Not picking up murmurs in newborns

[BSNbeauty, BSN, RN]

Some times I have a hard time hearing murmurs in newborns. Recently to of my babies had to get echos done due to a murmur. Me and other nurses missed this as well. What could I be doing wrong? Should I use another stethoscope? I currently have a littman's .

I used to do CVICU and pick up murmurs on adults all the time but these babies are throwing me for a loop. Any advice?

[dansamy]

They can be really hard to pick up due to the high heart rate of the neonate. I have to listen several times. And sometimes, I still don't hear it.

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[Elvish, BSN, DNP, RN, NP]

The other thing that makes it difficult is that neonatal murmurs come and go, as it sometimes takes a while for a PDA/PFO structure to fully close. So you may not have heard it because it may not have been there at the time, and when the pedi listened it was.

A few weeks ago, a colleague heard a murmur on a baby, so she let the NP know. Hour or two later, NP listens, hears nothing, hands the steth to my colleague, who also hears nothing. A couple hours later at the noon assessment, she hears the murmur again and makes me go in and listen to make sure she isn't crazy. I heard it and so did the NP at that time. Kid ended up getting an echo, had a PDA and small VSD.

After we coded a baby several months ago, one of the NNPs told us that some babies develop murmurs after PPV, because the increase in pressure during lung ventilation causes the ductus or foramen ovale to 'pop' back open (for lack of a better way of putting it). Just another thing to throw out.

Don't beat yourself up too much. It took me several years to get good at it. Listen to every baby you can with a known murmur, whether loud or soft....that helped me recognize one when I heard it in other kids.

[chrisrn24]

Not a peds nurse but thank you for that information! Fascinating to know that!

[BSNbeauty, BSN, RN]

Thanks so much ! This definitely helps clears things up for me. Elvish I will certaintly take your advice and listen to all babies with known murmurs.

[catfac]

Is the stethoscope you use one designed for listening to babies? The baby stethoscopes are more sensitive. Listening to known murmurs has really helped me.

[NicuGal, MSN, RN]

Also, listen thru the back, some murmurs are heard better there :). Murmurs can come and go!