Early clinical screening of neonates for congenital heart defects: the cases we miss

In a population-based study of 35,218 infants born alive during the 15 year s from 1982 to 1996, 353 (1%)were diagnosed as having a congenital heart de fect, of whom 84 (24%) were diagnosed subsequent to discharge from hospital after birth (2.4/1000). Of these, 40 (48%) had a ventricular septal defect , 14 (17%) an atrial septal defect, 9 (11%) a patent arterial duct, 8 (1.0% ) an aortic stenosis and 13 (15%) other defects. Compared with those in who m diagnosis was made before discharge, the group of patients with defects d etected late had an increased prevalence of atrial septal defects, patent a rterial duct and aortic stenosis, but less decreased prevalence of ventricu lar septal defects (p < 0.05). Median age at detection of the defects subse quent to discharge was 6 months (range 2 weeks-ii years). Seven patients (8 %) presented with clinical symptoms of cardiac decompensation. The mortalit y rate was significantly lower in those in whom defects were detected late (1/84; 1%) as compared with those detected immediately after birth (37/269; 14%) (P < 0.05) The total rate for early detection was the same after usin g one clinical examination (8.2/1000) of newborns as our basic routine inst ead of two (7.1/1000) (P > 0.05). A substantial proportion of congenital ca rdiac malformations are detected after discharge from hospital after birth. Some patients with these lesions present with cardiac decompensation and a re in need of medication and surgery. One clinical examination of newborns detects congenital malformations of the heart as efficient as two.