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Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term
S Friedman1, S E Richardson, S E Jacobs
1Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. smadar@bigfoot.com
Insights
Systemic Candida infection significantly increases short- and long-term health problems in extremely low birth weight infants. Central nervous system Candida infections lead to poor neurodevelopmental outcomes, underscoring the need for early diagnosis and treatment.
Area of Science:
- Neonatal Intensive Care
- Infectious Diseases
- Neurodevelopmental Pediatrics
Background:
- Extremely low birth weight (ELBW) infants are highly susceptible to infections.
- Systemic Candida infections pose a significant threat to ELBW infants' survival and long-term health.
- Understanding the neurodevelopmental sequelae of Candida infection in ELBW infants is crucial for improving outcomes.
Purpose of the Study:
- To determine mortality, morbidity, and neurodevelopmental outcomes at 2 years corrected age in ELBW infants with systemic Candida infection.
- To compare outcomes of infected ELBW infants with a non-infected control group.
- To identify factors influencing outcomes, including diagnostic methods and treatment.
Main Methods:
- Retrospective cohort study of ELBW infants (<1000 g) with Candida sepsis or meningoencephalitis (1988-1996).
- Comparison with a control group of 470 ELBW infants born between 1990 and 1994.
- Assessment of outcomes at discharge and at 2 years corrected age, including mortality, chronic lung disease, periventricular leukomalacia, retinopathy of prematurity, and neurodevelopmental status.
Main Results:
- Systemic Candida infection had a case fatality rate of 37%, similar to the control group (35%).
- Survivors of Candida infection showed significantly higher rates of chronic lung disease (100% vs. 33%), periventricular leukomalacia (26% vs. 12%), and severe retinopathy of prematurity (22% vs. 9%).
- At 2 years corrected age, 60% of infected survivors had adverse neurologic outcomes, and 41% had severe disabilities, compared to 35% and 12% in controls, respectively. Cranial ultrasound detected brain parenchymal lesions, predicting poor outcomes.
Conclusions:
- Systemic Candida infection is linked to increased short-term and long-term morbidity in ELBW infants.
- Candida infection of the central nervous system significantly impacts neurodevelopmental outcomes.
- Cranial ultrasound is recommended for diagnosing CNS involvement and predicting outcomes in these vulnerable infants.
Objective:
To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemic Candida infection during intensive care stay.
Method:
We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed with Candida sepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994.
Results:
Forty-six extremely low birth weight infants with systemic Candida infection, mean (+/-SD) gestational age of 24.7 +/- 1.6 weeks and birth weight 699 +/- 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P = 0.0001), a high incidence of periventricular leukomalacia (26% vs. 12%, P = 0.06) and an increase in severe retinopathy of prematurity (22% vs. 9%, P = 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41% vs. 12% had severe disabilities (P = 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous system Candida involvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome.
Conclusions:
Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants. Candida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.