Infective endocarditis is extremely rare in neonates and early infants but is associated with substantial morbidity and mortality. We report a sudden unexpected death in a 5-week-old male infant who was born at term in good condition. At one week of age, he presented with Enterococcus faecalis sepsis confirmed by blood culture. Ultrasound revealed a previously undiagnosed congenital renal duplex anomaly. Intravenous ampicillin-based beta-lactam antibiotics were administered after which the baby demonstrated clinical improvement. The baby was discharged after 2 weeks and was given antibiotic prophylaxis to be administered at home; blood culture was negative before discharge. At 5 weeks of age, he presented at the Accident and Emergency department in cardiac arrest. Despite aggressive resuscitation, the baby died. At autopsy, there was cardiomegaly and the aortic valves showed multiple friable vegetations (measuring approximately 2–3 mm), in keeping with infective endocarditis. Renal duplex anomaly was confirmed. Culture from heart blood, aortic vegetations and urine revealed a pure growth of Enterococcus faecalis. This case highlights the importance of early echocardiographic evaluation and renal anomaly surveillance in neonate with Enterococcus sepsis to prevent diagnostic delay and improve clinical outcomes. Enterococcus neonatal sepsis can progress to infective endocarditis even after apparent recovery. Congenital renal anomalies may act as persistent reservoirs promoting recurrent bacteraemia. Echocardiography is essential following serious neonatal sepsis to exclude valvular infection. Delayed diagnosis carries major clinical and forensic implications.
Rao et al. (Mon,) studied this question.