Accuracy of Cardiac Auscultation for Diagnosing Congenital Heart Diseases in Newborns

Introduction: Congenital Heart Disease (CHD) is defined as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. Auscultation is one of the basic tools for evaluation of a patient with a suspected heart disease. The ability of cardiac auscultation for diagnosing a CHD in an asymptomatic neonate is limited and dependent on the physician's experience and level of clinical confidence. Although, echocardiography is the gold standard, auscultation is the primary screening tool for the diagnosis of a suspected CHD in resource limited settings. This study was undertaken to assess whether auscultation is effective as a screening tool in neonates. Methods: A cross sectional study was conducted over one year. Healthy term neonates who were born in the hospital were included. Physical examination of cardiovascular system was done by a pediatric resident. A pediatric cardiologist performed 2D echocardiography for all babies. The accuracy of the physical examination was assessed. Results: The sensitivity of physical examination was 37.8%, the specificity was 99.1%. The positive predictive value was 85% and the negative predictive value was 92.2%. Out of 377 term neonates 45 were diagnosed with a CHD out of which VSD was the most frequently found lesion. The prevalence of CHD was found to be 10.12 per 1000 live births. Conclusion: Physical examination is not sufficient to identify CHDs in neonates with murmur. Early 2D echocardiography is beneficial in delineating structural heart defects.