Key result
Abnormal clinical findings including signs of heart failure (OR 2.22; 95% CI 1.30-3.78) and cyanosis (OR 2.00; 95% CI 1.15-3.47) significantly increased the odds of having cardiac abnormalities.
Why the study?
Undetected congenital heart diseases carry high infant mortality, making accurate clinical cardiac examination crucial for early detection and treatment initiation.
Does clinical cardiac examination accurately detect congenital heart disease in neonates?
Cross-Sectional
No
Does clinical cardiac examination accurately detect congenital heart disease in neonates?
Odds Ratio: 2.22 (95% CI 1.3–3.78)
p-value: p=0.004
Clinical cardiac examination, particularly the presence of a cardiac murmur, is a sensitive initial screening tool for congenital heart disease in neonates, while signs like respiratory distress and heart failure are highly specific.
May support targeted echocardiography in neonates with heart failure or cyanosis; leaves open prospective validation of screening accuracy.
Background Infant mortality due to congenital cardiac defects is quite high. Since cardiovascular collapse and cardiac arrest are possible outcomes of congenital heart diseases (CHDs) that go undetected, accurate auscultation of the heart and physical examination of newborns, together with prompt echocardiography (echo), are crucial in the early detection of cardiac disorders and the initiation of therapy. Aim and Objectives To determine the sensitivity and specificity of clinical cardiac examination in detecting CHD in neonates. Subjects and Methods This research was a prospective cross-sectional study conducted at the neonatal intensive care unit of a children’s hospital in the period from the first of November 2020 up to the end of November 2021. Results In a complete physical examination for all the admitted neonates during the study period, 270 cases revealed abnormal clinical cardiac findings. We observed that the presence of a cardiac murmur increased the odds of having cardiac abnormalities by undefined times [odds ratio (OR) and 95% confidence interval (CI)], which was statistically significant ( p = .001), followed by signs of heart failure, which increased the odds of having cardiac abnormalities by 2.22 times (OR: 2.22) (CI: 1.30-3.78), which was statistically significant ( p = .004), followed by cyanosis, which increased the odds of having cardiac abnormalities by 2 times (OR: 2.00) (CI: 1.15-3.47), which was statistically significant ( p = .01), followed by signs of respiratory distress not improved after treatment of chest condition, which increased the odds of having cardiac abnormalities by 1.93 times (OR: 1.93) (CI: 1.10-3.41), which was statistically significant ( p = .02). The study found that the most sensitive was a cardiac murmur, with sensitivity: 67%, specificity: 53%, positive predictive value (PPV): 84%, negative predictive value (NPV): 31%, and the most specific were signs of respiratory distress, with sensitivity: 6%, specificity: 100%, PPV: 100%, NPV: 23%, and signs of heart failure, with sensitivity: 2%, specificity: 100%, PPV: 100%, NPV: 22%. Conclusion The precise physical examination of neonates and meticulous auscultation of the heart, in conjunction with signs of respiratory distress, heart failure, routine pulse oximetry examination, cyanosis, and timely echo, play an essential role in the early diagnosis and initiation of treatment for heart diseases.
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Shalaby et al. (2025) conducted a cross-sectional in Congenital heart disease. Abnormal clinical cardiac findings (e.g., signs of heart failure) vs. Absence of abnormal clinical cardiac findings was evaluated on Presence of cardiac abnormalities (OR 2.22, 95% CI 1.30-3.78, p=0.004). Abnormal clinical findings including signs of heart failure (OR 2.22; 95% CI 1.30-3.78) and cyanosis (OR 2.00; 95% CI 1.15-3.47) significantly increased the odds of having cardiac abnormalities.
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