Andersons pediatric cardiology 1498

Endocarditis Implantable cardiac electronic devices (ICEDs) constitute permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICD); cardiac resynchronization therapy devices are rarely used in children Lead-associated endocarditis (LAE) is usually a late lead-associated infection (>6 months from time of the procedure), whereas the early lead-associated infections (20 mm) lead-associated vegetations or when surgery is indicated for other reasons Results for children with LAE are likely to be much more favorable than these for adults and should be published separately Neonatal Infective Endocarditis ■ Most often related to catheters ■ Systemic hypotension ■ Signs of generalized sepsis (feeding difficulties, respiratory distress or apnea, tachycardia) ■ Particularly prone to septic embolization (focal neurologic signs, seizures, hemiparesis) and development of satellite infections (meningitis, osteomyelitis, pneumonia) ■ Higher proportion of fungal IE ■ Osler nodes, Roth spots, Janeway lesions, and splinter hemorrhages are not seen Prophylaxis Prophylaxis for Dental Procedures IE prophylaxis has dramatically been changed since 2002 French, 2007 AHA,3 2008 UK National Institute of Clinical Excellence (NICE)244/update 2016,5 and 2009 ESC/update 20151 recommendations that reduced the indications for IE prophylaxis as per the lack of scientific evidence for its efficacy being widely accepted The basis to support this recommendation is: ■ There is no consistent association between having an interventional procedure, dental or nondental, and the development of IE ■ Regular toothbrushing almost certainly presents a greater risk of IE than a single dental procedure because of repetitive exposure to bacteremia with oral flora ■ The clinical effectiveness of antibiotic prophylaxis is not proven ■ Antibiotic prophylaxis against IE for dental procedures may lead to a greater number of deaths through fatal anaphylaxis than a strategy of no antibiotic prophylaxis and is not cost effective