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2019, Number 5

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Rev Mex Pediatr 2019; 86 (5)

Neonatal infectious endocarditis: diagnosis and treatment

Cullen‑Benítez PJ, González‑Morán RJ, Hidalgo‑Vázquez MM, López‑Enríquez CC, Martínez‑Hernández A, Barrón‑San Pedro R, Iglesias‑Leboreiro J

Language: Spanish
References: 32
Page: 202-209
PDF size: 315.61 Kb.


ABSTRACT

Infectious endocarditis is a valvular or mural endocardial inflammation caused by microorganisms. Subacute presentation is the most frequent form in newborns. Risk factors associated to endocarditis are post-cardiac surgery patients, congenital heart disease, and use of central catheters for prolonged periods of time; the former is the most common in neonates. Annual incidence of endcarditis is 0.05 to 0.12 cases per 1,000 hospitalized children and 7% in neonates. Duke and Li are the most widely accepted criteria for diagnosis, where clinical evidence, imaging studies and microbiology are mandatory. Staphylococcus followed by Streptococcus are the most frequent causal germs, followed by Gram-negative bacilli, fungus and Enterococcus; polymicrobial germs are the less frequent. Combination of antimicrobial treatment is the cornerstone, where at least one needs to be bactericidal. Antimicrobial combination should be based on in vitro susceptibility and local known epidemiology. Central devices ought to be removed, and blood cultures must be obtained daily until they are become negative. Surgical treatment is reserved for those patients with life threatening complications.


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