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Infective endocarditis successfully treated in extremely low birth weight infants with recombinant tissue plasminogen
Kyla A Marks1, Nili Zucker, Joseph Kapelushnik
1Department of Neonatal Medicine, Soroka Medical Centre Beersheva, Israel 54101, USA. kyla@netvision.net.il
Insights
Recombinant tissue plasminogen activator (tPA) successfully treated infective endocarditis in extremely low birth weight infants when standard therapies failed. This approach rapidly cleared sepsis and cardiac vegetations, offering a promising option for high-risk neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Infectious Diseases
Background:
- Indwelling catheters improve survival for extremely low birth weight infants but pose risks of thrombus formation and line infection.
- Infected intracardiac thromboses in neonates mimic infective endocarditis, leading to prolonged sepsis and emboli risk.
- Standard anti-infective therapy and line removal often fail to resolve sepsis and cardiac vegetations in these cases.
Observation:
- Two cases of extremely low birth weight infants with infective endocarditis are presented.
- Both infants received recombinant tissue plasminogen activator (tPA) in addition to prolonged anti-infective therapy.
- Treatment with tPA led to rapid sterilization of blood cultures and disappearance of cardiac vegetations.
Findings:
- Recombinant tissue plasminogen activator (tPA) demonstrated efficacy in treating infective endocarditis in extremely low birth weight infants.
- Successful treatment resulted in sterile blood cultures and resolved cardiac vegetations within days.
- No systemic complications were observed in the treated infants.
Implications:
- Recombinant tissue plasminogen activator (tPA) may be a crucial therapeutic option for neonatal infective endocarditis, especially when standard care is insufficient.
- This treatment approach offers a potential to improve outcomes and reduce morbidity in high-risk preterm infants.
- Further research into tPA's role in neonatal cardiology is warranted to optimize management strategies.
Abstract:
Increased survival of extremely low birth weight infants depends on the use of indwelling catheters. These catheters expose the infant to the risk of thrombus formation and line infection. When intracardiac thromboses become infected, the entity is indistinguishable from infective endocarditis and exposes the infant to prolonged sepsis and risk of disseminated infected emboli. Despite prolonged antiinfective therapy and removal of the infected line, resolution of the sepsis and dissolution of the vegetations is frequently not achieved. We describe 2 cases of infective endocarditis in extremely low birth weight infants successfully treated with recombinant tissue plasminogen activator in addition to prolonged antiinfective therapy. Blood cultures became sterile and vegetations disappeared within days of commencing treatment, and there were no systemic complications. A literature search detailed in the article confirms the poor outcome associated with infectious endocarditis in preterm infants. Tissue plasminogen activator may play an important role when standard care has failed.