Transient solitary diastolic murmurs in the newborn

Novel algorithm to screen for heart murmurs using computer-aided auscultation in neonates: a prospective single center pilot observational study

BACKGROUND

Automated detection of heart murmurs with computer-aided auscultation is not yet in clinical routine use. Aim of this study was to test sensitivity and specificity of a novel prototype algorithm in automated detection of heart murmurs from digitally recorded phonocardiograms in neonates admitted at the Neonatal Intensive Care Unit.

METHODS

In a prospective pilot observational study from November 2012 to December 2013 auscultations by pediatricians and computer aided auscultation were performed within 12 hours of neonatal echocardiography. Echocardiography was defined as pathological when resulting in any clinical consequences or causing murmur. Phonocardiograms and auscultation were defined as pathological if a murmur was detected. Phonocardiograms were analyzed offline with a novel algorithm prototype (CSD Labs, Graz, Austria) for detection of murmurs in neonates in a first run and with an optimized algorithm in a second run and were compared with echocardiography. Sensitivity and specificity of auscultation by pediatrician and computer aided auscultation were analyzed.

RESULTS

Thirty-six neonates (gestational age: 36±3 weeks) were included. Twenty-three (64%) neonates had pathological or murmur causing findings in echocardiography (positive echocardiography). Sensitivity and specificity of auscultation by pediatrician were 17% and 100%, respectively. In comparison to auscultation by pediatrician sensitivity of first run and second run were significantly higher with 70% and 83%, respectively. Specificity of first run and second run were 77% and 85%, respectively.

CONCLUSIONS

Phonocardiogram analysis using the novel algorithm prototype had a higher sensitivity than auscultation by pediatrician in detecting positive echocardiography findings in neonates.