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Screening neonates for heart problems

Q I am sometimes requested to carry out a 'day three heart check' on a new baby. Is this an effective screening tool?

A Modern obstetric practice allows discharge from the maternity unit on the first day after birth, often at six hours. Then a routine pre-discharge assessment has to be performed early in the first day or, in some centres, not at all. This results in requests for subsequent GP examination, such as a 'heart check' at about three days.

By strict definition there is no clear evidence base that cardiovascular examination is, or is not, an effective screening test, but this is accepted as good practice and updated guidelines are likely to recommend it should continue.

There is no specific requirement for a three-day examination if the child was previously checked.

Since the most severe cardiac lesions are dependent on patency of the ductus arteriosus, clinical signs and symptoms are minimal in the first hours and only become apparent in the next day or two as the duct closes.

Remember that in very severe lesions there may be no murmur and, particularly in this age group, there is more to cardiovascular examination than auscultation.

In many with a significant lesion, overactivity of the heart is apparent on palpation of the sub-xiphoid region of the epigastrium for a heave, not felt in normal infants.

Cyanosis may be apparent. Heart failure presents with tachycardia (>150 beats/min), tachypnoea (>50 breaths/ min) and hepatomegaly (>1cm). The arm and femoral pulses should be compared for any difference in volume.

Alan Houston is consultant paediatric cardiologist, Royal Hospital for Sick Children, Glasgow

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