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This guideline is applicable to medical and nursing staff caring for neonates in the West of Scotland.
Investigation will vary depending upon local resources and expertise. The following recommendations represent the minimum requirements to ensure the safe management of neonates with heart murmurs and the timely identification of congenital heart disease.
CXR and 4 limb blood pressure
There is no evidence to support the use of CXR or 4 limb blood pressure measurements in the assessment of neonates with heart murmurs 3,4,5,6.
1. Likely significant congenital heart disease –urgent echocardiogram and review (same day)
Infants with a heart murmur and any of the following warning signs: lower limb saturations < 96%; >3% pre / post ductal difference; absent/weak femoral pulses; signs of heart failure or shock. These infants require admission to a neonatal unit for consideration of prostaglandin and urgent discussion +/- transfer to a cardiac centre. If appropriately skilled local PEC or visiting cardiologist is available to perform echocardiogram while retrieval is awaited then this can be linked by telemedicine link / used to update surgical centre. This should not be allowed to delay transfer.
2. Asymptomatic but clinically pathological murmur – soon echocardiogram (pre-discharge or as soon as possible within 1 week)
Infants without any of the above warning signs but with any of the following abnormal clinical findings: dysmorphism; heave; abnormal heart sounds; loud murmur (>2/6); pansystolic, diastolic, continuous murmur; murmur location other than left sternal edge/radiation.
3. Low risk of congenital heart disease - routine review neonatal OPC 2-6 weeks
Well infants with no signs of heart failure, normal pulses, lower limb saturations >96%, soft (1-2/6) systolic murmur at the left sternal edge with no radiation.
Based on the PECSIG 2013 guideline
Last reviewed: 19 October 2018
Next review: 01 November 2021
Author(s): PECSIG Neonatal Murmur Guideline Group (Kathleen O’Reilly, Hilary Maddicks, Vishna Rasiah, Venu Gopalan with BCCA input from Rob Martin and John Simpson)
Co-Author(s): Adapted for local use by: Duncan Boyd, Maria Ilina, Brodie Knight and Kathleen O’Reilly.
Approved By: MCN for Neonatology West of Scotland