Targeted Neonatal Echocardiography (TnECHO) and Increased Detection of Intracardiac Thrombi and Endocarditis in Very low Birth Weight Infants

Abstract

Objectives: Infective Endocarditis is a rare but potentially serious condition in very low birth weight infants and we aimed to evaluate the incidence and outcomes in this population. Study design: 203 infants <1500g were admitted to the NICU over 24 months. Routine echocardiography was introduced in the unit on all infants <1500g by a neonatologist trained in echocardiography. Echocardiography was specifically requested for persistent positive blood cultures, new onset murmur and patent ductus arteriosus evaluation. Results: Five infants were diagnosed with endocarditis giving an incidence of 2.5% compared to 0.4% in the previous 2 years. There were no cases of Congenital Heart Disease. All infants had a history of central venous or central arterial catheter use and received six weeks of antibiotic treatment. Four infants with endocarditis had persistently positive blood cultures and 2 infants received low molecular weight heparin. In all but one case, the sepsis resolved and the vegetative intracardiac lesions disappeared prior to completion of treatment.Conclusion: The diagnosis of endocarditis increased in VLBWs which coincided with institution of regular echocardiography. Thrombocytopenia, persistent positive blood cultures and a new murmur require urgent echocardiography to outrule endocarditis in VLBW infants.