Saturations should be checked Trained nurses/midwives are as good as doctors at assessing A sternal or subxiphoid heave should be looked for
New study from Sweden in BMJ suggests routine pulse oximetry helpful in increasing sensitivity without too many extra false positives. ECG, CXR may be abnormal but do not change management (echo for definitive diagnosis). Trained nurses/midwives are just as good as doctors in studies from centres where they perform routine neonatal checks. A heave implies a cardiac defect rather than an innocent murmur. Congenital cardiac disease can become symptomatic before the 6 week appointment but given the very high false positive rate, parents should be reminded that any concerns in general about their baby should be directed without hesitation to their community midwife, health visitor or GP; to mention a murmur then talk about symptoms of heart failure specifically is likely to cause anxiety.