Heart murmurs in a newborn baby: what it means

In a healthy person of any age, two tones should be heard when the heart muscle is working:

• diastolic, accompanying the phase of relaxation and filling of the ventricles with blood;
• systolic, corresponding to the moment of contraction of the heart muscle and the expulsion of blood into the systemic bloodstream.

Extraneous sounds heard in the pause between tones are called noises; they do not correspond to the characteristics of normal heart function, drowning out its tones.

The period when a child is called a newborn (neonatal) is calculated four weeks from the moment of birth. Heart murmurs in a newborn child are often heard by pediatricians-neonatologists in the maternity ward. Such news discourages young mothers and causes their anxiety and insomnia. Of course, there is a reason for concern, since the origin of the murmur must be determined, since it may indicate the presence of a serious pathology. This is exactly the case when vigilance will not be excessive. Finding out after a thorough examination that everything is in order is much more pleasant than missing time and a chance to restore the child's health.

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Epidemiology

Morbidity statistics show that various types of minor cardiac developmental anomalies occur among 2.2-10% of the population.

Congenital anatomical anomalies of the heart make up a third of all developmental defects, and the tendency for this pathology to increase in frequency is increasing. Approximately 0.7-1.2% of children are born with heart defects, most of whom die by the end of the first year of life without surgical correction. The probability of having children with structural anomalies of the heart and blood vessels in a family where there is already a child with such a pathology is somewhat higher - by about 5%.

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Causes heart murmurs in a newborn

The most important criterion for classifying noises is the cause of their occurrence. In newborn babies, extraneous sounds accompanying the work of the heart may be manifestations of congenital anomalies in the development of the heart muscle (pathological or organic causes), or may be caused by completely innocent reasons, usually disappearing over time, associated with the restructuring and adaptation of the heart to existence in new conditions outside the womb.

Such noises are classified as innocent, they are also called functional or benign. They can occur in absolutely healthy babies and the reasons for their appearance are so-called minor structural anomalies of the muscular and valvular apparatus, which do not cause gross disturbances in blood flow:

• tendinous thread-like formations (ectopic trabeculae or false chords) in the left ventricle of the heart;
• patent oval window;
• long Eustachian valve and others.

A number of disorders related to minor anomalies disappear with age, since they are fragments of embryonic blood circulation. Even if they remain, they often do not have a significant impact on the quality of cardiac activity. For example, valve prolapses, more often mitral, less often tricuspid, also in most cases are minor anomalies and are often diagnosed completely by accident. Severe degrees of such pathology (extremely rare) lead to blood flow disorders and require surgical intervention.

The causes of functional murmurs may not be directly related to cardiac pathologies. The presence of perinatal infections, anemia increases the load on the heart, and the child hears murmurs that disappear after eliminating such causes.

Most systolic murmurs are considered benign or harmless.

Extraneous sounds that are constant and heard throughout the systolic phase, appearing in the diastolic phase of the heart muscle, and late systolic sounds are considered dangerous. They are caused by malformations of the heart muscle, leading to severe blood flow disturbances, which inevitably entails oxygen starvation of other internal organs and tissues, and a deficiency of essential nutrients. There are developmental anomalies incompatible with life.

The most common causes of pathological or dangerous noises heard during the work of the heart are congenital (the child is still too young for acquired defects) anatomical deviations from the norm:

• pronounced valvular anomalies: mitral prolapse and stenosis, combined defect, tricuspid valve prolapse;
• defects in the septa separating the atria or ventricles of the heart;
• severe degrees of vascular malformations, for example, segmental narrowing (coarctation) of the aorta, open (after reaching one year of age) ductus arteriosus;
• combined anomalies – lesions of two, three, four (tetralogy of Fallot) structural elements of the heart;
• violation of the position (transposition) of the main vessels;
• abnormal drainage (partial or complete) of the pulmonary veins.

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Risk factors

Risk factors for congenital anatomical abnormalities of the heart and major vessels are numerous. Negative roles can be played by heredity, abnormal pregnancy, in particular, infectious and chronic diseases of the expectant mother, drug therapy during pregnancy, miscarriage and prolonged infertility and related treatment, taking over-the-counter drugs and vitamins during pregnancy. It is impossible not to take into account the impact of an unfavorable environmental situation in the place of permanent residence of the pregnant woman, as well as her addiction to bad habits. The risk group also includes women over 35 years of age. A serious factor that increases the likelihood of heart murmurs in an infant is delivery by Caesarean section.

