INFECTIVE ENDOCARDITIS IN NEWBORN-INFANTS WITH STRUCTURALLY NORMAL HEARTS

Twelve infants with structurally normal hearts were demonstrated to ha ve intracardiac vegetations on echocardiography and diagnosed as havin g infective endocarditis. All were found in the right side of the hear t, most frequently at the junction of the superior vena cava and the r ight atrium and in no case involved the tricuspid or pulmonary valves. Most were diagnosed in the course of investigation of repeatedly posi tive blood cultures, despite appropriate antibiotic therapy. Coagulase -negative staphylococci were isolated from blood culture in nine infan ts, and Streptococcus sanguis and Candida albicans from one each. All infants had had intracardiac central lines inserted to facilitate veno us access, either by a percutaneous technique or as a formal surgical procedure. Eight (67%) were successfully treated and made a full recov ery. Cardiac murmurs were absent in all of the cases. Echocardiography should be included in the investigation of all neonates with persiste ntly positive blood culture, particularly when intracardiac lines have been sited. Right-sided, non-valvar lesions and infection with coagul ase-negative staphylococci may carry a better prognosis than previousl y reported.