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Invasive fungal infection in very low birthweight infants: national prospective surveillance study
L Clerihew1, T L Lamagni, P Brocklehurst
1Centre for Newborn Care, Canberra Hospital, ACT 2606, Australia. william.mcguire@act.gov.au
Insights
Invasive fungal infections in very low birthweight (VLBW) infants are less common in the UK than previously thought. However, the death rate for these vulnerable infants remains significantly high, impacting neonatal outcomes.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Epidemiology
Background:
- Invasive fungal infections (IFIs) pose a significant threat to extremely low birthweight (ELBW) infants.
- Previous studies from North America and other regions reported higher incidence rates of IFIs in this population.
Purpose of the Study:
- To determine the incidence of IFIs in very low birthweight (VLBW) infants in the United Kingdom.
- To characterize the epidemiology and outcomes of IFIs in VLBW infants.
Main Methods:
- A national prospective surveillance study was conducted from February 2003 to February 2004.
- Data were collected through the British Paediatric Surveillance Unit and laboratory reports.
- Cases were reconciled with national health protection agencies and a mycology reference laboratory.
Main Results:
- Ninety-four cases of IFI were identified, with an annual incidence of 10.0 per 1000 VLBW live births.
- Infants of extremely low birth weight (ELBW) had a higher incidence of 21.1 per 1000 live births.
- Candida species (C. albicans, C. parapsilosis) accounted for 93% of infections, primarily in the bloodstream and urinary tract. Mortality was 41% before 37 weeks postconceptional age.
Conclusions:
- The incidence of IFIs in UK VLBW and ELBW infants is lower than previously reported.
- IFIs are associated with substantially higher late neonatal and post-neonatal mortality rates in these infants.
- Findings may guide the evaluation and implementation of antifungal infection control strategies.
Objective:
To describe the epidemiology of invasive fungal infection in very low birthweight (VLBW: <1500 g) infants in the United Kingdom.
Design:
National prospective surveillance study between February 2003 and February 2004 using the British Paediatric Surveillance Unit reporting system reconciled with cases identified through routine laboratory reporting to the Health Protection Agency (England, Wales, and Northern Ireland), the Scottish Centre for Infection and Environmental Health, and the UK Mycology Reference Laboratory.
Results:
Ninety four confirmed cases of invasive fungal infection were identified during the surveillance period giving an incidence of estimated annual incidence of 10.0 (95% confidence interval (CI) 8.0 to 12.0) cases per 1000 VLBW live births. Eighty one (86%) of the infants were of extremely low birth weight (ELBW: <1000 g), incidence 21.1 (95% CI 16.5 to 25.7) per 1000 ELBW live births. Candida species, predominantly C albicans and C parapsilosis, were isolated in 93% of cases. Most organisms were isolated from the bloodstream and urinary tract. Death occurred in 41% of the infected infants before 37 weeks postconceptional age.
Conclusions:
The incidence of invasive fungal infection in VLBW and ELBW infants in the United Kingdom is lower than reported in previous studies from tertiary centres in North America and elsewhere. The associated late neonatal and post-neonatal death rates are substantially higher than expected in infants without invasive fungal infection. These data may inform decisions about the evaluation and use of antifungal infection control strategies.
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