Overview
Neonatal acute aseptic myocarditis is a rare condition characterized by inflammation of the heart muscle in newborns without evidence of infectious agents. It can present with signs of heart failure and may be associated with various underlying causes.Diagnosis
Diagnosis is typically made based on clinical presentation, electrocardiogram (ECG) findings, echocardiography, and elevated cardiac biomarkers.
Cardiac biomarkers such as troponin and creatine kinase-MB may be elevated 1.
Echocardiography can reveal impaired ventricular function, wall motion abnormalities, and chamber dilation.
ECG may show arrhythmias, ST-segment changes, or conduction abnormalities.
Exclusion of infectious causes, including bacterial sepsis, is crucial.Management
Management is primarily supportive and focuses on optimizing hemodynamic status and treating heart failure.
Supportive care may include fluid management, inotropic support (e.g., dopamine, dobutamine), and mechanical ventilation if respiratory compromise is present.
Diuretics may be used to manage fluid overload.
Corticosteroids are sometimes considered, although their efficacy is not well-established.
Treatment of any underlying cause, if identified, is essential.Special Populations
Neonatal early-onset sepsis (EOS) is particularly severe in preterm infants 1.
Preterm infants are at higher risk for complications from sepsis, which can mimic or coexist with myocarditis 1.Key Recommendations
Elevated cardiac biomarkers such as troponin and creatine kinase-MB should be assessed in suspected cases 1. (Evidence: Moderate)
Echocardiography is recommended to evaluate cardiac function and structure in neonates with suspected myocarditis 1. (Evidence: Moderate)
Management should focus on supportive care, including hemodynamic support and management of heart failure 1. (Evidence: Moderate)References
1 Poggi C, Lucenteforte E, Petri D, De Masi S, Dani C. Presepsin for the Diagnosis of Neonatal Early-Onset Sepsis: A Systematic Review and Meta-analysis. JAMA pediatrics 2022. link