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Pathogenesis

The pathogenesis of extraneous noises during the work of the main muscular organ is associated with changes in intracardiac pressure and blood flow velocity in the main vessels, its turbulence, which is often provoked by loose valves, defects of septa or vessels. Benign noises, as a rule, mainly appear in the systolic phase of the cardiac muscle activity with increasing blood flow through the semilunar valves (usually aortic), which are anatomically quite normal. Unlike dangerous noises generated by structural anomalies of the heart valves, chambers or main vessels, safe ones are caused only by blood flow.

Heart murmur is heard in approximately every third newborn, however, it does not always indicate the presence of a disease. The probability that the infant's heart murmur is benign is almost equal to the probability that it is a symptom of congenital heart disease.

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Symptoms heart murmurs in a newborn

There are no rules without exceptions, however, diastolic murmurs are reflections of heart disease. Murmurs that are heard constantly are also.

Systolic murmur in the heart of a newborn is interpreted more ambiguously. Most early systolic murmurs are considered functional, however, pansystolic murmurs, heard throughout the systolic phase without a pause between the heart tone and the murmur, are also considered dangerous. Such murmurs indicate the development of valve insufficiency and backflow of blood from the ventricle to the atrium or non-closure of the interventricular septum. Depending on the size of the opening between the left and right ventricles, this pathology is expressed by oxygen deficiency, and the child develops shortness of breath.

Systolic murmurs may also indicate narrowing of the aortic or pulmonary artery.

Minor anomalies in the development of the heart are manifested by periodic systolic clicks when listening.

The diastolic type of murmurs occurs mainly with anomalies of the semilunar valves, which ensure the direction of blood flow from the ventricles to the aorta and pulmonary artery, as well as with mitral stenosis. The murmur with narrowing of the diameter of the aortic or pulmonary artery orifice is usually systolic in nature.

The first signs of severe congenital anomalies are usually detected during prenatal examination or almost immediately after birth. Experienced obstetricians, having accepted the child, notice that not everything is all right with him. The child is weak, has a poor appetite, often regurgitates, the skin of the hands and feet is pale-blue, there is blueness above the upper lip, at the nail bed and breathing disorders. When listening, pronounced noises, heart rhythm and heart rate disturbances are detected. Blood pressure indicators also deviate from the norm.

More insignificant (minor developmental defects) are often detected much later, but they also have a lesser or no effect on the functioning of the cardiovascular system. Minor heart murmurs in a newborn in the absence of other symptoms most likely indicate that the body is rebuilding and adapting to new conditions of autonomous existence. Such murmurs usually disappear during the first year of life and do not pose any danger to the further development of the baby.

The arterial duct, which connects the aorta with the pulmonary artery, is open until a certain time and normally closes after one and a half to two weeks after birth, but even for a child aged two to three months, this is acceptable. However, in children over three months of age, this is already a pathology. The same applies to other moments of restructuring of the cardiovascular system.

The oval window in the septum between the atria usually closes during the first month of a child's life. In some cases, it may close by the time the child reaches one year of age, but this will not affect hemodynamics. The child is healthy, develops normally, and is simply monitored by a pediatric cardiologist from time to time.

The venous duct is a communication with the umbilical cord of the central system of veins and venules of the fetus, it is blocked in the newborn child within the first or second hour of life; in some cases, more time passes or the venous duct is preserved.

Therefore, if after the permissible period of time the anomalies in the structure of the heart do not disappear, they are classified as defects and treatment is carried out depending on the impact on the functioning of the cardiovascular system.

Heart murmur in a newborn after a Caesarean section is a fairly common occurrence. This operation is performed only for strict indications, saving the life of the newborn and its mother. In this case, the process of natural childbirth and the launch of the mechanisms of autonomous existence of the child outside the mother's womb is disrupted. Nature has provided that during the natural process of birth, the child works hard, and an adaptive restructuring occurs. Surgically, he is taken out in a compressed position of the body and measures are taken to artificially launch the mechanisms of life. An entire vital cycle is eliminated from the process - the straightening of the lungs, the first breath, cry, and circulation of fluids are disrupted. The risk of the appearance of children with developmental defects, including cardiovascular ones, is much higher than with natural childbirth, since the Caesarean section itself indicates the presence of serious deviations from the norm and the lack of confidence in the successful outcome of natural childbirth.

Complications and consequences

Benign heart murmurs caused by physiological reasons go away on their own and without treatment. Minor anatomical congenital structural disorders of the heart muscle and main vessels are often unstable and disappear with age.

Severe congenital heart defects affecting the pulmonary artery and pulmonary valve, the most complex of which are tetralogy of Fallot and malposition of the main heart vessels, require immediate surgical intervention to save the child's life.

