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

Published online by Cambridge University Press:  23 April 2019

Qu-ming Zhao ,
Conway Niu ,
Fang Liu ,
Lin Wu Open the ORCID record for Lin Wu [Opens in a new window] ,
Xiao-jing Ma  and
Guo-ying Huang
Qu-ming Zhao
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Conway Niu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Fang Liu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Lin Wu
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China
Xiao-jing Ma
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China Shanghai Key Laboratory of Birth Defects, 399 Wan Yuan Road, Shanghai, China
Guo-ying Huang*
Affiliation:
Pediatric Heart Center, Children’s Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, China Shanghai Key Laboratory of Birth Defects, 399 Wan Yuan Road, Shanghai, China
*
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: [email protected]
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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.

Keywords

Congenital heart diseasenewborn screeningcardiac auscultationechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 679 - 683
Copyright
© Cambridge University Press 2019 

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