Sensitivity of Clinical Assessment in Term Neonates by General Pediatric Residents
Aungkana Gengsakul MD*1, Chalermkiet Tuntrakool MD*, Suriporn Kunathai MD*, Santa Haupara MD*, Sangkae Chamnanvanakij MD**
Affiliation : * Cardiology Unit, Department of Pediatrics, Phramongkutklao Hospital, Thailand ** Neonatology Unit, Department of Pediatrics, Phramongkutklao Hospital, Thailand 1Poster presentation in The Third World Congress of Pediatric Cardiology, May 2001, Toronto, Canada
Objectives : To determine the accuracy of physical examination in detecting congenital heart diseases
by pediatric residents and identify risk factors of congenital heart diseases.
Materials and Methods : Five hundred term infants (GA ≥ 37wks) who were born at Phramongkutklao
Hospital from July 1st, 1999 to June 30th, 2000 were examined by pediatric residents and pediatric
cardiologists within the first week of life. The echocardiography was performed in all 500 infants for
definite diagnosis. The accuracy of physical examination was determined by comparing with
echocardiographic finding and presented as sensitivity and specificity.
Results : Congenital heart diseases were found in 18 of 500 term infants (3.6%). The physical examination
by pediatric residents and pediatric cardiologists showeds a sensitivity of 39% and 94% and the
specificity of 98% and 97%, respectively. After excluding spontaneously closed PDA within 2 weeks,
the first and second most common congenital heart diseases in infants were Ventricular septum defect
(VSD) (44%) and Patent ductus arteriosus (PDA) (33%). The positive other cardiovascular signs, such
as cyanosis or abnormal pulses with heart murmur were significantly associated to diagnosis of congenital
heart diseases.
Conclusion : Although echocardiography is the major tool to determine the definite diagnosis, most
congenital heart diseases can be well detected during physical examination by skilled physicians. As a
result, the value of physical examination of the cardiovascular system should be emphasized in training
general pediatricians concerning lower costs and early detection of congenital heart diseases.
Keywords : Clinical assessment, Heart murmur, Neonates, Pediatric residents
