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Risk factors for invasive fungal infection in neonates
F A Y El-Masry1, T J Neal, N V Subhedar
1Neonatal Intensive Care Unit, Liverpool Women's Hospital, UK.
Unlabelled:
Invasive fungal infection is an uncommon, but increasing cause of morbidity and mortality in neonates. There are few controlled studies defining risk factors for the development of fungal infection in a contemporary neonatal population. This retrospective case-control study was undertaken to investigate antenatal, demographic and postnatal variables that may be potentially important in the development of fungal infection. Two gestation-matched controls were identified for each index case. Information about perinatal and demographic variables, as well as important neonatal outcomes, was obtained from case notes. Microbiological data collected included the presence of fungal colonization, and organisms responsible for invasive fungal infection. Over a 5-y period, 24 infants with invasive fungal infection and 48 controls were identified. Candida albicans was the organism identified in 75% of cases of fungal septicaemia, and in all cases complicated by fungal meningitis. Preceding fungal colonization, pulmonary haemorrhage and intrauterine growth restriction were factors significantly and independently associated with invasive fungal infection. Fifty-four percent of infants with invasive fungal infection died, and 82% of survivors developed chronic lung disease.
Conclusion:
Some new and potentially important risk factors for the development of invasive fungal infection in a contemporary population of infants admitted to a neonatal intensive care were identified.
Insights
Invasive fungal infections in newborns are serious. Key risk factors include prior fungal colonization, pulmonary hemorrhage, and intrauterine growth restriction, impacting survival and long-term health.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatrics
Background:
- Invasive fungal infection (IFI) is an increasing cause of morbidity and mortality in neonates.
- Controlled studies defining risk factors for IFI in contemporary neonatal populations are limited.
Purpose of the Study:
- To investigate antenatal, demographic, and postnatal variables associated with the development of IFI in neonates.
- To identify new risk factors for IFI in a modern neonatal intensive care unit (NICU) population.
Main Methods:
- Retrospective case-control study design.
- Inclusion of 24 infants with IFI and 48 gestation-matched controls.
- Data collection from case notes on perinatal, demographic, and neonatal outcomes.
- Analysis of microbiological data for fungal colonization and causative organisms.
Main Results:
- Candida albicans was the predominant organism (75% of fungal septicemia, 100% of fungal meningitis).
- Significant independent risk factors for IFI included preceding fungal colonization, pulmonary hemorrhage, and intrauterine growth restriction.
- Mortality rate for infants with IFI was 54%; 82% of survivors developed chronic lung disease.
Conclusions:
- New and potentially important risk factors for invasive fungal infection in neonates were identified.
- Findings highlight critical areas for prevention and management strategies in NICU settings.