HEART MURMURS

Heart murmurs are common in the first days of life and do not usually signify structural heart problems. If a murmur is present at birth, however, it should be considered a valvular problem until proved otherwise because the common benign transitional murmurs (eg, patent ductus arteriosus) are not audible until minutes to hours after birth.
If an infant is pink, well-perfused, and in no respiratory distress and has palpable and symmetric pulses (right brachial pulse no stronger than the femoral pulse), the murmur is most likely transitional. Transitional murmurs are soft (grade 1–3/6), heard at the left upper to midsternal border, and generally loudest during the first 24 hours. If the murmur persists beyond 24 hours, blood pressure in the right arm and a leg should be determined. If there is a difference of more than 15 mm Hg (arm > leg), cardiology consultation should be arranged to evaluate for coarctation of the aorta. If there is no difference, the infant can be discharged home with follow-up in 2–3 days for auscultation and evaluation for signs of congestive failure. If signs of failure or cyanosis are present, the infant should be referred for evaluation without delay. If the murmur persists without these signs, the infant can be referred for elective evaluation at age 2–4 weeks.