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ORIGIN AND NATURAL HISTORY OF INNOCENT HEART MURMURS IN NEWBORNS

Fifty healthy term babies with the clinical diagnosis of an innocent heart murmur and 50 controls without a murmur were studied. Each baby had a complete 2-dimensional and pulsed Doppler echocardiogram and those with abnormality were followed up at 6 weeks, 3 months, and 6 months until the murmur had disappeared or the heart was totally normal. Babies with congenital heart disease were excluded from the study.

Pulmonary branch stenosis (PBS) was found in 25 (50%) of the study group and in six (12%) controls; patent ductus arteriosus (PDA) was found in 30 (60%) subjects and in 6 (12%) controls; and a patent foramen ovale (PFO) in 50 (100%) subjects and in 41 (82%) controls. At 6 weeks the murmur had disappeared in 64% of babies. PBS was still present in 8 of 22 (36%) babies at 6 weeks, in 12% at 3 months, but in none at 6 months. At 6 weeks, 7 of the 8 with PBS still had murmur compared with 2 of 14 (14%) babies in which the PBS had resolved (p < 0.005). At 6 weeks the PDA had closed in all patients but foramen ovale was patent in 29 of 44 (66%) subjects and 9 of 33 (27%) controls. The closure of PFO was not influenced by its size at birth.

Conclusions : An innocent heart murmur in a term baby is often related to PBS particularly, if the murmur is still present after 24 hrs of birth, when most PDA have closed. At 6 weeks the murmur had disappeared and the PBS had resolved in 64% of the babies. PBS had resolved in all babies at 6 months.

Abstracted from : Arch Dis Childh Fetal Neonate Ed 1998; 78/3