6403 Retrospective analysis of referrals and clinical outcome of a new neonatal murmur clinic service in a district general hospital

Objectives This study retrospectively reviewed referrals made to a new neonatal murmur clinic service at a district general hospital. Appropriateness of the referral and time interval from identification of murmur to clinic review were analysed against standards set in the local guideline. Murmur persistence at review and clinical outcomes were also evaluated. Methods Retrospective observational study of babies less than 30 days old referred to the neonatal murmur clinic on the amber and green pathway in accordance with local guideline from July 2021 -July 2022. Data was collected from the online referral form and clinical notes. Results There were 77 patients <30 days of age referred for a murmur. Of these, 38% were reviewed outside of neonatal murmur clinic. 69 patients with online referrals were analysed further. 97% of referrals had incomplete information, including documentation of cardiac observations. 80% had documented 4 limb blood pressures, 91% documented femoral pulses. 94% of families did not receive an information leaflet. On the 'green' pathway, 70% of patients were seen within the 4–6 weeks standard target, an average 6.31 weeks. 73% of these patients had a normal ECHO at cardiac review. In this group, 21 had a murmur and of these, 48% had a normal ECHO and 52% an abnormal ECHO. 31 patients did not have a murmur at point of cardiac review, of these 84% had a normal ECHO, 10% had an abnormal ECHO, 6% did not have an ECHO. On the 'amber' pathway, 85% of patients were seen within the 2–4 weeks standard target, an average 1.97 weeks. 78% of these patients with a murmur at the time of cardiac review had an abnormal ECHO. There was no association between presence of murmur and abnormality detected on ECHO in this group. Conclusion In conclusion, our audit showed that the majority of online referrals had incomplete information. As previously seen in literature, there is evidence to suggest that all patients should have a thorough clinical examination and that clear communication including the use of information leaflets will help reduce parental anxiety.¹ ² The majority of the patients were seen within the target timeframe stated in the guideline. Absence of a murmur at time of cardiac review in 'green' patients related to normal ECHO findings; however, the presence or absence of a murmur at time of cardiac review in amber patients did not relate to presence of abnormality on ECHO. References Rao H, Shenvi A. 'G251(P) cardiac murmurs in neonates: Review of current local practice and clinical outcomes', Paediatricians with expertise in cardiology special interest group [Preprint]. 2018; doi:10.1136/archdischild-2018-rcpch.244. Frank JE, Jacobe KM. Evaluation and management of heart murmurs in children, American family physician. 2011; Available at: https://www.aafp.org/pubs/afp/issues/2011/1001/p793.html (Accessed: 27 October 2023).