Objectives:
To study the incidence, etiological basis and natural history of murmurs in full term healthy neonates
Methodology:The present study included 3348 neonates. It was conducted in the postnatal ward starting Nov2007 till September2008.Inclusion criteria:All full term neonates with a murmur detected on routine examination within the first week of life. Exclusion criteria: neonates(<36weeks), sick neonates with comorbid conditions.
Study design:Prospective/cohort study: All newborns were screened for the murmur by Residents at birth and later .A detailed history and anthropometric assessment was done. ECG, Chest Xray, SPO2, color doppler by a neonatal probe of 7MHz on Acuson color doppler machine was done by a Cardiologist initially and repeated at 2,6 and 12 weeks. The cases were classified as Normal,physiological variants , structural heart diseases and assessed for single or multiple lesions, severity and progression.
Results:Out of 3348 newborn murmurs were detected in 46(1.3%).The incidence was13.73/1000. Among those with the murmur 20(43%) had structural heart diseases either alone or in combination, VSD(58%), ASD(25%),Pulmonary stenosis(12.5%),TOF(4.1%),Mitral atresia(4.1%).Physiologial variants showed PFO(38%), PDA(34%),TR(26%).Xray chest had sensitivity of 45% , specificity 90% and negative predictive value of 69%. Only 3 with proven CHD had abnormal ECG.No statistical significance was noted between the day of appearance,location or the intensity of the murmur in relation to the structural cardiac lesion(p>.05).Growth monitoring showed a statistically significant fall in weight among those with structural heart lesion(p<.01). Consanguinity did not affect the incidence of CHD.
Conclusion:Murmurs are a clue to underlying cardiac lesions. However, confirmation is based on various supportive investigations.