Surgical management of active infective endocarditis in a premature neonate weighing 950 grams

Picarelli, Dante; Surraco, José; Zúñiga, Carlos; Peluffo, Carlos; Anzíbar, Rafael; Tambasco, Jorge; Leone, Ruben; Nozar, José; Duhagon, Pedro

doi:10.1016/s0022-5223(00)70196-6

Cited by 11 publications

(3 citation statements)

References 5 publications

(13 reference statements)

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“…[77,78] With some changes in CPB technique, such as the size of the cannulas and a minimal priming volume with fresh leucocyte depleted blood to attenuate inflammation, a surgical approach may be performed. [79] Thrombectomy can also be performed with the aid of inflow stasis; [56] however, reports of a surgical approach for thrombi in this age group remain extremely rare and anecdotal. [29,56,79] Moreover they are commonly related to infected thrombi in the presence of endocarditis.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…[79] Thrombectomy can also be performed with the aid of inflow stasis; [56] however, reports of a surgical approach for thrombi in this age group remain extremely rare and anecdotal. [29,56,79] Moreover they are commonly related to infected thrombi in the presence of endocarditis. [79] Therefore, definitive guidelines to choose between thrombolysis and surgery do not exist and a case-by-case approach will be required to outweigh the respective risks.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…[29,56,79] Moreover they are commonly related to infected thrombi in the presence of endocarditis. [79] Therefore, definitive guidelines to choose between thrombolysis and surgery do not exist and a case-by-case approach will be required to outweigh the respective risks. Indications for surgical intervention are related to the haemodynamic instability and mobility of the mass, as well as fungal masses, which may be difficult to treat by medical therapy alone.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Management of Preterm Infants with Intracardiac Thrombi

2001

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Improvement in neonatal care has led to improvements in survival and patient outcome in preterm infants; however, this improved survival has been associated with the development of secondary complications, such as catheter-associated intravascular and intracardiac thrombus formation with a non-negligible morbidity and mortality. The sick preterm infant is at high risk of catheter-related thrombus formation because of the combination of a high prothrombotic activity, low levels of natural anticoagulants, and various imbalances in the fibrinolytic systems. Based on clinical experience in adults and children, and several neonatal case reports demonstrating the efficacy and tolerability of specific thrombolytic treatment, this approach should be recommended as a first choice treatment in the premature infant with intracardiac or intravascular thrombosis. The thrombolytic agents of choice are urokinase or tissue plasminogen activator (tPA); however, none of them have proven to be superior to the other in terms of efficacy or tolerability, either in adult patients or premature infants. In the past, it has been suggested that newborn infants may require higher doses of thrombolytic agents than adults for effective systemic thrombolysis; however, based on more recent in vitro studies, it seems unlikely that this is true. Nevertheless, systemic (high dose) fibrinolysis is of concern as premature neonates present an increased risk of cerebral haemorrhage during the first weeks of life; therefore, low dose treatment has been proposed with, if possible, direct infusion of the fibrinolytic agent into, or close to, the thrombus. This approach has proven to be efficient and well tolerated in several small case series of newborn and preterm infants. Recommended doses are 1000 to 3000 U/kg/h for urokinase or 0.01 to 0.05 mg/kg/h for tPA. A systemic proteolytic state will not be induced by this low dose; however, specific monitoring of fibrinogen plasma levels has to be recommended. Fibrinogen levels should remain above 100 mg/dL during low dose treatment. Lower levels of fibrinogen will indicate the presence of an unwanted systemic fibrinolytic state. After successful thrombolysis, a follow-up treatment, preferentially with low-molecular-weight heparin for neonates at adjusted doses, should be instituted for at least 6 weeks in the absence of any persisting thrombophilic factor. A longer course (3 to 6 months) of anticoagulation therapy is recommended when thrombophilic factors (i.e. hereditary thrombophilia or central venous catheter still in place) are present. Furthermore, it is recommended that any neonate with thrombosis should be evaluated for hereditary thrombophilia later in life.

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

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Management of Preterm Infants with Intracardiac Thrombi

2001

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Outcome of Cardiac Thrombi in Infants

et al. 2007

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Use of central lines in the neonatal intensive care unit (NICU) has led to the formation of intracardiac thrombi. A paucity of data exists on the management of neonatal cardiac thrombi, with the few reported cases focusing on outcomes following thrombolytic therapy. This study was undertaken to evaluate the outcome of cardiac thrombi in neonates who do not receive thrombolytic therapy. Nineteen patients younger than 3 months of age diagnosed with cardiac thrombi were included. All 19 patients had a central line. Management consisted of a combination of antibiotics and low-molecular-weight heparin (n = 16) or surgical removal (n = 2). In one case, no treatment was instituted. One patient was lost to follow-up after partial resolution of the thrombus. Complete thrombus resolution occurred in 18 patients, 9 with negative blood cultures and 9 with positive blood cultures. It took longer for resolution of thrombi associated with positive blood cultures than for sterile thrombi. No patient had evidence of thrombus embolization. From these data we concluded that the natural history of cardiac thrombi is resolution. Infected thrombi require more prolonged therapy. Surgery is seldom required and thrombolytics are not usually necessary for clot resolution.

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Yeast and Fungal Infections of the Fetus and Neonate

Demmler-Harrison¹

2009

Feigin and Cherry's Textbook of Pediatric Infectious Diseases

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Surgical management of active infective endocarditis in a premature neonate weighing 950 grams

Cited by 11 publications

References 5 publications

Management of Preterm Infants with Intracardiac Thrombi

Management of Preterm Infants with Intracardiac Thrombi

Outcome of Cardiac Thrombi in Infants

Yeast and Fungal Infections of the Fetus and Neonate

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