A study of congenital cardiac disease in a neonatal population–the validity of echocardiography undertaken by a neonatologist
Abstract
OBJECTIVES: To estimate the incidence of, and profile the spread of, congenital cardiac defects, and to assess the accuracy of the echocardiographic diagnosis as performed by a neonatologist. DESIGN: Hospital-based study. METHODS: All neonates meeting our criterions, specifically those with a persistent murmur 48 hours after birth, underwent an echocardiographic examination to exclude an underlying congenital cardiac defect. All scans performed by the neonatologist were videotaped and reviewed by a paediatric cardiologist. We assessed concordance according to inter-rater agreement. RESULTS: Out of 11,085 live births, there were 83 infants with a congenital cardiac defect, giving an incidence of 7.49 per 1000 live births, with 95% confidence interval from 5.88 to 9.09. Of the infants with a murmur persisting at or greater than 48 hours after birth, who had a median age of 4.5 days, 75% had a congenital heart defect, with ventricular septal defect being the commonest, encountered in 56.7% of cases. Concordance between the neonatologist and the cardiologist was good, with Cohen's Kappa coefficient being calculated at 0.68, and 95% confidence interval from 0.51 to 0.85. CONCLUSION: The incidence of congenital cardiac malformations as determined in our hospital-based study in the United Arab Emirates is similar to that described in the Gulf region and worldwide. A persistent murmur at or greater than 48 hours after birth is strongly suggestive of an underlying congenital cardiac malformation. Our experience shows that a neonatologist appropriately trained in echocardiography can perform as well as a paediatric cardiologist. Where specialist resources are limited, this allows for early diagnosis, earlier referral if necessary, and early institution of appropriate therapy.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The predominance of ventricular septal defect is similar to the findings in spontaneously conceived pregnancies.
“Ventricular septal defect was the predominant cardiac anomaly (5 of 8 newborns with cardiac anomalies), similar to the findings in spontaneously conceived pregnancies (16,17).”
From Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate (2006) · cites this paper as [16]
Cites
Practical Statistics for Medical Research.
Walter, S., & Altman, D. G. (1992) · Biometrics · doi:10.2307/2532320 · Cited by 11,665 · see citing works
Practical Statistics for Medical Research
Altman, D. G. (1990) · doi:10.1201/9780429258589 · Cited by 10,668 · see citing works
Incidence of congenital heart disease: I. Postnatal incidence
Hoffman, J. I. E. (1995) · Pediatric Cardiology · doi:10.1007/bf00801907 · Cited by 786 · see citing works
Becerra, J. E., Khoury, M. J., Cordero, J. F., & Erickson, J. D. (1990) · PEDIATRICS · doi:10.1542/peds.85.1.1 · Cited by 622 · see citing works
Presentation of congenital heart disease in infancy: implications for routine examination
Wren, C., Richmond, S., & Donaldson, L. (1999) · Archives of Disease in Childhood - Fetal and Neonatal Edition · doi:10.1136/fn.80.1.f49 · Cited by 303 · see citing works
The Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients
Fisher, D. C., Fisher, E. A. A., Budd, J. H., et al. (1995) · CHEST Journal · doi:10.1378/chest.107.6.1504 · Cited by 282 · see citing works
Eronen, M., Siren, M., Ekblad, H., et al. (2000) · PEDIATRICS · doi:10.1542/peds.106.1.86 · Cited by 246 · see citing works
Cardiovascular malformations in infants of diabetic mothers
Wren, C., Birrell, G., & Hawthorne, G. (2003) · Heart · doi:10.1136/heart.89.10.1217 · Cited by 230 · see citing works
McMahon, C. J., Feltes, T. F., Fraley, J. K., Bricker, J. T., Grifka, R. G., Tortoriello, T. A., Blake, R., & Bezold, L. I. (2002) · Heart · doi:10.1136/heart.87.3.256 · Cited by 221 · see citing works
Loffredo, C. A., Wilson, P. D., & Ferencz, C. (2001) · Teratology · doi:10.1002/tera.1051 · Cited by 217 · see citing works
Ferencz, C., Rubin, J. D., McCarter, R., & Clark, E. B. (1990) · Teratology · doi:10.1002/tera.1420410309 · Cited by 171 · see citing works
Maternal Risk Factors and Major Associated Defects in Infants with Down Syndrome
Torfs, C. P., & Christianson, R. E. (1999) · Epidemiology · doi:10.1097/00001648-199905000-00013 · Cited by 143 · see citing works
Congenital heart disease in Down's syndrome: two year prospective early screening study.