Cases of babies being born with holes in the partitions between the atria or ventricles are quite common. The severity of this defect directly depends on the size of the hole; with this anomaly, arterial and venous blood mix, which results in tissue hypoxia. Small holes often heal themselves; if it is necessary to close the hole, surgical assistance is used.

Often, a timely operation completely restores the child's health, and he or she can live a full and long life. Non-surgical course of congenital heart defects or untimely correction are fraught with the development of secondary immunodeficiency and a reduction in life expectancy. Most children (approximately 70%) with severe hemodynamic disorders due to abnormal development of the heart muscle die in the first year of life. With timely cardiac surgery, mortality is 10%.

Missed time for surgery also leads to the development of irreversible disorders, in particular, various postoperative complications.

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Diagnostics heart murmurs in a newborn

The very first diagnostic procedure is carried out in the maternity ward. The neonatologist will definitely conduct a visual examination and listen to the baby's heart sounds. If there are extraneous sounds, as well as additional symptoms (cyanosis, pallor, shortness of breath), he or she may recommend further examination.

The absence of murmurs in the heart of a newborn does not mean that there are no developmental defects of the heart muscle, however, gross anomalies requiring immediate intervention are usually immediately noticeable.

The child will definitely undergo tests, in particular, a clinical blood test, to rule out anemia and possible inflammatory processes. A biochemical blood test can also be informative in some cases.

Instrumental diagnostics that allow assessing the condition of the newborn's heart include the following methods:

• electrocardiography – provides an idea of the main indicators of heart activity (rhythm, heart rate) and allows one to determine the degree of their deviation from the norm;
• phonocardiography, which records noises for their subsequent recognition;
• ultrasound examination of the heart (echocardiography) is a fairly informative method that provides a virtually complete picture of the structure of the organ and main vessels, pressure, speed and direction of blood flow;
• tomography (magnetic resonance or computed tomography), possibly with the use of contrast, allows you to supplement the data of previous examinations, identify the smallest anomalies and characteristics of the disease.
• X-ray and angiography, prescribed if necessary
• catheterization – is carried out as a diagnostic procedure, during which it is possible to immediately carry out minimally invasive intervention, for example, to correct a heart valve defect.

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Differential diagnosis

Differential diagnostics is carried out based on the data collected as a result of examination and surveys. Minor anomalies in the development of the heart and main vessels are differentiated from the so-called major or serious defects. The main criterion is the degree of danger of the symptom and the determination of further treatment tactics. There is a high probability that the noise will be recognized as harmless and the child will simply be under the dispensary supervision of a pediatric cardiologist.

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Treatment heart murmurs in a newborn

In cases where, after examination, the murmurs in the heart of a newborn are recognized as benign or caused by minimal structural changes in the heart muscle (major vessels), the child is not prescribed treatment. He is treated by a local pediatrician, sometimes consultations with a cardiologist are required. Often, the murmurs go away on their own. If it turns out that the cause of the functional murmur is not heart disease, but an inflammatory process caused by an intrauterine infection, anemia, rickets, Rhesus conflict, then the detected cause is eliminated, after which the child's condition normalizes and the murmurs in the heart disappear.

If the heart murmur in a newborn is recognized as pathological, that is, caused by a congenital heart defect, surgical treatment is usually indicated. However, surgical treatment is not always resorted to. If the child's condition is satisfactory, he is active, eats well and gains weight, he does not have cyanosis and shortness of breath, he may be prescribed drug therapy.

Taking medications is prescribed both in the preoperative period and after surgery. In some cases (if the defects are not subject to complete surgical correction), long-term drug therapy is indicated. Treatment regimens are individual in each case.

In newborns with congenital heart defects, it is necessary to compensate for heart failure and eliminate venous blood congestion. First of all, the baby is provided with favorable environmental conditions, placed in an incubator or a heated crib.

In mild cases at the initial stages of cardiac dysfunction, it is sufficient to reduce the load on the heart muscle by adjusting the water-electrolyte balance. Additionally, the newborn is fed with a tube, thereby reducing the effort required to suck. At the same time, oxygen therapy is prescribed with regular monitoring of the gas content in the blood.

