Infective Endocarditis in the Premature Neonate

Abstract

We describe a series of 11 high-risk neonates with infective endocarditis (IE) in this retrospective review. Previously IE has rarely been diagnosed in newborns and is usually fatal. The frequency was 4.3 cases per 100 patients. Five patients survived. Microorganisms included gram positives such as S. aureus and coagulase-negative Staphylococcus, gram negatives such as Klebsiella pneumoniae, Enterobacter cloacae, Enterococcus faecalis, Serratia marcescens, and Acinetobacter calcoaceticus. Echocardiographic location of the lesions showed four left sided, five right sided, and two bilateral. We conclude that IE may be more common than previously described. Prompt diagnosis and treatment led to survival in 45% of our patients. Prospective studies are needed to identify patients at risk and to establish the true incidence of IE in high-risk neonates.

Infective endocarditis in congenital heart disease

“…Age may be another risk factor as IE peaks in infancy and late adolescence [36]. IE in preterms, neonates, or infants younger than 2 years of age is related to other risk factors than in older patients with CHD [35,91,101]. Leading risk factors are prematurity with immune compromise and central venous access with catheter-related blood stream infections [94].…”

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…In all seven cases, amniotic fluid culture as well as initial blood culture of a sample from the infant yielded S. aureus, and in three cases, antenatal invasive procedures (amniocentesis or amnioinfusion) performed within a day of delivery were presumed to have contributed to infection of the fetus. Late-onset S. aureus infections in neonates include skin and deep-seated tissue abscesses, bacteremia/sepsis, endocarditis, septic arthritis, osteomyelitis, pneumonia, and meningitis (19,224,334,365,368). In addition, S. aureus is one of the most common etiologic agents of ventriculoperitoneal shunt infections in preterm infants with posthemorrhagic hydrocephalus (63,106).…”

“…Generally, 2 to 4 weeks of intravenous therapy after negative cultures is recommended for treatment of candidemia in preterm neonates, with longer courses being appropriate for meningitis and deep-seated infections. Despite prolonged courses of appropriate therapy, recurrence of Candida infection, including se- (80,352,352,365). For VLBW infants with candidemia, delayed catheter removal increases the risk of prolonged candidemia, end-organ dissemination, poor neurodevelopmental outcome, and increased mortality (243,359,447).…”

Left Atrial Appendage Mimicking an Intra-Cardiac Vegetation in Preterm Neonates

“…Infective endocarditis is emerging as a significant cause of morbidity in the neonatal intensive care with an incidence ranging from 0.07 to 4.3% [1,2] . Ensuring diagnostic certainty is important before commencing a prolonged course of antibiotics and removal of indwelling intravenous access [3] .…”