PEDIATRICS Vol. 117 No. 1 January 2006, pp. 84-92 (doi:10.1542/peds.2004-2292)
ARTICLE |
Neonatal Candidiasis Among Extremely Low Birth Weight Infants: Risk Factors, Mortality Rates, and Neurodevelopmental Outcomes at 18 to 22 Months
a Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, North Carolina
b Department of Pediatrics, Emory University, Atlanta, Georgia
c Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio
d Research Triangle Institute, Research Triangle Park, North Carolina
e Brown University, Rhode Island Hospital, Providence, Rhode Island
f National Institute of Child Health and Human Development, Bethesda, Maryland
g University of Miami, Jackson Memorial Hospital, Miami, Florida
BACKGROUND. Neonatal candidiasis is associated with substantial morbidity and mortality rates. Neurodevelopmental follow-up data for a large multicenter cohort have not been reported.
METHODS. Data were collected prospectively for neonates born at <1000 g at National Institute of Child Health and Human Development-sponsored Neonatal Research Network sites between September 1, 1998, and December 31, 2001. Uniform follow-up evaluations, including assessments of mental and motor development with the Bayley Scales of Infant Development II, were completed for all survivors at corrected ages of 18 to 22 months. We evaluated risk factors for the development of neonatal candidiasis, responses to antifungal therapy, and the association between candidiasis and subsequent morbidity and death.
RESULTS. The cohort consisted of 4579 infants; 320 of 4579 (7%) developed candidiasis; 307 of 320 had Candida isolated from blood, 27 of 320 had Candida isolated from cerebrospinal fluid, and 13 (48%) of 27 of those with meningitis had negative blood cultures. In multivariate analysis of risk factors on day of life 3, birth weight, cephalosporins, gender, and lack of enteral feeding were associated with development of candidiasis. After diagnosis, most neonates had multiple positive cultures despite antifungal therapy, and 10% of neonates had candidemia for 
14 days. Death or neurodevelopmental impairment (NDI) was observed for 73% of extremely low birth weight infants who developed candidiasis. Death and NDI rates were greater for infants who had delayed removal or replacement of central catheters (>1 day after initiation of antifungal therapy), compared with infants whose catheters were removed or replaced promptly.
CONCLUSIONS. Blood cultures were negative for approximately one half of the infants with Candida meningitis. Persistent candidiasis was common. Delayed catheter removal was associated with increased death and NDI rates.
Key Words: candidiasis • meningitis • sensitivity • specificity • culture • premature infant
Abbreviations: CSF—cerebrospinal fluid • CI—confidence interval • DOL—day of life • EGA—estimated gestational age • ELBW—extremely low birth weight • IVH—intraventricular hemorrhage • NDI— neurodevelopmental impairment • MDI—Mental Developmental Index • OR—odds ratio • PDA—patent ductus arteriosus • PDI—Psychomotor Developmental Index
Accepted Mar 29, 2005.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  P Manzoni, M Mostert, E Jacqz-Aigrain, and D Farina The use of fluconazole in neonatal intensive care units Arch. Dis. Child., December 1, 2009; 94(12): 983 - 987. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Howell, D Isaacs, R Halliday, and T. A. S. G. f. N. Infections Oral nystatin prophylaxis and neonatal fungal infections Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2009; 94(6): F429 - F433. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Jacquot, J-M Labaune, T-P Baum, G Putet, and J-C Picaud Rapid quantitative procalcitonin measurement to diagnose nosocomial infections in newborn infants Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2009; 94(5): F345 - F348. