Ainsworth S, Wyllie J P, Wren C
South Cleveland Hospital, Middlesbrough.
Arch Dis Child Fetal Neonatal Ed. 1999 Jan;80(1):F43-5. doi: 10.1136/fn.80.1.f43.
To determine the prevalence and clinical significance of murmurs detected during routine neonatal examination.
In a two year prospective study, 7204 newborn babies underwent routine examination by senior house officers. All those with murmurs underwent echocardiographic examination. All babies presenting later in infancy were also identified, to ascertain the total prevalence of congenital heart disease in infancy.
Murmurs were detected in 46 babies (0.6%) of whom 25 had a cardiac malformation. The most common diagnosis was a ventricular septal defect, although four babies had asymptomatic left heart outflow obstruction. A further 32 infants from the same birth cohort had a normal neonatal examination but were found to have a cardiac malformation before 12 months of age.
The neonatal examination detects only 44% of cardiac malformations which present in infancy. If a murmur is heard there is a 54% chance of there being an underlying cardiac malformation. Parents and professionals should be aware that a normal neonatal examination does not preclude a clinically significant cardiac malformation. The detection of a murmur should prompt early referral to a paediatric cardiologist for diagnosis or appropriate reassurance.
确定在新生儿常规检查中发现的杂音的发生率及临床意义。
在一项为期两年的前瞻性研究中，7204名新生儿接受了住院医师的常规检查。所有有杂音的婴儿均接受了超声心动图检查。还对所有在婴儿期后期就诊的婴儿进行了识别，以确定婴儿期先天性心脏病的总发生率。
46名婴儿（0.6%）检测到杂音，其中25名有心脏畸形。最常见的诊断是室间隔缺损，不过有4名婴儿有无症状的左心流出道梗阻。同一出生队列中另有32名婴儿新生儿检查正常，但在12个月龄前被发现有心脏畸形。
新生儿检查仅能检测出婴儿期出现的心脏畸形的44%。如果听到杂音，存在潜在心脏畸形的可能性为54%。家长和专业人员应意识到，新生儿检查正常并不能排除临床上有意义的心脏畸形。发现杂音应促使尽早转诊至儿科心脏病专家处进行诊断或给予适当的安慰。
