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Invasive fungal dermatitis in the < or = 1000-gram neonate
J L Rowen1, J T Atkins, M L Levy
1Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030.
Pediatrics
|May 1, 1995
Summary
Invasive fungal dermatitis affects extremely low birth weight neonates, linked to prematurity, vaginal birth, and steroid use. The skin may be a fungal entry point, leading to systemic infection.
Area of Science:
- Neonatal dermatology
- Infectious diseases
- Neonatal intensive care
Background:
- Invasive fungal dermatitis (IFD) emerged in extremely low birth weight (ELBW) neonates.
- Characterized by erosive skin lesions and high risk of systemic fungal infection.
- Previous studies noted its emergence in ELBW infants.
Purpose of the Study:
- Define invasive fungal dermatitis in neonates.
- Identify potential risk factors associated with its development.
- Examine the relationship between IFD and subsequent systemic fungal infections.
Main Methods:
- Retrospective chart review of 16 neonates with IFD over 2 years.
- Confirmed cases (7) with skin biopsy; probable cases (9) with clinical signs and fungal evidence.
- Matched controls (3 per case) by hospital, admission date, and birth weight.
Main Results:
- IFD occurred in 5.9% of at-risk infants; mean birth weight 635g.
- Common pathogens included Candida albicans, other Candida species, Aspergillus, Trichosporon beigelii, and Curvularia.
- Disseminated infection occurred in 69% of cases, primarily Candida species. Case patients were more premature, more likely to be vaginally delivered, received postnatal steroids, and had prolonged hyperglycemia compared to controls.
Conclusions:
- IFD is a significant condition in the smallest, most immature neonates.
- Associated factors include vaginal birth, steroid administration, and hyperglycemia.
- The skin may act as a portal for fungal entry, leading to disseminated disease; improving skin barrier function may be preventative.