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Risk factors associated with fungal peritonitis in very low birth weight neonates with severe necrotizing
1Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23507.
Abstract:
Fungal peritonitis is uncommon in infants with severe necrotizing enterocolitis with intestinal perforation. In our institution we noted a significant (P < 0.01) increase in fungal peritonitis from 7% (3 of 45 cases of peritonitis) from January, 1980, to June, 1989, to 35% (8 of 23 cases of peritonitis) from July, 1989, to December, 1991. The mean birth weight of 11 infants with fungal peritonitis (946 +/- 70 g) (mean +/- SE) was significantly less (P = 0.008) than that of 57 infants with bacterial peritonitis (1282 +/- 52 g). In a case-control study to identify risk factors associated with fungal peritonitis, 11 infants with bacterial peritonitis were matched to the 11 infants with fungal peritonitis by age at bowel perforation and birth weight. Infants with fungal compared with bacterial peritonitis had significantly longer (P < 0.05): median duration of umbilical vessel catheterization before bowel perforation, 10 vs. 3 days, respectively; median duration of antibiotic therapy before bowel perforation, 23 vs. 14 days, respectively; and median duration of intubation, 13 vs. 5 days, respectively. Other potential risk factors that were not significant in this study included duration of central venous catheterization, total parenteral nutrition, intravenous lipid administration, aminoglycoside use, dexamethasone use or methyl xanthine therapy. In summary fungal peritonitis in neonates with necrotizing enteritis was significantly related to extremely low birth weight, prolonged umbilical vessel catheterization, prolonged exposure to antibiotics and prolonged intubation.
Insights
Fungal peritonitis in infants with necrotizing enterocolitis increased significantly. Risk factors include extremely low birth weight, prolonged umbilical catheterization, antibiotic exposure, and intubation.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Infectious Diseases
Background:
- Fungal peritonitis is a rare complication in infants with necrotizing enterocolitis and intestinal perforation.
- A notable increase in fungal peritonitis cases was observed at the institution.
Purpose of the Study:
- To investigate the trend of fungal peritonitis in neonates with necrotizing enterocolitis.
- To identify risk factors associated with fungal peritonitis in this vulnerable population.
Main Methods:
- A retrospective analysis of peritonitis cases in infants with necrotizing enterocolitis.
- A case-control study comparing infants with fungal peritonitis to those with bacterial peritonitis, matched for birth weight and age at perforation.
Main Results:
- Fungal peritonitis incidence rose from 7% to 35% between two study periods.
- Infants with fungal peritonitis had significantly lower birth weights compared to those with bacterial peritonitis.
- Prolonged umbilical vessel catheterization, antibiotic therapy, and intubation were significantly associated with fungal peritonitis.
Conclusions:
- Extremely low birth weight, prolonged umbilical vessel catheterization, extended antibiotic exposure, and prolonged intubation are significant risk factors for fungal peritonitis in neonates with necrotizing enterocolitis.
- These findings highlight the need for vigilant monitoring and potential preventative strategies in high-risk neonates.