OBJECTIVE: Heart murmurs are prevalent in children being the most common reason for referral to a pediatric cardiologist. This study aimed to determine the clinical significance of murmur to detect congenital heart disease (CHD) in children.
METHOD: A prospective cohort study was conducted at the Department of Child Health, Dr Sardjito Hospital, Yogyakarta, Indonesia recruiting children aged <18 years old who referred with suspected CHD between 1st February, 2016 to 31st May, 2019. The sensitivity and specificity of murmur to diagnose CHD were calculated. 
RESULT: We recruited 2475 children during the study period, which consisted of 912 (46.5%) males. Of 2475 children, 1963 (79.3) were confirmed CHD. The most common diagnosis was ventricle septal defect (VSD) in 563 (28.7%) children, patent ductus arteriosus (PDA) in 409 (20.8%), and atrial septal defect (ASD) in 370 (18.8%). Of those who confirmed CHD, heart murmurs were heard in 1704 (86.8%) children. In children with VSD, the sensitivity of pansystolic murmur was 75%(434/579) and the specificity was 87.1% (1206/1384). In children with PDA, the sensitivity continuous murmur was 50.6% (207/409) and the specificity was 95.4% (1482/1554). In children with ASD, the sensitivity of ejection systolic murmur was 56.5% (209/370) and the specificity was 63% (1003/1593). 
CONCLUSION: Of all children with CHD, heart murmurs were heard in more than two-third children. Heart murmurs perform well as a screening test in children with left-to-right shunt CHD, particularly VSD and PDA.