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Systemic fungal infection in very low-birth-weight infants
1Department of Pediatrics, Chi-Mei Foundation Hospital, Tainan, Taiwan, R.O.C.
Abstract:
This retrospective study was designed to investigate the related factors and outcome of systemic fungal infection in very low-birth-weight (VLBW) infants. Medical records of infants admitted to the neonatal intensive care unit of National Cheng Kung University Hospital between January 1990 and June 1994 were reviewed. Of the 262 VLBW infants, 15 (5.7%) had fungemia (14 Candida 1 Cryptococcus) during the study period. Among the fungemic infants, 60% also had urinary tract infection; 18% had central nervous system infection. Their mean birth weight was 1079 +/- 78 g (504-1474 g), and the gestational age was 28.6 +/- 0.6 weeks (23-32 weeks). Thirteen of them (87%) had respiratory distress syndrome and patent ductus arteriosus, while 60% had chronic lung disease. The percentage of antibiotic usage, parenteral hyperalimentation, endotracheal intubation, placement of central venous line and steroid therapy were 100%, 100%, 73%, 67% and 36% respectively. The mean age at diagnosis of fungemia was 40.5 +/- 4.8 days (10-76 days). Common clinical manifestations were respiratory deterioration (93%), poor feeding (58%) and fever (53%). The frequency of side effects of amphotericin B in decreasing order were: hypokalemia (54%), hyponatremia (31%) and decreased urine amount (23%). The mortality rate was 40%. It was concluded that systemic fungal infection in VLBW infants might result in high mortality and the side effects were high in the treated infants.
Insights
Systemic fungal infections are common in very low-birth-weight infants, leading to high mortality. Treatment with amphotericin B caused significant side effects in these vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatrics
Background:
- Systemic fungal infections pose a significant threat to very low-birth-weight (VLBW) infants.
- VLBW infants are particularly susceptible to invasive fungal infections due to immature immune systems.
Purpose of the Study:
- To investigate the factors associated with systemic fungal infections in VLBW infants.
- To evaluate the outcomes and treatment-related side effects of systemic fungal infections in VLBW infants.
Main Methods:
- Retrospective review of medical records of VLBW infants admitted to a neonatal intensive care unit from 1990 to 1994.
- Analysis of clinical characteristics, comorbidities, treatments, and outcomes of infants with fungemia.
Main Results:
- Fungemia occurred in 5.7% of VLBW infants, with Candida species being the most common pathogen.
- Common comorbidities included respiratory distress syndrome, patent ductus arteriosus, and chronic lung disease.
- Mortality rate was 40%, and common side effects of amphotericin B treatment included hypokalemia and hyponatremia.
Conclusions:
- Systemic fungal infections are associated with high mortality in VLBW infants.
- Treatment with amphotericin B can lead to significant side effects in this population.
- Further research is needed to optimize antifungal strategies for VLBW infants.