Clinical and Echocardiographic Evaluation of Neonates with Heart Murmur
Journal Title: The Indian Journal of Maternal-Fetal and Neonatal Medicine - Year 2018, Vol 5, Issue 2
Abstract
Background and objectives: Congenital heart disease is the most common form of heart disease in children affecting 7-8 per 1000 live births. Affected babies are mostly asymptomatic at birth. Although most are not pathologic, a murmur may be the sole manifestation of the heart disease. Materials and methods: This is a prospective observational study performed on new-borns delivered, admitted in NICU, attended OPD & neonatal follow up clinics at Kamineni Hospital, L.B. Nagar, Hyderabad during 16 months period. Total of 1120 neonates were evaluated during the study period of 16 months. Once the murmur was heard, murmur was reconfirmed by senior resident/consultant pediatrician and clinical diagnosis was made based on history and clinical examination. Echocardiography was done in all neonates with murmur for confirmation of the diagnosis. Neonates with gestational age < 28 weeks were excluded from the study for PDA. Results: Out of 1120 babies examined, 48 babies (4.28%) found to have murmur. While out of 48 babies with murmur, 27 (56.25%) were male & 21 (44.75) were female babies. Out of total 817 term babies examined, 32 babies (3.91%) had murmur. Total 303 preterm babies examined, 16 babies (5.2%) were found to have murmur. History of consanguinity was present in 11 babies (22.92%) out of total 48 babies with murmur. Majority of babies (87.5%) had no significant family history. Maximum no. babies (41.66%) were presented without any maternal risk factor. The most frequently associated risk factor was polyhydramnios 20.83% (10 cases). No. of murmurs detected in the first 24 hrs of birth are least. 32 out of 48 were asymptomatic. Total 16 cases were diagnosed clinically as VSDs out of which 10 confirmed by echocardiography. Clinically 12 cases were diagnosed as PDA, but 13 was the no. diagnosed on echocardiography as PDA. The total number of ASDs diagnosed clinically were 7 in all, of these 3 were diagnosed and confirmed by ECHO. Out of 14 acyanotic congenital heart diseases 4 were diagnosed clinically. 5 out of 5 functional murmurs were detected by clinical examination. 2 out of 3 complex cyanotic congenital heart diseases were diagnosed as complex cyanotic congenital heart disease but could not specify the lesion by clinical examination. Conclusion: Although clinical evaluation could determine the presence or absence of heart disease in most neonates, the lesion-specific diagnosis was not quite satisfactory. Echocardiography is necessary for neonates with a clinically diagnosed heart disease or possible heart diseases, and may be unnecessary for those with innocent murmurs diagnosed by paediatricians.
Authors and Affiliations
Amol K. Phale
Keywords
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- EP ID EP572118
- DOI 10.21088/ijmfnm.2347.999X.5218.3
- Views 93
- Downloads 0
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