Tubman, T. R. J., Shields, M. D., Craig, B., Mulholland, H., & Nevin, N. C. (1991) · BMJ · doi:10.1136/bmj.302.6790.1425 · Cited by 124 · see citing works
Trends in congenital heart disease in Dallas County births. 1971-1984.
Fixler, D. E., Pastor, P. L., Chamberlin, M., Sigman, E. S., & Eifler, C. W. (1990) · Circulation · doi:10.1161/01.cir.81.1.137 · Cited by 124 · see citing works
Epidemiology of Down syndrome in 118,265 consecutive births
Stoll, C. G., Alembik, Y., Dott, B., & Roth, M. (2005) · American Journal of Medical Genetics · doi:10.1002/ajmg.1320370715 · Cited by 110 · see citing works
Janssen, P. A., Rothman, I. K., & Schwartz, S. M. (1996) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.1996.tb00026.x · Cited by 92 · see citing works
Echocardiography on neonatal intensive care units in Australia and New Zealand
Evans, N. J. (2000) · Journal of Paediatrics and Child Health · doi:10.1046/j.1440-1754.2000.00469.x · Cited by 88 · see citing works
Incidence of congenital heart disease among hospital live births in India.
Khalil, A., Aggarwal, R., Thirupuram, S., & Arora, R. (1994) · PubMed · Cited by 88 · see citing works
Southall, D. P., Johnson, M. A., Shinebourne, E. A., et al. (1981) · PEDIATRICS · doi:10.1542/peds.68.1.58 · Cited by 76 · see citing works
Congenital heart disease: A 10 year cohort
BOWER, C., & RAMSAY, J. M. (1994) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.1994.tb00691.x · Cited by 74 · see citing works
Evaluation of echocardiography on the neonatal unit
Moss, S., Kitchiner, D. J., Yoxall, C. W., et al. (2003) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fn.88.4.f287 · Cited by 71 · see citing works
Congenital Heart Disease in Infants With Downʼs Syndrome
Wells, G., Barker, S., FINLEY, S. C., et al. (1994) · Southern Medical Journal · doi:10.1097/00007611-199407000-00010 · Cited by 67 · see citing works
Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study
Arlettaz, R., Archer, N., & Wilkinson, A. R. (1998) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fn.78.3.f166 · Cited by 63 · see citing works
Incidence of congenital heart disease in Qatari children
Robida, A., Folger, G. M., & Hajar, H. A. (1997) · International Journal of Cardiology · doi:10.1016/s0167-5273(97)00067-3 · Cited by 62 · see citing works
Echocardiography on the neonatal unit: a job for the neonatologist or the cardiologist?
Skinner, J. R. (1998) · Archives of Disease in Childhood · doi:10.1136/adc.78.5.401 · Cited by 61 · see citing works
Down’s Syndrome in Saudi Arabia: Incidence and Cytogenetics
Niazi, M., Al-Mazyad, A. S., Al-Husain, M. A., et al. (1995) · Human Heredity · doi:10.1159/000154261 · Cited by 59 · see citing works
Incidence and spectrum of congenital heart disease in Oman
Subramanyan, R., Joy, J. C., Venugopalan, P., Sapru, A., & Al-Khusaiby, S. M. (2000) · Annals of Tropical Paediatrics · doi:10.1080/02724936.2000.11748155 · Cited by 58 · see citing works
Significance of a Cardiac Murmur as the Sole Clinical Sign in the Newborn
Rein, A. J. J. T., Omokhodion, S. L., & Nir, A. (2000) · Clinical Pediatrics · doi:10.1177/000992280003900902 · Cited by 55 · see citing works
Congenital heart disease in 740 subjects: epidemiological aspects
Alabdulgader, A. A. A. (2001) · Annals of Tropical Paediatrics · doi:10.1080/02724930120058160 · Cited by 51 · see citing works
Clinical and echocardiographic evaluation of neonates with heart murmurs
Zd, D., Roguin, N., & Barak, M. (1997) · Acta Paediatrica · doi:10.1111/j.1651-2227.1997.tb08580.x · Cited by 49 · see citing works
Ward, C., & PURDIE, J. (2001) · Journal of Paediatrics and Child Health · doi:10.1046/j.1440-1754.2001.00695.x · Cited by 48 · see citing works
Echocardiography for the neonatologist
Skinner, J. R., Farran, D. C., & Hunter, S. (2000) · Cited by 41 · see citing works
Echocardiography by a neonatologist
Whitehall, J. S. (1999) · Archives of Disease in Childhood · doi:10.1136/adc.80.6.e579 · Cited by 35 · see citing works
Neonatal murmurs: are senior house officers good enough?
