Abstract
The objective of this study was to determine the differences between neonatologists and pediatric cardiologists with regards to the initial assessment of neonatal heart murmur and to evaluate the role of echocardiography in this group of patients. During a period of 1 year, all neonates with heart murmur seen in pediatric cardiology consultation from neonatal intensive care units at the Children Hospital of Eastern Ontario and Ottawa General Hospital were included in this study. Neonates with heart murmur were initially evaluated clinically by a neonatologist and the most likely clinical diagnosis was recorded. This was followed by similar evaluation and assessment by the pediatric cardiologist, who did not know the result of the previous assessment. Echocardiography diagnosis was considered the gold standard for the accurate diagnosis in the two groups, and it was done for all patients. For the neonatologists, the sensitivity to detect a pathological murmur was 78% and the specificity was 33%; the positive predictive value was 77% and the negative predictive value was 37%. For the pediatric cardiologists, the accuracy of the clinical examination showed a sensitivity of 83% in detecting a pathological murmur and a specificity of 25%; the positive predictive value was 80% and the negative predictive value was 29%. There was no significant difference between the two groups. Certified neonatologists are able to assess the significance of neonatal heart murmurs well as pediatric cardiologists, although echocardiogram is still needed to reach the accurate diagnosis of congenital heart disease in neonates even if a pediatric cardiologist is consulted.
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References
Ainsworth SB, WyllieJP, Wren C (1999) Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed 80:F43–F45
American Heart Association (1994) Guidelines for evaluation and management of common congenital cardiac problems in infants, children and adolescents. Circulation 90:2180–2188
Castello-Herbreteau B, Vaillant MC, Magontier N, et al (2000) Diagnostic value of physical examination and electrocardiogram in the initial evaluation of heart murmurs in children. Arch Pediatr 7:1041–1049
Danford DA, Martin AB, Fletcher SE, Gumbiner CH (2002) Echocardiographic yield in children when innocent murmur seems likely but doubts linger. Pediatr Cardiol 23:410–414
Farrer KFM, Rennie JM (2003) Neonatal murmurs: are senior house officers good enough? Arch Dis Child Fetal Neonatal Ed 88:F147
Gaskin PRA, Owens SE, Talner NS, et al. (2000) Clinical auscultation skills in pediatric residents. Pediatrics 105:1184–1187
Geggel RL (2004) Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 114:e409–e417
Hansen LK, Birkebaek NH, Oxhoj H (1995) Initial evaluation of children with heart murmurs by the non-specialised paediatrician. Eur J Pediatr 154:15–17
McCrindle BW, Shaffer KM, Kan JS, et al. (1996) Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med 150:169–174
Meberg A, Otterstad JE, Froland G, et al (1999) Early clinical screening of neonates for congenital heart defects; the cases we miss. Cardiol Young 9:169–174
Rice MJ, McDonald RW, Reller MD, Salin DL (1996) Pediatric echocardiography: current role and a review of technical advances. J Pediatr 128:1–14
Silove ED (1994) Assessment and management of congenital heart in the newborn by the district paediatrician. Arch Dis Child 70:F71–F74
Smythe JF, Teixeira OHP, Vlad P, et al. (1990) Initial evaluation of heart murmurs: are laboratory tests necessary? Pediateics 86:497–500
Wren C, Richmond S, Donaldson L (1999) Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed 80:F49–F53
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Azhar, A., Habib, H. Accuracy of the Initial Evaluation of Heart Murmurs in Neonates: Do We Need an Echocardiogram?. Pediatr Cardiol 27, 234–237 (2006). https://doi.org/10.1007/s00246-005-1122-1
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DOI: https://doi.org/10.1007/s00246-005-1122-1