{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:06:54Z","timestamp":1785168414847,"version":"3.55.0"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"published-print":{"date-parts":[[1999,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>AIM<\/jats:title>\n                  <jats:p>To investigate the performance of routine neonatal and 6 week examinations for detecting congenital heart disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec sec-type=\"methods\">\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A retrospective review of findings on clinical examination was conducted of a cohort of live born infants with congenital heart disease in one health region in 1987\u201394<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of 1590 babies with congenital heart disease, 523 (33%) presented before neonatal examination because of symptoms or non-cardiac abnormalities. 1061 underwent routine neonatal examination which was abnormal in 476 (45%), but only 170 were referred directly for diagnosis. Of 876 discharged with no diagnosis, 306 presented or died undiagnosed before 6 weeks. At 6 weeks 252 of 569 babies underwent a second routine examination which was abnormal in 164 (65%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Routine neonatal examination fails to detect more than half of babies with heart disease; examination at 6 weeks misses one third. A normal examination does not exclude heart disease. Babies with murmurs at neonatal or 6 week examinations should be referred for early paediatric cardiological evaluation which will result either in a definitive diagnosis of congenital heart disease or in authoritative reassurance of normal cardiac anatomy and function.<\/jats:p>\n                  <jats:p>\n                     <jats:boxed-text position=\"float\">\n                        <jats:sec>\n                           <jats:title>Key points<\/jats:title>\n                           <jats:def-list>\n                              <jats:def-item>\n                                 <jats:term>\u2002\u2022<\/jats:term>\n                                 <jats:def>\n                                    <jats:p>More than half of babies with undiagnosed congenital heart disease which comes to light in infancy are missed by routine neonatal examination and more than one third by the 6 week examination<\/jats:p>\n                                 <\/jats:def>\n                              <\/jats:def-item>\n                           <\/jats:def-list>\n                           <jats:def-list>\n                              <jats:def-item>\n                                 <jats:term>\u2002\u2022<\/jats:term>\n                                 <jats:def>\n                                    <jats:p>Parents, community midwives, health visitors, general practitioners and paediatricians should recognise that a normal neonatal examination does not guarantee that the baby is normal and certainly does not exclude life threatening cardiovascular malformation<\/jats:p>\n                                 <\/jats:def>\n                              <\/jats:def-item>\n                           <\/jats:def-list>\n                           <jats:def-list>\n                              <jats:def-item>\n                                 <jats:term>\u2002\u2022<\/jats:term>\n                                 <jats:def>\n                                    <jats:p>Follow up of babies with murmurs without arranging for an early definitive (echocardiographic) diagnosis is of little value and can be risky<\/jats:p>\n                                 <\/jats:def>\n                              <\/jats:def-item>\n                           <\/jats:def-list>\n                           <jats:def-list>\n                              <jats:def-item>\n                                 <jats:term>\u2002\u2022<\/jats:term>\n                                 <jats:def>\n                                    <jats:p>Babies with murmurs at neonatal or 6 week examinations should be referred for early paediatric cardiological evaluation. This will result either in a definitive diagnosis of congenital heart disease or in authoritative reassurance of normal cardiac anatomy and function<\/jats:p>\n                                 <\/jats:def>\n                              <\/jats:def-item>\n                           <\/jats:def-list>\n                           <jats:def-list>\n                              <jats:def-item>\n                                 <jats:term>\u2002\u2022<\/jats:term>\n                                 <jats:def>\n                                    <jats:p>Babies with Down\u2019s syndrome have a high prevalence of congenital heart disease and all should be referred for early echocardiographic examination.<\/jats:p>\n                                 <\/jats:def>\n                              <\/jats:def-item>\n                           <\/jats:def-list>\n                        <\/jats:sec>\n                     <\/jats:boxed-text>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/fn.80.1.f49","type":"journal-article","created":{"date-parts":[[2009,4,8]],"date-time":"2009-04-08T11:39:47Z","timestamp":1239190787000},"page":"F49-F53","source":"Crossref","is-referenced-by-count":202,"title":["Presentation of congenital heart disease in infancy: implications for routine examination"],"prefix":"10.1136","volume":"80","author":[{"given":"Christopher","family":"Wren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Richmond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Donaldson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,1,1]]},"reference":[{"key":"2025090509432710000_80.1.F49.1","doi-asserted-by":"crossref","first-page":"F71","DOI":"10.1136\/fn.70.1.F71","article-title":"Assessment and management of congenital heart in the newborn by the district paediatrician.","volume":"70","author":"Silove","year":"1994","journal-title":"Arch Dis Child"},{"key":"2025090509432710000_80.1.F49.2","unstructured":"Hall DMB , ed (1996) Health for all children. 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