Neonatal cardiac murmurs and its causes in a tertiary care hospital

ABSTRACT Introduction: Congenital heart disease (CHD) is the commonest birth defect worldwide. Routine clinical examination diagnoses less than 50% of the children with CHD. However, the presence and character of cardiac murmurs narrow the differential diagnosis. Cardiac murmurs may also indicate a serious issue and in some cases may be potentially life-threatening. Objective: The aim of this study is to find out the causes of cardiac murmurs in the neonatal period and to assess short-term outcomes of neonates diagnosed with CHDs. Materials and Methods: A hospital-based cross-sectional study was carried out in the Pediatrics department, from August 2020 to December 2022 among 162 study participants selected by convenience sampling after approval by the Research Ethics Board. Results: Most of the study participants were in the age group of 0 to 7 days (47.5%) and were predominantly males (59%). About 19% of the neonates had cyanosis and 2% had preductal post ductal oxygen saturation difference. In most of the neonates, cardiac murmur were related to atrial septal defect (ASD) (18.5%), patent ductus arteriosus (PDA) (8.6%), ventricular septal defect (VSD) (8%), PDA with PFO (patent foramen ovale) (6.8%), and ASD with PDA (6.8%). About 43.2% of neonates had non cardiac causes of murmur. Around 6% of the neonates expired in the hospital, and 94% were discharged. There was a significant association between grade of murmur and short-term outcomes. Around 33.3% of neonates having grade 4 murmur expired, while only 9.5% neonates with grade 3 murmur and 1.8% with grade 2 murmur expired. Conclusion: Out of 162 neonates with cardiac murmur, 47.5% were detected within the first week of their life. Almost half of the neonates with murmur presented with respiratory distress. Around 5% of the neonates expired during the hospital stay, and rest were discharged. Most neonates with a higher grade of murmur had CHD. Most neonates with murmur had CHDs, and the single most common cardiac lesion was ASD (18.5%). This finding deviates from that of other studies where VSD was the commonest CHD detected. This may be due to the fact that almost half of the study population (47.5%) was diagnosed in the first 7 days of life and since many cases of ASD close spontaneously in the neonatal period, the number of ASDs detected was more in our study.