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Difficulties in Diagnosis and Therapy of Infective Endocarditis in Children and Adolescents-Cohort Study
Alina-Costina Luca1,2, Alexandrina-Stefania Curpan3, Heidrun Adumitrachioaiei1,2
1Sfânta Maria' Emergency Children's Hospital, 700309 Iasi, Romania.
Insights
Infective endocarditis (IE) remains a serious pediatric condition, often linked to congenital heart defects. This study analyzes IE cases in children, identifying causes, manifestations, and effective treatment strategies.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) presents significant mortality and complications, even in pediatric populations.
- Congenital heart disorders are the primary risk factor for pediatric IE (75-90%), but invasive procedures and immunosuppression also contribute.
- Despite advances, pediatric IE carries a substantial mortality rate of 16-25%.
Purpose of the Study:
- To investigate the recent trends and evolution of infective endocarditis in pediatric patients.
- To identify the primary etiological factors and progression patterns of IE in children.
- To evaluate clinical and paraclinical manifestations and determine optimal diagnosis and therapeutic approaches.
Main Methods:
- Retrospective case study analysis.
- Inclusion of 54 pediatric patients (23 days to 17 years) diagnosed with IE.
- Data collected from February 2007 to February 2020 at a dedicated pediatric hospital.
Main Results:
- Analysis of IE evolution, etiological factors, and clinical presentations in a pediatric cohort.
- Assessment of diagnostic and therapeutic strategies employed.
- Identification of key indicators for disease onset, progression, and patient outcomes.
Conclusions:
- Understanding IE's recent epidemiology in children is crucial for refining management strategies.
- Early diagnosis and tailored therapy are essential to improve outcomes in pediatric IE.
- This study provides insights into effective approaches for managing infective endocarditis in young patients.
Abstract:
Despite the progress in management and prophylaxis measures, infective endocarditis (IE) is still a condition associated with high mortality rates and severe complications. Fortunately, the incidence of IE is much lower in children and adolescents, with only 0.05-0.12/1000 cases being reported in hospitalized pediatric patients. According to recent data, IE is, in most cases, a complication of pre-existing congenital heart disorders, in up to 75-90% of cases. About 8-10% of all IE cases occur in children without a pre-existing heart condition, due to the widespread use of catheters and invasive procedures, or are associated with immunosuppression. The overall mortality rate due to IE among children and adolescents is 16-25%, a fairly high incidence despite advances made in management and treatment methodologies. We present a retrospective case study conducted in the Pediatric Cardiology Department of 'St. Maria' Emergency Children's Hospital of Iași between February 2007 and February 2020, including 54 children aged between 23 days and 17 years. Our study was aimed at revealing the evolution of IE in recent years in the pediatric population, at identifying the main causes leading to the onset and progress of the disease, at assessing the incidence of clinical and paraclinical manifestations and at determining efficient diagnosis and therapy approaches for the population under survey.
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