Farrer, K., & Rennie, J. M. (2003) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/fn.88.2.f147 · Cited by 31 · see citing works
Mironiuk, M., Kietlińska, Z., Jezierska-Kasprzyk, K., et al. (1997) · PubMed · Cited by 31 · see citing works
Venugopalan, P., & Agarwal, A. K. (2003) · PubMed · Cited by 29 · see citing works
Prader-Willi-like syndrome in a patient with an Xq23q25 duplication
Monaghan, K. G., Dyke, D. L. V., & Feldman, G. L. (1998) · American Journal of Medical Genetics · doi:10.1002/(sici)1096-8628(19981116)80:3 · Cited by 29 · see citing works
Spontaneous closure of ventricular septal defects in the first year of life.
Lin, M., Wang, N. K., Hung, K.-H., et al. (2001) · PubMed · Cited by 27 · see citing works
FETAL AND NEONATAL ARRHYTHMIAS
Tanel, R. E., & Rhodes, L. A. (2001) · Clinics in Perinatology · doi:10.1016/s0095-5108(05)70074-9 · Cited by 24 · see citing works
Congenital heart disease in Down syndrome: an echocardiographic study.
Bhatia, S., Verma, I. C., & Shrivastava, S. (1992) · PubMed · Cited by 22 · see citing works
Cytogenetic analysis of down syndrome in Libya
Verma, I. C., Mathews, A. R., Faquih, A. M., et al. (1990) · The Indian Journal of Pediatrics · doi:10.1007/bf02722095 · Cited by 17 · see citing works
A survey of serious congenital morphological abnormalities in Abu Dhabi
al-Jawad, S. T., Shubbar, A. I., Khafaji, N. A. A. R. S. Y. A., et al. (1988) · Annals of Tropical Paediatrics · doi:10.1080/02724936.1988.11748543 · Cited by 16 · see citing works
Evaluation of fetal cardiac arrhythmias. Ultrasound findings and neonatal outcome.
Calvin, S. E., Gaziano, E. P., Bendel, R. P., et al. (1992) · PubMed · Cited by 10 · see citing works
Echocardiography in congenital heart disease: Diagnosis, misdiagnosis, and ownership
Sholler, G. F. (2001) · Journal of Paediatrics and Child Health · doi:10.1046/j.1440-1754.2001.00696.x · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Tulandi, T., Martin, J., Al-Fadhli, R., Kabli, N., Forman, R., Hitkari, J., Librach, C., Greenblatt, E., & Casper, R. F. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.03.014 · Cited by 370 · see citing works
- Authors
- Samson, G. R., & Kumar, S. R.
- Affiliations
- Corniche Hospital (AE)
- Mafraq Hospital (AE)
- Venue
- Cardiology in the Young
- Publisher
- Cambridge University Press (CUP)
- Published
- 2004-12
- Volume
- 14
- Issue
- 6
- Pages
- 585-593
- ISSN
- 1047-9511 (ISSN-L)
- 1467-1107
- OpenAlex
- W2160967154
- Cited by
- 26
- References
- 44
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2016: 2 · 2015: 2 · 2013: 2 · 2012: 1
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiology in the Young (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- congenital heart disease, neonates, echocardiography, diagnostic accuracy, interobserver agreement, ventricular septal defect, incidence, United Arab Emirates
- MeSH terms
- Arrhythmias, Cardiac, Female, Heart Defects, Congenital, Heart Murmurs, Heart Septal Defects, Ventricular, Humans, Infant, Newborn, Neonatology, Pregnancy, Pregnancy in Diabetics, Ultrasonography, Reproducibility of Results, Observer Variation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
