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Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: a
J R Campbell1, E Zaccaria, C J Baker
1Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, TX 77030, USA. judithc@bcm.tmc.edu
Insights
Topical petrolatum ointment (TPO) use in extremely low birth weight (ELBW) infants was linked to a significant increase in systemic candidiasis (SC). Discontinuing TPO led to a decrease in SC incidence, suggesting TPO is a risk factor.
Area of Science:
- Neonatal Intensive Care Unit (NICU) research
- Infectious disease epidemiology
- Pediatric dermatology
Background:
- An increase in systemic candidiasis (SC) incidence was observed in extremely low birth weight (ELBW) infants following a change in skin care practices.
- The study investigated a potential association between topical petrolatum ointment (TPO) use and SC risk in this vulnerable population.
Purpose of the Study:
- To determine if TPO use for skin care in ELBW infants is associated with an increased risk of developing SC.
- To evaluate the impact of TPO on SC incidence in a neonatal intensive care unit (NICU) setting.
Main Methods:
- A case-control study was conducted in a 48-bed NICU.
- Ten ELBW infants with SC were matched with 30 ELBW infants without SC.
- Data were collected via retrospective medical record review, including molecular analysis of Candida isolates.
Main Results:
- Infants with SC did not differ significantly from controls in birth weight, gestational age, or duration of key therapies.
- A significantly higher odds ratio (11) for SC was associated with TPO use in case infants compared to controls.
- Discontinuation of TPO resulted in a decrease in SC incidence to baseline levels.
Conclusions:
- The use of TPO in ELBW infants is associated with an increased incidence of SC.
- Further research is warranted to investigate the infectious risks associated with TPO skin care in ELBW infants.
Background And Objective:
An increase in the incidence of systemic candidiasis (SC) followed a change in skin care for extremely low birth weight (ELBW) infants in our neonatal intensive care unit (NICU). We sought to determine whether the use of topical petrolatum ointment (TPO) for skin care of ELBW infants was associated with risk for SC.
Study Design:
Case-control study.
Setting:
A 48-bed NICU in a private hospital in Houston, Texas.
Patients:
Ten ELBW infants with and 30 without SC admitted to the NICU from December 1, 1997 through July 31, 1998.
Methods:
ELBW infants with SC were identified using hospital microbiology and infectious disease consultation databases. A case was defined as an infant weighing
Results:
Case infants had a mean (+/- standard deviation) age of onset of 21.5 +/- 24 days. Infants with SC and controls did not differ in birth weight, gestational age, or duration of therapy with steroids, antibiotics, insulin, or total parenteral nutrition. Although cases were more likely to be born vaginally and had a longer duration endotracheal intubation than controls, these differences were not significant. The odds ratio for skin care with TPO in case infants versus control infants was 11 (95% confidence interval: 1.9-63). Skin care with TPO was discontinued and the incidence of SC decreased to baseline. Several Candida spp and genetic profiles were identified, suggesting that there was not a common source outbreak.
Conclusions:
We conclude that the use of TPO promoted an increase in the incidence of SC in ELBW infants. Additional investigation of potential infectious risks for ELBW infants receiving TPO skin care is warranted.