1) Define incidence and characteristics of neurologic complications in a cohort of children hospitalized at a tertiary care facility with infective endocarditis (IE); and 2) identify risk factors for development of neurologic complications.

IE is a life-threatening bacterial infection of the heart that has serious potential neurological complications, including embolic stroke, intracranial hemorrhage, mycotic aneurysm, and brain abscess. Limited information exists about the incidence and risk factors for neurological complications of pediatric IE.

Retrospective single-center cohort study of children 0-18 years hospitalized with IE at a tertiary care children’s hospital from 1/1/08 to 12/31/17. Potentially eligible children were identified by electronic medical record (EMR) query for IE discharge diagnosis ICD-10 codes. Records were then manually reviewed to confirm diagnosis by Duke criteria and to abstract demographic and clinical data.

Seventy potentially eligible children were identified by EMR query, but only 32 (45.7%) met Duke criteria for IE (20 definite, 12 possible). Among children that met Duke criteria, median age at hospital admission was 1.6 years, and 53% were male. Eighteen (56%) had congenital heart disease, one of whom had a prosthetic mitral valve. Four children (13%) died. Twelve (37.5%) had neurologic complications (intracranial hemorrhage=6, arterial ischemic stroke=5, intracranial aneurysm=3, seizure=3, headache=3, encephalopathy=1, meningitis/encephalitis=1). Median age at hospital admission of children with a neurologic complication was higher than those without (15.6 vs 0.5 years, p=0.047). Children without congenital heart disease were more likely to have a neurologic complication (79% vs 33%, p=0.043). Mortality may have been higher in children with a neurologic complication (3 vs 1, p=0.098).

Nearly 40% of children with IE had neurologic complications, which were more common among older children. Additional studies are needed to determine if earlier identification through screening neuro and neurovascular imaging will accelerate time to therapy and improve outcomes.