Southern General Hospital, UK.
Scott Med J. 2013 Feb;58(1):e11-4. doi: 10.1177/0036933012474603.
Investigation and management of neonatal heart murmurs varies widely and is dependent on local resources. In order to standardise the management of heart murmurs in our hospital a guideline (based on clinical examination with selective cardiology review) was introduced.
To establish adherence to and safety of the guideline; to review workload implications and to define the causes of neonatal heart murmurs in our population.
Patients were prospectively identified over a 2-year period (August 2006 to July 2008). Case notes were reviewed and examination findings, investigations, follow up and diagnosis recorded.
89 babies were identified. The guideline was generally well adhered to. In total 51 (57%) of babies were referred for cardiology assessment. In 40 babies this assessment included an echocardiogram. 30 babies (34%) had an underlying cardiac malformation: 25 were identified before discharge home. 15/30 (50%) of the babies with a cardiac malformation remain under cardiology follow up at the age of 1 year. No baby discharged from follow up without cardiology review subsequently presented with a cardiac problem.
A significant minority of babies with a heart murmur have an underlying cardiac malformation. Our guideline appears to ensure the timely identification of these babies and rationalises our use of specialist services.
新生儿心脏杂音的调查和处理方法差异很大，取决于当地的资源。为了规范我院心脏杂音的处理，我们制定了一个基于临床检查（选择性心脏病学评估）的指南。
评估指南的执行情况和安全性；审查工作量的影响，并确定我院新生儿心脏杂音的病因。
在两年的时间（2006 年 8 月至 2008 年 7 月）内对患者进行前瞻性识别。审查病历，并记录检查结果、检查、随访和诊断。
共发现 89 名婴儿。该指南得到了普遍遵守。共有 51 名（57%）婴儿被转介给心脏病学评估。在 40 名婴儿中，评估包括超声心动图。30 名婴儿（34%）有心脏畸形：25 名在出院前被发现。15/30 名（50%）有心脏畸形的婴儿在 1 岁时仍在接受心脏病学随访。没有一名在没有心脏病学评估的情况下出院后出现心脏问题的婴儿。
有心脏杂音的婴儿中有相当一部分存在潜在的心脏畸形。我们的指南似乎确保了这些婴儿的及时识别，并合理利用了专科服务。
