Mobile septic intra-atrial masses in premature infants

Introduction

Mobile septic atrial masses are uncommon but severe complications in premature infants admitted to the neonatal intensive care unit. We describe eight premature infants with this diagnosis during an intensive care stay in our units.

Patients and methods

We identified all premature infants with this diagnosis admitted to the Neonatal Intensive Care Units of Hospital Anchieta, HRAS and Hospital Santa Lúcia between 2000 and 2002.

Results

Eight infants with gestational age of 27–35 weeks and birth weights of 1000–3040 g were identified. All of them had a diagnosis of a mobile intra-atrial mass attached to the septum (six cases), tricuspid valve (one case) or right atrial wall and catheter (one case) made by echocardiography. All of them used central venous catheters. Six of the infants had positive hemocultures for fungus and two were positive for coagulase-negative Staphylococcus. All of them but one were treated with amphotericin B (22–72 days) and two were treated with vancomycin. Three premature infants received continuous heparin infusion, and one a full course of tissue-type plasminogen activator. One patient went to cardiomyotomy due to clinical deterioration and failure of clinical treatment. He died after surgery. The other death was due to septic complications after resolution of the mass with clinical treatment.

Conclusions

Right atrial masses in premature infants constitute a diagnostic challenge (catheter-related thrombosis vs septic vegetations or 'atrial balls', or both). Due to a lack of adequate randomized trials, the choice of clinical or surgical treatment remains based on the description of a clinical series of cases. Despite the dramatic appearance, most patients do well with current treatment options.