Audit on changes in new born heart murmur follow-up pathway due to covid pandemic

ABSTRACT

AimsBackgroundHeart murmurs in a new born are common due to transition from fetal circulation to neonatal circulation. Majority of these heart murmurs disappear in few days, but they can also be a sign of underlying congenital heart disease. In UK the practice in majority of neonatal units is, heart murmur in an asymptomatic new born with normal examination and passing pulseOx, is reviewed again by middle grade after 24 hours. If the murmur is innocent (Grade 1-2/6, no signs or symptoms) then baby is brought back to neonatal clinic in 4 -6 weeks for follow-up. Due to the Covid pandemic in March 2020 our unit policy changed for all innocent murmurs to be followed up by the GP at 6 – 8 weeks.ObjectiveTo assess the outcome of change in policy of heart murmur follow-up during the pandemic.MethodsA retrospective study from March 2020 – June 2021 (15 months). Data collected of infants who had a heart murmur on routine newborn examination, using NIPE Smart data, admission notes, Badger and postnatal notes. Infants discharged for GP follow up as per revised guideline were identified, and parents of these infants were contacted to enquire about GP follow up and the outcome.ResultsDuring the audit period, 101 infants were found to have a heart murmur on routine neonatal examination.Of these 101• 72 had resolved on middle grade review after 24 hours• 11 received inpatient ECHO before discharge.• 18 were discharged for GP review at 6-8 weeks.17 of 18 parents of these infants were contacted, with one baby excluded due to incorrect data. 16 were aware of the heart murmur at the time of discharge.17/17 (100%) patients contacted had a GP review at 6-8 weeks as planned.At this review, the murmur persisted in 4/17 (24%) infants. One of these infants was re-reviewed by the GP and subsequently resolved, and a further two infants were referred to paediatrics for ECHO. The final infant was not referred or re-reviewed, but has remained clinically well.ConclusionAll infants discharged for GP follow up were reviewed, and all have remained clinically well since discharge. Murmur had resolved in the majority of infants. Where the murmur persisted, the infant was appropriately referred or re-reviewed in the majority of cases. Asymptomatic infants with low grade (likely innocent) murmurs, we can continue to discharge home with GP follow-up.