Cardiac Murmurs in The Newborn – When to Worry?

Congenital Heart Disease (CHD) contributes to a large proportion of mortality among infants and young children. Newborns (birth to 1 month of age) are at higher risk of having a serious lesion requiring early intervention, than older infants and children. Detecting a murmur in a newborn on physical exam can provide a clue to the presence of CHD, but its utility is limited by provider expertise and neonatal factors, such as rapid heart rate and respiratory symptoms. Furthermore, not all murmurs are pathological. Health care providers including primary care physicians, pediatricians or nurse practitioners often face difficulties when determining whether a murmur warrants further investigation. We aim to describe key differences between innocent and pathological heart murmurs in the newborn. Further, we describe current screening protocols for Critical Congenital Heart Defects (CCHD) that may assist primary care physicians in deciding when to refer for further evaluation.