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Neurological complications in children with infective endocarditis: Incidence, risk factors, and outcome: A 10-year

Tala AlBassri1, Maha Sheikho1, Farah Chaikhouni2

  • 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

International Journal of Pediatrics & Adolescent Medicine
|August 5, 2021
PubMed

Insights

Neurological complications in children with infective endocarditis (IE) occurred in nearly a quarter of cases, primarily as stroke. Lower body weight and higher inflammatory markers like C-reactive protein (CRP) were identified as potential risk factors.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Neurology

Background:

  • Infective endocarditis (IE) poses significant risks in children, with neurological complications leading to poor outcomes.
  • Understanding the incidence and characteristics of neurological complications in pediatric IE is crucial for improving patient management.

Purpose of the Study:

  • To determine the incidence, etiology, risk factors, and outcomes of neurological complications in pediatric patients with infective endocarditis.
  • To compare characteristics of IE patients with and without neurological involvement.

Main Methods:

  • A retrospective cohort study analyzed pediatric patients diagnosed with IE between 2009 and 2019.
  • Patients were categorized into two groups: those with neurological complications and a control group without.
  • Statistical analysis was performed to compare the groups and identify risk factors.

Main Results:

  • Neurological complications were observed in 23% of pediatric IE patients, with stroke being the most frequent.
  • Risk factors identified included lower body weight, elevated C-reactive protein (CRP) levels, and left-sided valvular lesions.
  • While mortality was higher in the neurological complications group (43% vs. 21%), this difference was not statistically significant. Large vegetation size (>10 mm) was also more common in this group.

Conclusions:

  • Neurological complications are a significant concern in pediatric infective endocarditis, affecting nearly a quarter of cases.
  • Lower body weight, left-sided valvular lesions, and elevated inflammatory markers (CRP) are potential risk factors.
  • Stroke is the most common neurological complication, associated with an increased risk of mortality.
Abstract

Keywords:
CNS, Central Nervous SystemCRP, C-reactive proteinECMO, Extracorporeal membrane oxygenationESR, Erythrocyte sedimentation rateIE, Infective EndocarditisInfective endocarditisMRSA, Methicillin-resistant Staphylococcus aureusNeurological complicationsPCICU, Pediatric cardiac intensive care unitPediatricsWBC, White blood countWBCs, White blood cells

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