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Infective endocarditis in previously healthy children with structurally normal hearts

Daphna Marom1, Shai Ashkenazi, Zmira Samra

  • 1Department of Pediatrics A, Schneider Children's Medical Center, Petach Tikva, Israel. dmarom@clalit.org.il

Pediatric Cardiology
|March 14, 2013
PubMed

Insights

Infective endocarditis (IE) in children with structurally normal hearts presents acutely with high complication rates. Prompt diagnosis and pediatrician awareness are crucial for this distinct pediatric IE subgroup.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Infective endocarditis (IE) typically affects individuals with structural heart disease or invasive devices.
  • Limited data exists on IE in pediatric patients with structurally normal hearts and no predisposing factors.
  • Understanding this subgroup is vital for accurate diagnosis and management.

Purpose of the Study:

  • To characterize infective endocarditis (IE) in pediatric patients (<18 years) with structurally normal hearts and no predisposing factors.
  • To compare IE characteristics between children with and without predisposing factors.

Main Methods:

  • Retrospective review of 51 IE events in 50 pediatric patients treated at a single medical center.
  • Patients categorized into groups with and without predisposing factors (structural heart disease, catheters, invasive procedures).
  • Duke criteria used for IE classification; data analyzed for clinical presentation, causative organisms, complications, and outcomes.

Main Results:

  • Nine percent (18%) of pediatric IE cases occurred in children without predisposing factors; these were community-acquired with acute onset, fever, new murmur, and left-sided infection.
  • Children without predisposing factors experienced a 100% complication rate (heart failure, embolic phenomena) and required emergency cardiac surgery (7/9).
  • IE in children with predisposing factors (82%) was more frequently healthcare-associated, right-sided, and had lower rates of echocardiographic findings, complications, and surgery.

Conclusions:

  • Pediatric infective endocarditis (IE) presents differently in children with and without predisposing factors.
  • IE in children with structurally normal hearts is characterized by acute onset and severe complications, necessitating high clinical suspicion.
  • Enhanced awareness and prompt diagnosis by pediatricians are critical for managing this distinct IE population.

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