The newborn cardiac examination should include inspection for adequate perfusion and palpation of the radial, brachial, and femoral pulses. Capillary refill time in the neonate is normally less than 2 seconds, and all pulses should be strong and equal bilaterally. Cyanosis or diaphoresis with crying, feeding, or Valsalva maneuver can be a sign of congenital heart disease and should be evaluated further. On auscultation, the heart rate should be regular and without murmur, and both heart sounds should be heard distinctly.

In the first 24 hours of life, the continuous rumbling murmur of a patent ductus arteriosis (PDA) is often heard in the second left intercostal space (Tappero and Honeyfield, 2003). In an otherwise asymptomatic infant, PDA can be observed and should resolve quickly. Coarctation of the aorta often produces a systolic ejection murmur radiating to the cardiac apex and to the back and may also be associated with asymmetric or absent femoral pulses.

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