At any stage, medications that activate metabolic processes and muscle nutrition of the myocardium are indicated. These are enzymatic preparations that are usually well tolerated. Interaction with cardiac glycosides, antianginal and inotropic drugs, which are also included in the treatment regimen, is positive. The infant may be prescribed:

1. Cocarboxylase (a single daily dose is calculated individually at 10 mg/kg of body weight) – normalizes the heart rhythm and prevents blood acidification, the development of hypoxic encephalopathy, pneumonia, and restores blood circulation. Potentiates the action of cardiac glycosides and improves their tolerance.
2. Riboxin, which activates oxidation-reduction processes in the heart muscle, its nutrition, normalizes the heart rate and blood circulation in the coronary vessels. It should be noted that the drug can occasionally contribute to an increase in the concentration of uric acid in the blood serum.
3. Panangin normalizes the heart rhythm, the disorder of which is caused by potassium deficiency (not recommended for hyperkalemia), improves oxygen uptake and reduces hypoxia of the heart muscle. Experience with the use of this drug in children is insufficient, but it is sometimes prescribed.
4. Cytochrome C – improves cellular respiration, eliminates myocardial hypoxia and restores its trophism (dosed at 10 mg per injection).

Infants with heart defects are also prescribed diuretics to remove excess fluid and reduce the load on the heart muscle. They are especially effective when symptoms of interstitial pulmonary edema are observed.

For long-term therapy, thiazides (Chlorothiazide, Cyclomethiazide), Veroshpiron are used, dosing 1-3 mg per day per kilogram of the child's weight. Triamterene can be prescribed if there is a threat of potassium deficiency - dosed at 0.3 mg per kilogram of weight. Usually taken orally. If urgent help is needed, a single intravenous injection of Furosemide is performed, the dose is determined based on 1-3 mg per kilogram of the baby's weight, in severe cases it is increased to 8-10 mg / kg, the use of this drug is fraught with the opening of the Botallov duct, which is explained by the potentiation of the effect of prostaglandins. Each time the prescriptions are individual, a combination of diuretics with dosage adjustment is possible.

Medicines used to treat newborns with heart defects should restore and maintain normal heart rhythm and heart rate. For this purpose, cardiac glycosides are used, they are taken in long courses. Treatment begins with saturating the newborn's body with Digoxin for a day or one and a half. The drug is most often administered intravenously, the dosage is calculated using the formula 0.03-0.04 mg of Digoxin for each kilogram of the baby's weight. Half of the calculated dose is administered the first time. Then, twice, maintaining an interval of eight to 12 hours, another quarter of the dose is administered. Then they switch to maintenance therapy - every 12 hours, an eighth of the dose is administered. During the entire course of treatment with the drug, regular monitoring of the child's pulse rate is necessary, since the toxic effects of the drug occur very quickly in newborns. If the pulse rate decreases, the time interval between administrations of the drug is increased during maintenance therapy.

The following factors contribute to the appearance of signs of intoxication: oxygen starvation of tissues, calcium deficiency, and blood acidification. When Indomethacin is introduced into the treatment regimen (to suppress the autoimmune process), the dosage of Digoxin is halved to avoid intoxication. The toxic effect of this drug is manifested by refusal to eat, frequent regurgitation, vomiting, and deterioration of the general condition.

To relieve symptoms of intoxication, Unithiol, Lidocaine or Diphenin are prescribed in antiarrhythmic doses.

In the absence of a response to cardiac glycoside therapy, monotherapy with drugs that inhibit the enzymatic activity of exopeptidase (Capoten or Captopril) may be prescribed at the initial stage of heart failure. The drug is dosed individually, ensuring that the infant's blood pressure is not reduced, based on the daily dose of 1-4 mg per kilogram of weight, divided into two to four administrations.

In the second stage of cardiac disease, ACE inhibitors are prescribed simultaneously with diuretics; in the third stage, treatment is carried out against the background of Digoxin.

Stimulation of myocardial contractility is performed by cardiotonics of non-glycoside origin (Dobutamine, Dopamine), which dilate blood vessels, increase contractility of the heart muscle and systolic blood volume. In critical conditions, when there is no heart contraction, Amrinone is used. Medicines of this group are used exclusively with careful monitoring of cardiac activity, correction of metabolic disorders, dysfunction of external respiration and gas exchange.

To prevent the development of endocarditis, newborns are prescribed antibacterial drugs.

Vitamin therapy is recommended for children with heart murmurs: B vitamins improve metabolic processes and trophism of the heart muscle, ascorbic acid helps to increase immunity, has antioxidant properties. Vitamins A and E will not be superfluous for the prevention of complications. The doctor can prescribe a course of vitamins or a vitamin-mineral complex depending on the results of the child's examination. Breastfeeding and proper nutrition of the mother are the best vitamin therapy for a newborn with safe heart murmurs.

Physiotherapeutic treatment depends on the child’s condition and should be aimed at normalizing cardiac functions: myocardial automatism, its excitability and contractility, improving blood circulation in the systemic and pulmonary circulation, delivering oxygen to organs and tissues, especially to the brain, and activating immune processes.

