PEDIATRICS Vol. 83 No. 1 January 1989, pp. 101-107
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Mucocutaneous and Invasive Candidiasis Among Very Low Birth Weight (< 1,500 Grams) Infants in Intensive Care Nurseries: A Prospective Study

Roger G. Faix MD1, Steven M. Kovarik MD1, Thomas R. Shaw MD1, and Robert V. Johnson MD1

1 The Department of Pediatrics and Communicable Diseases, Section of Newborn Services, University of Michigan Medical Center, Ann Arbor

To determine whether mucocutaneous candidiasis presages the development of invasive candidiasis and to assess factors influencing the development of mucocutaneous candidiasis and invasive candidiasis among infants requiring neonatal intensive care, all infants admitted to our neonatal intensive care unit during a 47-month period were prospectively examined twice weekly for mucocutaneous candidiasis. Because 16 of 18 (89%) infants in whom invasive candidiasis (defined by positive cultures of blood, CSF, deep tissue or ge2 suprapubic urine aspirates) developed had birth weights <1,500 g, further analysis was focused toward the very low birth weight group. Of 358 very low birth weight infants hospitalized for >three days and serially studied until discharge from the neonatal intensive care unit, mucocutaneous candidiasis developed in 28 (7.8%), invasive candidiasis developed in 16 (4.5%), and in 323 there was no evidence of mucocutaneous candidiasis or invasive candidiasis. Although many risk factors were shown by univariate analysis to be significantly more common among those with invasive candidiasis and mucocutaneous candidiasis, adjustment for the covariant effects of duration of hospitalization and gestational age revealed that only prolonged duration of antibiotic therapy and duration of endotracheal intubation were significantly associated with invasive candidiasis. Invasive candidiasis developed later in nine of 28 (32%) infants with mucocutaneous candidiasis despite nystatin therapy of mucocutaneous candidiasis in all nine (median duration of therapy before invasive candidiasis, nine days). Very low birth weight infants in whom mucocutaneous candidiasis develops are at significantly greater risk of invasive candidiasis developing later than those in whom mucocutaneous candidiasis did not develop (9/28 v 7/330, P < .001).

Key Words: Candidiasis • very low birth weight infant • neonatal intensive care

Submitted on October 5, 1987
Accepted on January 4, 1988




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