underlying congenital heart defect. SAB in children
with congenital heart disease is highly associated
with IE. The minor diagnostic criteria for IE include
a predisposing heart condition. One of these patients,
a neonate with cleft mitral valve, was only discovered
at the time of echocardiogram during this study.
Echocardiography is therefore a useful tool in the
assessment of children with SAB, particularly neonates
who may have undiagnosed congenital heart
disease. Interestingly, none of the 6 neonates with an
isolated patent ductus arteriosus had evidence of IE
in this investigation.
Second, most patients (63%) in this study had
health care–associated bacteremia. This finding has
been noted in adults but not in children.9 Most children
(73%) developed bacteremia as a consequence
of an infected intravascular device, which may be
especially true in premature neonates. Although the
significance of IE associated with an infected intravascular
catheter has been reported in adults,9,10 this
current investigation examining the association
among children did not reach statistical significance.
Of the 10 patients with IE in this study, 3 were
premature. There have been several reports of S aureus
IE in premature neonates. Armstrong et al11
reported 3 extremely low birth weight infants, all
with percutaneous central venous catheters who developed
S aureus IE, confirmed by echocardiography.
Similarly, both of the preterm neonates in the present
report with definite endocarditis also had percutaneous
central venous catheters in place.