What is the first quality an examiner should assess when a murmur is detected?

When a murmur is detected during a neonatal examination, the first quality an examiner should assess is timing. Timing refers to when the murmur occurs in relation to the cardiac cycle—whether it's systolic, diastolic, or continuous. This is crucial because the timing of the murmur can help determine its etiology and significance, potentially indicating underlying cardiovascular conditions.

In the context of neonates, precise assessment of timing can also assist healthcare providers in differentiating between innocent murmurs, which are common in this population, and those that may signify pathological conditions. Thus, understanding when the murmur occurs within the heart's cycle lays the foundation for further investigation and diagnosis.

While intensity, location, and quality are also important characteristics of a murmur to evaluate, focusing on timing first provides critical information for formulating an initial assessment and deciding on the necessity for further evaluation or intervention.