. Likely innocent heart murmur:
A well baby with no symptoms or signs of heart failure or shock, with normal pulses, post-ductal saturation ≥96%, and soft systolic murmur at left sternal edge with no radiation can be discharged home after senior review.
GP should be informed with a discharge letter, who can review during next baby check.
Letter should be sent to consultant-in-charge’s secretary or ward clerk to arrange a general follow-up clinic in 6 - 8 weeks.
2. Likely pathological heart murmur but asymptomatic:
A baby with family history of CHD, dysmorphic, ≥grade 3 murmur, pan systolic, diastolic, continuous murmur, abnormal heart sounds, heave or thrill should be reviewed by a senior and be discussed with consultant in-charge before discharge.
Don’t do routine chest X-ray or ECG unless needed for other clinical reasons.
Consider having urgent echocardiogram if available or discuss with paediatric cardiology team.
Arrange appropriate follow-up, which should be notified to parents before discharge.
GP should be informed with discharge letter with copy to parents. Guideline 390.1 2 of 3 Uncontrolled if printed
3. Likely significant heart murmur with symptoms:
A baby with heart murmur and having any signs of heart failure, shock, absent or weak femoral pulse, post-ductal saturation ≤96% or ≥3% difference between pre and postductal saturation should be admitted to NICU for urgent review by a senior paediatrician and to have further investigations.
Consider X-ray ± ECG but do not delay treatment. ECG usually will show right axis deviation in normal newborn baby. ECG is not diagnostic in most CHD except in atrioventricular septal defect which can be helpful in babies with suspected Trisomy 216 .
Urgent echocardiogram should be performed if facility is available, otherwise discuss with paediatric cardiology team at Oxford.
Consider starting prostaglandin E2 (Dinoprostone) IV. Refer to the BNFc for dose and direction for administration. Review any local pharmacy guidelines about starting this drug.
A well baby with no symptoms or signs of heart failure or shock, with normal pulses, post-ductal saturation ≥96%, and soft systolic murmur at left sternal edge with no radiation can be discharged home after senior review.
GP should be informed with a discharge letter, who can review during next baby check.
Letter should be sent to consultant-in-charge’s secretary or ward clerk to arrange a general follow-up clinic in 6 - 8 weeks.
2. Likely pathological heart murmur but asymptomatic:
A baby with family history of CHD, dysmorphic, ≥grade 3 murmur, pan systolic, diastolic, continuous murmur, abnormal heart sounds, heave or thrill should be reviewed by a senior and be discussed with consultant in-charge before discharge.
Don’t do routine chest X-ray or ECG unless needed for other clinical reasons.
Consider having urgent echocardiogram if available or discuss with paediatric cardiology team.
Arrange appropriate follow-up, which should be notified to parents before discharge.
GP should be informed with discharge letter with copy to parents. Guideline 390.1 2 of 3 Uncontrolled if printed
3. Likely significant heart murmur with symptoms:
A baby with heart murmur and having any signs of heart failure, shock, absent or weak femoral pulse, post-ductal saturation ≤96% or ≥3% difference between pre and postductal saturation should be admitted to NICU for urgent review by a senior paediatrician and to have further investigations.
Consider X-ray ± ECG but do not delay treatment. ECG usually will show right axis deviation in normal newborn baby. ECG is not diagnostic in most CHD except in atrioventricular septal defect which can be helpful in babies with suspected Trisomy 216 .
Urgent echocardiogram should be performed if facility is available, otherwise discuss with paediatric cardiology team at Oxford.
Consider starting prostaglandin E2 (Dinoprostone) IV. Refer to the BNFc for dose and direction for administration. Review any local pharmacy guidelines about starting this drug.
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