Doctor please feel my pulses! An aid to diagnosis in the newborn

Menahem, Samuel; Sehgal, Arvind

doi:10.1111/jpc.13299

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…Assessing the presence and volume of the infant's pulses and checking the prenatal and postductal saturations will provide further important information (see below) 13 . Occasionally even with a tight coarctation or aortic obstruction with a wide open duct, the femoral pulse will be as good if not better than the brachial, though the post ductal saturations will be reduced 13 …”

Section: Clinical Diagnosis Of Chd In the Newbornmentioning

confidence: 99%

“…A duct‐dependent systemic circulation 13 may confound or delay the neonatal diagnosis of CHD as the RV through the patent duct assists the systemic circulation if the left ventricle (LV) is small and/or poorly functioning, or where there is aortic obstruction such as from critical aortic valve stenosis, interrupted or hypoplastic aortic arch or a tight coarctation. A murmur, for example, arising from subaortic stenosis in a baby with an interrupted type B aortic arch immediately suggests CHD, though differential pulse volumes may be absent if the duct is wide open 13 . Occasionally a loud summated second heart sound in the pulmonary area suggestive of pulmonary hypertension may be the only auscultatory sign 19…”

Section: Clinical Diagnosis Of Chd In the Newbornmentioning

confidence: 99%

“…13 Occasionally even with a tight coarctation or aortic obstruction with a wide open duct, the femoral pulse will be as good if not better than the brachial, though the post ductal saturations will be reduced. 13…”

Section: Pulsesmentioning

confidence: 99%

“…A murmur, for example, arising from subaortic stenosis in a baby with an interrupted type B aortic arch immediately suggests CHD, though differential pulse volumes may be absent if the duct is wide open. 13 Occasionally a loud summated second heart sound in the pulmonary area suggestive of pulmonary hypertension may be the only auscultatory sign. 19 Once the duct begins to close, differential pulses may be noted.…”

Section: Duct-dependent Systemic Circulationmentioning

confidence: 99%

“…19 Once the duct begins to close, differential pulses may be noted. 13 However that may occur following the infant's discharge as most women in Australia leave hospital on day 2 after a vaginal birth or day 4 after a Caesarean section. Gradual duct closure may make the baby unwell, developing mild tachypnoea, poor feeding etc.…”

Section: Duct-dependent Systemic Circulationmentioning

confidence: 99%

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Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening

Menahem

Sehgal

Meagher

2021

J Paediatrics Child Health

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Fetal cardiac and newborn pulse oximetry screening has greatly facilitated the detection of cardiac abnormalities, which may be serious with potentially dire neonatal consequences. The prenatal diagnosis of a serious cardiac abnormality allows the attending obstetrician to organise the much safer in‐utero transfer of the fetus for delivery at a tertiary centre, particularly if there is evidence of a duct‐dependent lesion that may require the infusion of Prostaglandin E1 to maintain duct patency pending surgical intervention. Newborn pulse oximetry alerts the paediatrician that the baby may have a significant cardiac abnormality, which warrants further elucidation prior to discharge, rather than for the baby to represent unwell a few days later. Despite these advances, serious cardiac abnormalities may be missed on screening. Their detection then falls back onto the clinical acumen of the attending paediatrician/family physician to review the history, carefully elicit and evaluate the clinical signs further aided by whatever investigations that may be available at the birthing hospital, frequently less resourced than the tertiary centres. At the outset, a brief synopsis is provided of the clinical findings that may point to a cardiac abnormality. That is followed by a critical review of the accuracy of prenatal and newborn pulse oximetry screening with emphasis on the lesions that may be missed. Suggestions are made as to how to improve the diagnostic accuracy.

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Section: Clinical Diagnosis Of Chd In the Newbornmentioning

confidence: 99%

Section: Clinical Diagnosis Of Chd In the Newbornmentioning

confidence: 99%

Section: Pulsesmentioning

confidence: 99%

Section: Duct-dependent Systemic Circulationmentioning

confidence: 99%

Section: Duct-dependent Systemic Circulationmentioning

confidence: 99%

See 3 more Smart Citations

Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening

Menahem

Sehgal

Meagher

2021

J Paediatrics Child Health

Self Cite

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Arch watch: current approaches and opportunities for improvement

Thomas,

Levy,

Sperotto

et al. 2023

J Perinatol

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Fifteen-minute consultation: How to spot serious heart disease in the newborn

Menahem¹,

Sehgal

2021

Arch Dis Child Educ Pract Ed

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Congenital heart disease (CHD) is common and important as it remains a leading cause of neonatal morbidity and appreciable mortality. Prenatal diagnosis, the presence of a murmur, cyanosis, tachypnoea and/or poor or differential peripheral pulses raise the suspicion of CHD aided by differential pre/postductal saturations. Yet even serious CHD may not be considered when such clues are absent. Nevertheless, there are clinical cues which may alert the clinician to the possibility of a significant CHD which may lead to an early and accurate diagnosis and appropriate intervention to achieve best results. This paper addresses these issues which become especially difficult if caring for infants away from facilities provided by tertiary centres. Tachypnoea on the first postnatal day is generally non-cardiac in origin. Exceptions include large arteriovenous fistulae and/or ‘pump’ (ventricular) failure. In addition, attention is drawn to two important confounding factors in the newborn, namely the patency of the ductus arteriosus and the initially high pulmonary vascular resistance, both of which alter and may mask the clinical findings of a serious cardiac abnormality. An appreciation of the physiological changes that occur in early infancy will aid the clinician’s understanding of CHD as it affects the newborn.

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Doctor please feel my pulses! An aid to diagnosis in the newborn

Cited by 7 publications

References 8 publications

Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening

Early detection of significant congenital heart disease: The contribution of fetal cardiac ultrasound and newborn pulse oximetry screening

Arch watch: current approaches and opportunities for improvement

Fifteen-minute consultation: How to spot serious heart disease in the newborn

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