Exploring Diagnostic Criteria for Post-operative Infectious Endocarditis in Pediatric Patients with Congenital Heart Disease

Authors:
Katharine Milani, Nirali Trivedi, Swetha Sriramoju

Body of Abstract:
Background : Infective Endocarditis (IE) is a postoperative complication that poses unique challenges among pediatric patients with congenital heart disease (CHD). This scoping review identified gaps in literature regarding criteria utilized to diagnose pediatric IE and evaluated which diagnostic criteria is most effective in diagnosing postoperative IE among CHD pediatric patients.

Methods : Research studies published between January 2010 to April 2024 were included in this analysis. To be included in this review, studies needed to include the following: pediatric patients diagnosed with CHD, and IE diagnostic criteria. Types of studies included: randomized-controlled trials, cohort studies, and literature reviews.

Results : After applying the previously noted criteria 54 studies were identified and were included in this scoping review. Findings indicate support for the use of Modified Duke’s criteria for diagnosing pediatric IE in comparison to alternative models including Duke’s criteria, Von Reyn criteria, and Beth Israel criteria. Studies have reported that transesophageal echocardiography (TEE), a major diagnostic modality in most research, demonstrates the highest specificity for diagnosing pediatric infective endocarditis (IE). Additionally, PET-CT imaging has been identified as a valuable tool due to its high sensitivity and utility in detecting metastatic infections or inflammatory activity. Novel minor diagnostic criteria including presence of inflammatory biomarkers, including elevated levels of C-reactive protein (CRP), interleukin-15 (IL-15), and chemokines, are found to aid in reinforcing the clinical suspicion of pediatric IE.

Conclusion : Based on this extensive review of the published literature, this review proposes the use of Modified Duke’s Criteria, in addition to inflammatory biomarkers for enhanced diagnosis of postoperative IE among pediatric patients with CHD.