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Infective endocarditis in neonates
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Infective endocarditis (IE) in infants is often linked to central venous catheters and congenital heart disease. Staphylococci and Candida are common culprits, necessitating blood cultures and echocardiography for diagnosis.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) in neonates and infants presents unique challenges.
- Early identification and diagnosis are crucial for improving outcomes.
Purpose of the Study:
- To identify predisposing factors and clinical signs of IE in infants younger than 3 months.
- To suggest diagnostic criteria for neonatal IE.
Main Methods:
- Retrospective chart review of 16 infants diagnosed with IE.
- Analysis of maternal/infant risk factors, clinical and laboratory features.
- Review of microbiological and echocardiographic findings.
Main Results:
- Key infant risk factors included congenital heart disease, patent ductus arteriosus (PDA), and central venous catheters.
- Common clinical signs were cardiac murmurs, hepatomegaly, and skin abscesses.
- Staphylococci and Candida were the most frequent microorganisms; echocardiography identified vegetations in most cases.
Conclusions:
- Central venous catheters and congenital heart disease are primary risk factors for neonatal IE.
- Staphylococci and Candida species are the main causative agents.
- Blood/urine cultures and echocardiography are vital diagnostic tools; proposed criteria include definite, probable, and possible IE.
Abstract:
We studied retrospectively the predisposing factors and signs of infective endocarditis (IE) in neonates and infants younger than 3 months of age, and we suggest diagnostic criteria. The charts of 16 infants less than 3 months of age, diagnosed with IE during a 5-year period, were reviewed for possible maternal and infant risk factors and for pathognomonic clinical and laboratory features. No apparent maternal risk factors were noted. Infant risk factors were congenital heart disease (4), patent ductus arteriosus (PDA) (5), and the use of central venous catheters (14). The main clinical findings were cardiac murmurs (12), petechiae (2), skin abscesses (7), arthritis (2), hepatomegaly (9), and splenomegaly (2). Echocardiography revealed a mass or vegetation in nine patients. Of the 27 microorganisms isolated from blood, the most common were staphylococci (15) and Candida sp. (6). Urine cultures were positive in six patients and cerebrospinal fluid cultures were positive in one. Other laboratory findings were not of diagnostic value. We conclude that the main risk factors for neonatal IE are central venous catheters and congenital heart disease, including PDA. The main causative microorganisms are staphylococci and Candida sp. The main investigations of diagnostic value are blood and urine cultures and echocardiography. We propose the diagnostic categories of definite, probable, and possible cases of neonatal IE, based primarily on clinical, blood culture, and echocardiographic data.