Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis – case report and review of the literature

Avasiloaiei, Andreea; Iftime, Ecaterina; Scripcaru, Daniela; Petrariu, Andrei; Zonda, Gabriela Ildikó; Stamatin, Maria; Păduraru, Luminiţa

doi:10.22551/2020.27.0702.10171

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…The positive confirmation of infectious endocarditis through diagnostic ECHO results in higher morbidity and mortality in the neonatal population. 14 Serial ECHOs ruled out vegetation and showed normal heart function.…”

Section: Clinical Findings/ Timeline/ Diagnosismentioning

confidence: 98%

“…The incidence of infectious endocarditis is rare in premature infants with MSSA bacteremia, with higher occurrences in infants with multiple positive blood cultures. The positive confirmation of infectious endocarditis through diagnostic ECHO results in higher morbidity and mortality in the neonatal population 14. Serial ECHOs ruled out vegetation and showed normal heart function.…”

Section: Clinical Findings/timeline/diagnosismentioning

confidence: 99%

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Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess

Huneycutt¹,

Carlson²,

Newberry³

2023

Advances in Neonatal Care

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Background: Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. Clinical Findings: A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. Primary Diagnosis: The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Interventions: Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Outcomes: Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Practice Recommendations: Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

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Section: Clinical Findings/ Timeline/ Diagnosismentioning

confidence: 98%

Section: Clinical Findings/timeline/diagnosismentioning

confidence: 99%

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess

Huneycutt¹,

Carlson²,

Newberry³

2023

Advances in Neonatal Care

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“… 3 Nevertheless, the incidence of neonatal IE has increased in recent years. 4 The improved survival of severe preterm infants with central venous catheters in place, beyond the improvement of echocardiographic diagnostic techniques, may explain that. 5 In fact, most cardiac lesions usually involve the right side of the heart, supporting the hypothesis that central venous catheters represent the major risk factor for neonatal IE, due to mechanical trauma leading to endocardial or valvular endothelial injury.…”

mentioning

confidence: 99%

A Case of Enterococcal Patent Ductus Arteriosus-associated Endarteritis in a Preterm Neonate

Mayer,

Crippa,

Pietrasanta

et al. 2024

Pediatric Infectious Disease Journal

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Introduction: The persistent patency of the ductus arteriosus frequently occurs in premature neonates and can cause infective endocarditis (IE) or ductal endarteritis (DE) during sepsis. Even though neonatal IE and DE are believed to be a rare eventuality, their incidence has been increasing in the last decades due to the improved survival of even more preterm babies, favored by highly invasive procedures and therapies. In parallel, antimicrobial resistance is another rising problem in neonatal intensive care units, which frequently compels to treat infections with broad-spectrum or last generation antibiotics. Case Presentation: We report the case of a preterm neonate affected by patent ductus arteriosus-associated DE that followed an episode of sepsis caused by a high-level aminoglycoside-resistant enterococcus. The neonate was successfully treated with the synergistic combination of ampicillin and cefotaxime. Discussion: IE and patent ductus arteriosus-associated DE are rising inside neonatal intensive care units and neonatologists should be aware of these conditions. Enterococcal IE and patent ductus arteriosus-associated DE sustained by high-level aminoglycoside-resistant strains can be successfully treated with the synergistic combination of ampicillin and cefotaxime even in preterm neonates.

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Infective Endocarditis due to Unusual Pathogens Complicated with Pulmonary Thromboembolism: A Rare Occurrence in a Premature Infant

Patra,

Patwal,

Chetan

et al. 2024

Indian Pediatrics Case Reports

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Background: Survival of low birth weight preterm neonates has increased with the availability of better neonatal care, however, the use of central lines for longer duration increases the risk of bacterial and fungal sepsis. Neonatal infective endocarditis (IE) is a rare presentation of neonatal sepsis and is often associated with complications and high mortality. Clinical Description: A 36 weeker, premature baby, hospitalized for early onset sepsis, was transferred to our hospital on day 15 of life, with an umbilical catheter in situ, with fever, respiratory distress, and persistent thrombocytopenia. Clinical examination revealed decreased oxygen saturation, crepitations in the right lung field, systolic murmur, and hepatomegaly. Management and Outcome: Baseline investigations revealed positive septic screen with thrombocytopenia with meningitis, neonatal cholestasis, and right sided consolidation on chest X ray. A two dimensional echocardiography (ECHO) revealed vegetation on the tricuspid valve, and blood culture from two sites revealed growth of Candida tropicalis and Serratia marcescens. Colistin, tigecycline, and amphotericin B therapy were initiated as per sensitivity along with low molecular weight heparin for prevention of embolization. The baby developed acute worsening in respiratory distress after 4 weeks of therapy. Repeat ECHO revealed increased size of cardiac vegetation and computed tomography of thorax with pulmonary angiography revealed pulmonary thromboembolism. Unfortunately, the baby succumbed to complications of IE. Conclusion: Invasive instrumentations such as umbilical catheterization and prolonged hospitalizations of premature newborns predispose them to develop IE, especially with unusual organisms. Such infections have a complicated course and may be fatal.

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Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis – case report and review of the literature

Cited by 3 publications

References 19 publications

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess

A Case of Enterococcal Patent Ductus Arteriosus-associated Endarteritis in a Preterm Neonate

Infective Endocarditis due to Unusual Pathogens Complicated with Pulmonary Thromboembolism: A Rare Occurrence in a Premature Infant

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