Bacterial endocarditis in neonatal intensive care

Objectives: To ascertain the incidence of bacterial endocarditis in a level iii neonatal nursery. To document the clinical features, assess survival, and evaluate the role of central venous catheters in neonates with bacteria l endocarditis. Methodology: Index cases were identified by retrospective review of the ech ocardiographic records of infants admitted to the neonatal nursery from 198 3 to 1995. Data obtained by review of the clinical records of these infants , and case-matched controls. Results: From January 1983 to December 1995, 12 249 infants were admitted t o the Special Care Nursery. Eight infants with endocarditis were identified , an incidence of 0.07%. Presenting symptoms and signs were often vague and nonspecific. Gestation less than 32 weeks, birthweight less than 1500 g, t hrombocytopenia and neutropenia or neutrophilia were common features. Infan ts with endocarditis had a significantly higher Clinical Risk Index for Bab ies score than those without endocarditis. The tricuspid valve was involved in seven infants, six of whom had a percutaneous central venous catheter i n situ before diagnosis. Mitral Valve involvement occurred in two infants, neither of whom had central lines inserted. However, compared to infants wi thout endocarditis, the placement of a central Venous line was not of stati stical significance. Seven of the eight infants survived following prolonge d antibiotic therapy. Conclusions: Bacterial endocarditis is a rare but serious condition, which is usually not fatal. In the premature newborn infant, presenting signs and symptoms are often nonspecific. Endocarditis should therefore be considere d in the unwell very low birthweight infant.