To prevent hypoxia, the baby may be prescribed the following baths: sodium chloride (normalization of the sympathetic nervous system), oxygen (oxygen saturation), carbon dioxide (improves myocardial function, increases resistance to physical stress), iodine-bromine and nitrogen (have calming properties).

Immunostimulating procedures – sun and air baths, inhalations with ginseng, aloe extract and other immunomodulators.

In the presence of foci of chronic infection, local and general ultraviolet irradiation is used.

The procedures are contraindicated in cases of second and third degree heart failure and in cases of complications with endocarditis.

Folk remedies

The arsenal of traditional medicine recipes for treating heart diseases, including murmurs, is quite extensive. Basically, this is treatment with herbs that have sedative properties and thin the blood. However, the age of the patients we are interested in is too young to risk using decoctions and infusions of medicinal herbs orally, but you can add infusions or decoctions of medicinal herbs to the bath. They disinfect the baby's skin and soothe him before bed, strengthen the immune system and give strength. Pine needles, valerian, lavender, oregano and mint have a good effect on the nervous system. In pharmacies, you can buy herbal bath mixtures, for example, they mix motherwort and string grass, valerian rhizome, lemon balm leaves.

Baths with sea salt for bathing children have a general strengthening effect on the body. You can consult a doctor about the possibility and frequency of their use, as well as the concentration of salt. The salt is diluted separately in a bowl, and then filtered into the bath through four layers of gauze. You can also add an infusion of some herb (lavender, motherwort, mint).

It is important to remember that herbs can cause an allergic reaction in such a small child. To do a test, you need to soak a piece of cotton wool in a decoction or infusion of herbs and apply it to the skin on the arm, if after a quarter of an hour there is no redness - you can bathe.

Decoctions and infusions are prepared at the rate of a handful of herbs per five-liter bath. Pour a liter of boiling water over the herbs in an enamel, glass or earthenware container, leave for about an hour, strain well and add to the prepared water. Herbal infusions are taken in proportions of 1:1, making sure that there is no allergy to the components. Decoctions and infusions for bathing newborns are used only freshly prepared.

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Homeopathy

Homeopathic therapy is the safest for newborns. Even children with developmental defects can be successfully treated with this treatment, the only exceptions are those whose defects are incompatible with life, and their adaptation to extrauterine existence is impossible in principle. Such children need emergency surgical treatment, and in the rehabilitation period, homeopathy helps to recover quickly and fully.

Homeopathic doctors claim that the infant's body has excellent reactivity and the younger the child, the faster it responds to homeopathic treatment. A homeopathic doctor should prescribe medications and dose them. More than forty medications are used to stimulate cardiac activity, eliminate arrhythmia, hypoxia and normalize blood circulation in case of heart defects, including the same Digitalis, Camphor, Lily of the Valley, only in homeopathic dilutions.

Surgical treatment

Correction of congenital anomalies of the structure of the heart and major vessels is performed by open surgery or, when possible, using minimally invasive technologies. Often, as a result of the operations performed, the normal functioning of the heart muscle is completely restored. In complex cases, several operations are performed in stages, as a result of which the performance of the diseased organ is significantly improved, the patient's condition is stabilized, and the duration and quality of life are increased.

Prevention

Parents should think about preventing congenital anomalies in the future child even before its birth. It has now been established that a number of factors affecting a woman during pregnancy can increase the likelihood of the birth of a child with congenital heart pathologies. Most of them can be prevented. If it is not possible to influence the hereditary predisposition, the environmental situation in the region of residence and the age of the expectant mother, then it is entirely within our power to eradicate bad habits - not to drink alcohol, not to smoke, not to self-medicate, to eat well and lead a healthy lifestyle.

During pregnancy, you should try to limit the possibility of infection. Flu, hepatitis, childhood infections (rubella, chickenpox, etc.) suffered by the expectant mother have a negative impact on the intrauterine development of the fetus.

It is especially important for pregnant women with an unfavorable family history, chronic diseases, and mature age to undergo all prescribed diagnostic examinations during this period and not to take any medications or vitamins without first discussing this with their doctor.

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Forecast

Functional or benign heart murmurs in a newborn will not have any negative impact on the functioning of the cardiovascular system, quality and duration of further life. If the ultrasound of the heart did not reveal serious organic disorders of the heart structure, then there is no reason to worry.

Registration with a cardiologist and periodic preventive examinations are necessary in order not to miss the time to provide assistance (if it is needed).

Even if a child is diagnosed with a heart defect, a successful operation can completely restore its normal functions, and the child will live a full life. Without surgery, most children with severe heart defects do not survive to the age of one.

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