Background: Congenital heart disease (CHD) is the most common predisposing cause for childhood infective endocarditis (IE), accounting for 80% of cases. Knowledge about the disease and its complications is a key factor in promoting adherence to prophylaxis recommendations.
Objective: To assess the level of understanding among caregivers of children with CHD of their disease, risks of IE and attitudes concerning oral health and antibiotic prophylaxis of IE.
Patients and methods: Caregivers' knowledge was assessed during outpatient visits using a 15-item questionnaire developed for this study. Answers were related to patients' age, cardiac condition and risk of IE and respondents' age and education level.
Results: Of the 97 questionnaires completed, 83 were considered valid. The mean age of patients was 7.7 +/- 5.9 years (range 1 to 24 years). Eleven (13%) patients were at high risk for IE and 30 (36%) at moderate risk. Most respondents (80%) alleged that they knew the patient's cardiac condition but only 37% described it correctly. Twenty-nine respondents (35%) were aware of the risk of IE, while only 13 related that risk to dental procedures. Knowledge of IE risk was associated with respondents' education level (p = 0.03) but not with respondents' age or patients' actual risk of IE. Most respondents (76%) recalled having been advised on oral hygiene measures and declared that their child brushed their teeth at least once a day (92%). Forty-three children (52%) had already been to the dentist and 27 had done so in the previous six-month period. Almost all (42 out of 43) informed the dentist about the child's CHD, but only 20 (48%) reported having received antibiotics before dental procedures. Antibiotic prophylaxis was associated with patients' age (p = 0.04) but not with respondents' education level or actual risk of IE. Being aware of IE risk was significantly associated with better oral hygiene (p = 0.001) and more frequent dental appointments (p = 0.03), independently of education level.
Conclusions: The results of this survey support the need to reinforce information about risks of IE and prophylaxis recommendations among caregivers of children with CHD.