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Accuracy of cardiac auscultation in detection of neonatal congenital heart disease by general paediatricians

  • Qu-ming Zhao (a1), Conway Niu (a1), Fang Liu (a1), Lin Wu (a1), Xiao-jing Ma (a1) (a2) and Guo-ying Huang (a1) (a2)...

Abstract

Background:

Challenges remain in the judgement of pathological murmurs in newborns at maternity hospitals, and there are still many simple major CHD patients in developing countries who are not diagnosed in a timely fashion. This study aimed to evaluate the accuracy of cardiac auscultation on neonatal CHD by general paediatricians.

Methods:

We conducted a prospective study at three hospitals. All asymptomatic newborns underwent auscultation, pulse oximetry monitoring, and echocardiography. Major CHD was classified and confirmed through follow-up. We evaluated the accuracy of various degrees of murmurs for detecting major CHD to determine the most appropriate standards and time of auscultation.

Results:

A total of 6750 newborns were included. The median age of auscultation was 43 hours. Cardiac murmurs were identified in 6.6% of newborns. For all CHD, 44.4% had varying degrees of murmurs. A murmur of grade ≥2 used as a reference standard for major CHD had a sensitivity of 89.58%. The false positive rate of murmurs of grade ≥2 for detecting major CHD was significantly negatively related to auscultation time, with 84.4% of false positives requiring follow-up for non-major CHD cardiac issues. Auscultation after 27 hours of life could reduce the false positive rate of major CHD from 2.7 to 0.9%.

Conclusions:

With appropriate training, maternity hospital’s paediatricians can detect major CHD with high detection rates with an acceptable false positive rate.

Copyright

Corresponding author

Author for correspondence: Guo-ying Huang, MD, Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai 201102, People’s Republic of China. Tel: +86 21 64931928; Fax: +86 21 64931002; E-mail: gyhuang@shmu.edu.cn

References

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