What is the significance of hearing a heart murmur during the newborn physical examination?

Journal article

Seignior, H.L. (2021). What is the significance of hearing a heart murmur during the newborn physical examination? British Journal of Midwifery. 29 (3), pp. 158-170. https://doi.org/10.12968/bjom.2021.29.3.158
AuthorsSeignior, H.L.
AbstractBackground Newborn screening for congenital heart disease (CHD) forms part of the newborn physical examination (NPE) in the UK. However, research has shown that up to 50% of cases of CHD can be missed by this examination. The purpose of this literature review is to investigate the significance of hearing an asymptomatic heart murmur at the NPE in relation to the presence of CHD. Methodology A critical literature review was conducted to answer the research question. The findings were discussed using a narrative synthesis approach. Findings There was considerable heterogeneity of results. The prevalence of murmur in newborns ranged between 0.6%–10.7%. Between 13%–67% of those newborns had some form of CHD, although many had clinically insignificant lesions. Between 2%–9% of newborns with murmurs had a form of critical CHD (CCHD). The ability to discern whether a heart murmur relates to pathology or not improves with experience. No single optimal timing for the NPE was identified. Pulse oximetry was shown to increase sensitivity of screening for CCHD. Conclusion There is a significant increase in the prevalence of CHD when a newborn has a heart murmur, hence referral for diagnostic echocardiography is required when a heart murmur is identified. Pulse oximetry is an important adjunct to newborn screening for CCHD. Some newborns affected by CCHD will not present with murmur at the NPE. Therefore, those caring for newborns during the early days must know the signs and symptoms of CHD so that appropriate medical assistance can be sought.
KeywordsMaternity and Midwifery
JournalBritish Journal of Midwifery
Journal citation29 (3), pp. 158-170
PublisherMark Allen Group
Digital Object Identifier (DOI)https://doi.org/10.12968/bjom.2021.29.3.158
Publication dates
Online02 Mar 2021
Print02 Mar 2021
Publication process dates
Deposited01 Apr 2021
Accepted author manuscript
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Submission for open access version 1st April 2021.docx
License: CC BY 4.0
File access level: Open

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