A study on clinical and echo cardiographic evaluation of neonatal cardiac murmurs and their follow up at 6 weeks of age

Saranya Ravichandran, Sampath Kumar Dhanaraj, Shankar Radhakrishnan


Background: The echocardiogram permits early accurate anatomical diagnosis either to reassure parents that the heart was normal, or to detect a heart disease and explain the nature of the abnormality and make an early referral for definitive treatment. Aim: Assessment of neonatal cardiac murmurs clinically and by echocardiogram at birth and at 6 weeks of age. Materials and Methods: A prospective longitudinal study was conducted on neonates for a period of one year at Government Mohan Kumaramangalam Medical College Hospital, Salem. Cardiac murmur was graded between 1 and 6 based on the intensity of the murmur. All neonates underwent an echocardiographic examination by Cardiologists at 1st week and later at 6 weeks. Results: The incidence of murmur in the first week of life was 23/1000 live births and the incidence of congenital heart disease was 12.6/1000 live births and at 6 weeks it was 6.6/1000 live births. The most common congenital heart disease during the 1st week examination was found to be VSD, followed by ASD and PDA. Identifying a pathological murmur and its association with structural congenital heart disease was found to be statistically significant (p<.05), whereas identifying an innocent murmur and its association with a normal heart did not show a statistical significance and so it infers that all the innocent murmurs has to be followed up with a echocardiogram to rule out structural heart disease in the neonates. Conclusion: It is important to evaluate all neonatal cardiac murmurs with echocardiogram before they become symptomatic.

Full Text:



Abu-Harb M, Hey E, Wren C. Death in infancy from unrecognized congenital heart disease. Arch Dis Child. 1994 Jul; 71 (1):3-7.

Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39 (12): 1890-900.

Wren C, Reinhardt Z, Khawaja K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed. 2008; 93 (1):F33-F35. DOI: 10.1136/adc. 2007. 119032.

Richmond S, Wren C. Early diagnosis of congenital heart disease. Semin Neonatol. 2001 Feb;6(1):27-35.

Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics. 1999 Apr; 103 (4 Pt 1):743-7.

Abu-Harb M, Wyllie J, Hey E, Richmond S, Wren C. Presentation of obstructive left heart malformations in infancy. Arch Dis Child Fetal Neonatal Ed. 1994 Nov; 71 (3):F179-83.

Gandy GM. Examination of the neonate including gestational age assessment. In: Roberton NR, ed. Textbook of Neonatology. 2nd edn. Edinburgh: Churchilll Livinstone, 1992.

Rudolph AM. The changes in the circulation after birth. Their importance in congenital heart disease. Circulation. 1970 Feb;41(2):343-59.

Renine JM. Examination of the newborn. In: Rennie JM, editor. Roberton’s Textbook of Neonatology. 4th ed. Philadelphia: Churchill Livinstone; 2005. p. 249-66.

Poddar B, Basu S. Approach to a child with a heart murmur. Indian J Pediatr. 2004 Jan;71(1):63-6.

Ainsworth S, Wyllie JP, Wren C. Prevalence and clinical significance of cardiac murmurs in neonates. Arch Dis Child Fetal Neonatal Ed.1999Jan;80(1):F43-5.

Danilowicz DA, Rudolph AM, Hoffman JIE, Heymann M. Physiologic pressure differences between main and branch pulmonary arteries in infants. Circulation 1972;XLV:410- 19.

Silove ED. Assessment and management of congenital heart disease in the newborn by the district paediatrician. Arch Dis Child Fetal Neonatal Ed. 1994 Jan; 70 (1):F71-4.

Silverman ME, Wooley CF. Samuel A. Levine and the history of grading systolic murmurs. Am J Cardiol. 2008 Oct 15;102(8):1107-10.

Mirzarahimi M, Saadati H, Doustkami H, Alipoor R, Isazadehfar K, Enteshari A. Heart murmur in neonates: how often is it caused by congenital heart disease? Iran J Pediatr. 2011 Mar;21(1):103-6.

Park MK. Pediatric cardiology for practitioners. 5 th edition. Mosby. An Imprint of Elsevier; 2008:48-63.

Becker SM, Al Halees Z, Molina C, Paterson RM. Consanguinity and congenital heart disease in Saudi Arabia. Am J Med Genet. 2001 Feb 15;99(1):8-13.

Ramegowda S, Ramachandra NB. Parental consanguinity increases congenital heart diseases in South India. Ann Hum Biol. 2006 Sep-Dec;33(5-6): 519-28.

E. Clarke, M.R. Kumar. Evaluation of suspected congenital heart disease in the neonatal period. Current Paediatrics. 2005:15(7):523-531.

Swenson JM, Fischer DR, Miller SA, Boyle GJ, Ettedgui JA, Beerman LB. Are chest radiographs and electrocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain? Pediatrics. 1997 Jan;99(1):1-3.

Preethi S. Pillai, Neelima Narayanan, Lyla Chacko. An evaluation of cardiac murmurs in new-born. Int J Contemp Pediatr. 2017 Sep;4(5):1652-1657.

Hussain S, Sabir MU, Afzal M, Asghar I. Incidence of congential heart disease among neonates in a neonatal unit of a tertiary care hospital. Journal of the Pakistan Medical Association 2014; 64(2):175-8.

Yang Xue-yong, LI Xiao-feng, LU Xiao-dong, LIU Ying-long. Incidence of congenital heart disease in Beijing, China. Chinese Medical Journal 2009; 122(10): 1128-32.

Samitha R, Karat SC, Narayanappa D, Krishnamurthy B, Prasanth SN, Ramachandra NB. Prevalence of congenital heart diseases in Mysore. Indian Journal of Human Genetics 2006; 12 (2): 11-16.

B. S. Chakravathy, S. Prathimadevi. Evaluation of cardiac murmurs in neonates. J of evidence based med & health care 2015. Oct. Vol. 2 (42) p-7477-83. DOI: 10.18410/jebmh/2015/1010.

K F M Ferrer and J M Rennie Neonatal murmurs: are senior house officers good enough? Archives of Disease in childhood Fetal and Neonatal Edition 2003: 88:F147-150.

Moss S, Kitchiner DJ, Yoxall CW, Subhedar NV. Evaluation of echocardiography on the neonatal unit. Arch Dis Child Fetal Neonatal Ed. 2003 Jul;88 (4): F287-9; discussion F290-1.


  • There are currently no refbacks.