Presented at the American Academy of Pediatrics National Conference, 2016
Michael E. Fenster, MD; John Hokanson, MD
Background: In the era of improved prenatal detection and universal congenital heart disease screening, we aimed to evaluate the utility of echocardiograms in the normal newborn nursery (NNN).
Methods: This chart review was performed on all newborn echocardiograms performed at one hospital from January 2008 through December 2015. Only the first echocardiogram done on each patient was studied. The studies were screened based on birth weight, ordering provider, and documented indication for study to exclude tests performed in the intensive care unit. The study reports were reviewed to categorize the indication for study, impact on patient care, and primary lesion identified. In addition, nursery physicians were surveyed to determine their specialty, management of murmurs in the NNN, and whether their evaluation of murmurs has changed since completing residency.
Results: 26,565/30,430 infants born at Meriter received their care in the NNN, of which 499 (1.88%) had echocardiograms. The most common indication for echocardiogram was for a murmur (71%), followed by findings on fetal ultrasound (9%). Fifty percent of studies were normal, 42% showed incidental findings, the most common being small VSDs, 6% had abnormalities that may need treatment in the future, but did not change management before discharge, and 2% resulted in some change in care before hospital discharge. Of the 11 infants with a change in management, 3 required transfer to a surgical center and 8 needed only increased monitoring or supplemental oxygen. One of the three requiring surgery was diagnosed on fetal ultrasound, and the other two had loud (3/6 or 4/6) murmurs. The surgical patients included two cases of aortic stenosis and one coarctation of the aorta. Sixty three of 135 (47%) physicians completed the survey. In otherwise asymptomatic infants with a murmur, 30% of respondents order echocardiograms before discharge, 24% would schedule early outpatient follow-up, and 24% would provide routine follow-up with the primary care provider.
Conclusions: In a modern normal newborn nursery, critical congenital heart lesions are rarely identified by echocardiograms. Infants with benign murmurs who are otherwise asymptomatic could safely be followed as an outpatient.