However several studies have reported that the examination does not perform well as a screening tool. [15][16][17][18][19][20] An appropriate test of quality would be how far practitioners adhere to agreed best practice in administering the examination and this could be assessed with the aid of video recordings. In psychological research, video recordings are often used for assessments with subsequent structured evaluation of objectivity and quality of administration by examiners.…”