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 X. Saez-Llorens, M. Macias, P. Maiya, J. Pineros, H. S. Jafri, A. Chatterjee, G. Ruiz, J. Raghavan, S. K. Bradshaw, N. A. Kartsonis, et al. Pharmacokinetics and Safety of Caspofungin in Neonates and Infants Less than 3 Months of Age Antimicrob. Agents Chemother., March 1, 2009; 53(3): 869 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Bassler, B. J. Stoll, B. Schmidt, E. V. Asztalos, R. S. Roberts, C. M. T. Robertson, R. S. Sauve, and for the Trial of Indomethacin Prophylaxis in Prete Using a Count of Neonatal Morbidities to Predict Poor Outcome in Extremely Low Birth Weight Infants: Added Role of Neonatal Infection Pediatrics, January 1, 2009; 123(1): 313 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Brecht, L Clerihew, and W McGuire Prevention and treatment of invasive fungal infection in very low birthweight infants Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2009; 94(1): F65 - F69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Healy Fungal Prophylaxis in the Neonatal Intensive Care Unit NeoReviews, December 1, 2008; 9(12): e562 - e570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Petraitiene, V. Petraitis, W. W. Hope, D. Mickiene, A. M. Kelaher, H. A. Murray, C. Mya-San, J. E. Hughes, M. P. Cotton, J. Bacher, et al. Cerebrospinal Fluid and Plasma (1->3)-{beta}-D-Glucan as Surrogate Markers for Detection and Monitoring of Therapeutic Response in Experimental Hematogenous Candida Meningoencephalitis Antimicrob. Agents Chemother., November 1, 2008; 52(11): 4121 - 4129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Wade, D. Wu, D. A. Kaufman, R. M. Ward, D. K. Benjamin Jr., J. E. Sullivan, N. Ramey, B. Jayaraman, K. Hoppu, P. C. Adamson, et al. Population Pharmacokinetics of Fluconazole in Young Infants Antimicrob. Agents Chemother., November 1, 2008; 52(11): 4043 - 4049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kaufman Fluconazole Prophylaxis Decreases the Combined Outcome of Invasive Candida Infections or Mortality in Preterm Infants Pediatrics, November 1, 2008; 122(5): 1158 - 1159. [Full Text] [PDF]
|
|
|
|
|
|
C. M. Healy and C. J. Baker Fluconazole Prophylaxis Decreases the Combined Outcome of Invasive Candida Infections or Mortality in Preterm Infants: In Reply Pediatrics, November 1, 2008; 122(5): 1159 - 1159. [Full Text] [PDF]
|
|
|
|
|
|
L Clerihew and W McGuire Antifungal prophylaxis for very low birthweight infants: UK national survey Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2008; 93(3): F238 - F239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Healy, J. R. Campbell, E. Zaccaria, and C. J. Baker Fluconazole Prophylaxis in Extremely Low Birth Weight Neonates Reduces Invasive Candidiasis Mortality Rates Without Emergence of Fluconazole-Resistant Candida Species Pediatrics, April 1, 2008; 121(4): 703 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Benjamin Jr First, Do No Harm Pediatrics, April 1, 2008; 121(4): 831 - 832. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Ragouilliaux, S. E. Keeney, H. K. Hawkins, and J. L. Rowen Maternal Factors in Extremely Low Birth Weight Infants Who Develop Spontaneous Intestinal Perforation Pediatrics, December 1, 2007; 120(6): e1458 - e1464. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A McCrossan, E. McHenry, F. O'Neill, G. Ong, and D. G Sweet Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F454 - F458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Manzoni, I. Stolfi, L. Pugni, L. Decembrino, C. Magnani, G. Vetrano, E. Tridapalli, G. Corona, C. Giovannozzi, D. Farina, et al. A Multicenter, Randomized Trial of Prophylactic Fluconazole in Preterm Neonates N. Engl. J. Med., June 14, 2007; 356(24): 2483 - 2495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Burwell, D. Kaufman, J. Blakely, B. J. Stoll, and S. K. Fridkin Antifungal Prophylaxis to Prevent Neonatal Candidiasis: A Survey of Perinatal Physician Practices Pediatrics, October 1, 2006; 118(4): e1019 - e1026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Cotten, S. McDonald, B. Stoll, R. N. Goldberg, K. Poole, D. K. Benjamin Jr, and on behalf of the National Institute for Child Heal The Association of Third-Generation Cephalosporin Use and Invasive Candidiasis in Extremely Low Birth-Weight Infants Pediatrics, August 1, 2006; 118(2): 717 - 722. [Abstract] [Full Text] [PDF]
|
|
