Newborn Cardiac Examination

A Comprehensive Guide

Dr. Tom Collins, a Clinical Associate Professor of Cardiology and Cardiovascular Medicine, demonstrates that a newborn cardiovascular examination involves several crucial steps to assess the heart's structure and function shortly after birth. The examination aims to promptly identify congenital heart defects and structural abnormalities in newborns through a systematic approach of observation, palpation, and auscultation.

Key Steps in the Newborn Cardiovascular Examination:

  1. Observation 
  2. Palpation
  3. Auscultation

Start with Observation:

  • General Appearance: Assessing the baby’s overall comfort, skin color, breathing patterns, and any signs of cyanosis or dysmorphic features.

  • Precordium Examination: Looking for chest wall bulges which can indicate an enlarged heart, visible Point of Maximum Impulse (PMI), and signs of obvious congenital heart conditions like ectopia cordis.

Palpation:

  • Pulse Assessment: Checking for simultaneous pulses at the brachial and femoral arteries to detect conditions like coarctation of the aorta.
  • Precordium and Liver Palpation: Feeling for PMI localization, presence of thrills, and liver enlargement which could indicate heart abnormalities.

Auscultation: Listening to the Heart

Auscultation is a critical part of the newborn cardiovascular examination. It involves listening to the heart sounds and identifying any abnormalities. Key aspects include:

Identifying Systole and Diastole:

  • Systole: Defined by the closure of the atrioventricular valves (mitral and tricuspid).
  • Diastole: Initiated by the closure of the semilunar valves (aortic and pulmonary).
     

Listening Areas:

Listen throughout the precordium as the heart's position can vary. Pay special attention to:

  • Infraclavicular Area: For patent ductus arteriosus (PDA) sounds.
  • Upper Sternal Border: For aortic and pulmonary valve stenosis.
  • Axilla: For mitral regurgitation.
    Abdomen: To check for bruits or abnormal sounds.
     

Murmurs:

  • Patent Ductus Arteriosus (PDA): A continuous machinery-like murmur.
  • Aortic and Pulmonary Stenosis: Crescendo-decrescendo murmurs.
  • Mitral Regurgitation: Holosystolic, harsh murmur radiating to the axilla.
  • Ventricular Septal Defect (VSD): A holosystolic murmur, common in newborns.
  • Peripheral Pulmonary Stenosis: High-frequency murmur heard in the axilla and back.

Watch the Playlist: Newborn Exams