Article Text

Detection of heart disease in infancy
  1. MILES WAGSTAFF
  1. Department of Paediatrics
  2. Royal United Hospital
  3. Combe Park
  4. Bath
  5. Child Health Department
  6. Newbridge Hill
  7. Bath BA1 3QE
    1. FIONA FINLAY,
    2. STUART MURRAY
    1. Department of Paediatrics
    2. Royal United Hospital
    3. Combe Park
    4. Bath
    5. Child Health Department
    6. Newbridge Hill
    7. Bath BA1 3QE

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      Editor—Gregory et al 1 state that after neonatal examination, the 6–8 week examination provides the only opportunity for detection of heart disease in infancy, other than the opportunistic recognition of a murmur or the development of symptoms. This is supported by the most recent report of the joint working party on Child Health surveillance,2 which states: “there is no justification for carrying out a screening check for heart murmurs after 8 weeks of age.”

      In the Bath clinical area routine auscultation of the heart was, until recently, carried out at the 8 month check, and indeed in the Wiltshire catchment area this is still current practice. A retrospective study was performed, looking at the records of around 10 000 children seen over 27 months. Hospital records, community child health records, and General Practitioner records were reviewed, as appropriate, to determine the outcome of children referred to general paediatric outpatient clinics with a murmur. Forty seven children were seen and notes were available for 45.

      When examined in outpatients, six children (13.3%) had no audible murmur and 30 children (66.7%) were felt to have an innocent murmur. Nine children (20%) were thought to have a cardiac lesion. These children were all asymptomatic and all had had normal six week checks. Of the nine children, two were thought to have ventricular septal defects and seven were referred to a paediatric cardiologist. Subsequently, three were found to have structurally normal hearts, two pulmonary valve stenosis, and one a ventricular septal defect. There was no further information on one child.

      Therefore, as a result of the 8/12 check, three children with ventricular septal defects and two with pulmonary valve stenosis were identified.

      Our study highlights the importance of vigilent opportunistic screening if the routine 8/12 check is dropped. Ways to promote opportunistic screening must be sought.

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