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The hidden mortality in surgically treated necrotizing enterocolitis: fungal sepsis
Abstract:
From 1979 to 1986, 82 infants underwent surgical treatment for necrotizing enterocolitis (NEC), with 36 deaths. The records of 30 of the 36 infants who died were available for review. Fungal colonization and sepsis, the sites of infection, and timing of diagnosis and therapy were determined. Sixteen of 30 (53%) neonates had no evidence of fungus. Six (20%) were colonized with Candida species. Eight (27%) had fungal sepsis, with two of these eight found only at necropsy. Positive fungal blood cultures were a late finding. In only four of the six patients with positive blood cultures were the results known in time to initiate treatment with amphotericin B. Two of these four babies received less than 2 days of amphotericin B treatment prior to death. Fungal sepsis is a significant lethal factor in the surgical mortality of NEC. Vigorous efforts at earlier diagnosis are mandatory.
Insights
Fungal sepsis is a critical factor in surgical mortality for infants with necrotizing enterocolitis (NEC). Earlier diagnosis and treatment are crucial for improving outcomes in these vulnerable neonates.
Area of Science:
- Neonatal Surgery
- Pediatric Infectious Diseases
- Fungal Infections in Neonates
Background:
- Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition in neonates.
- Surgical intervention for NEC carries a significant mortality rate.
- The role of fungal infections in NEC-related deaths requires further investigation.
Purpose of the Study:
- To determine the prevalence and impact of fungal colonization and sepsis in infants who died after surgical treatment for NEC.
- To analyze the timing of fungal diagnosis and the effectiveness of antifungal therapy.
Main Methods:
- Retrospective review of medical records of 30 infants who died from NEC between 1979 and 1986.
- Analysis of fungal colonization, sites of infection, and fungal sepsis.
- Evaluation of the timing of diagnosis and initiation of antifungal treatment (amphotericin B).
Main Results:
- Fungal infection was present in 47% of the reviewed NEC deaths (8/30), with 27% having proven fungal sepsis.
- Candida species were the most common fungal isolates.
- Fungal sepsis was often diagnosed late, with positive blood cultures frequently identified post-mortem or too late for effective treatment.
Conclusions:
- Fungal sepsis is a significant contributor to mortality in surgical NEC cases.
- Delayed diagnosis and treatment of fungal infections in NEC are common.
- Earlier diagnostic methods and prompt initiation of antifungal therapy are essential for reducing NEC-related mortality.