INFECTIVE ENDOCARDITIS IN NEONATES

We studied retrospectively the predisposing factors and signs of infec tive endocarditis (IE) in neonates and infants younger than 3 months o f age, and rye suggest diagnostic criteria. The charts of 16 infants l ess than 3 months of age, diagnosed with IE during a 5-year period, we re reviewed for possible maternal and infant risk factors and for path ognomonic 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), an d 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 wer e positive in six patients and cerebrospinal fluid cultures were posit ive in one. Other laboratory findings were not of diagnostic value. Mi e conclude that tile main risk factors for neonatal IE are central ven ous catheters and congenital heart disease, including PDA. The main ca usative microorganisms are staphylococci and Candida sp, The main inve stigations of diagnostic value are blood and urine cultures and echoca rdiography. We propose the diagnostic categories of definite, probable , and possible cases of neonatal IE, based primarily on clinical, bloo d culture, and echocardiographic data.