What is the appropriate action if a newborn has a pathologic S4 sound?

When a newborn presents with a pathologic S4 heart sound, the appropriate action is to assess for compliance issues or heart failure. The S4 sound, or "atrial gallop," is an abnormal finding typically indicative of a stiff or hypertrophied left ventricle, which can occur due to increased resistance to filling during late diastole.

In the context of a newborn, the presence of a pathologic S4 may suggest underlying cardiovascular issues such as cardiomyopathy or other conditions affecting heart function. Therefore, it becomes crucial to conduct a thorough evaluation. This may include assessing cardiac function, determining the presence of any additional heart sounds, evaluating vital signs, and possibly conducting imaging studies like an echocardiogram to delineate the cardiac anatomy and function.

Monitoring for several days might not be sufficient, as timely identification and management of any potential heart failure or structural heart issues are vital. Ignoring the sound does not align with best practices, as it poses a risk of not recognizing significant underlying pathology. While referral for immediate surgery could be necessary in severe cases, the first step is to accurately assess the situation to determine the appropriate course of action, which may or may not lead to surgical intervention. Therefore, assessing for compliance issues or heart