Early onset systemic Candida infection in extremely preterm neonates

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Pediatric Critical Care

Background:

• Systemic Candida infections typically present in neonates around one month of age.
• Recent observations in a Regional Neonatal Intensive Care Unit (NICU) identified a pattern of early-onset severe Candida infections.

Purpose of the Study:

• To characterize the clinical presentation and timing of severe Candida infections in extremely preterm neonates.
• To investigate potential contributing factors to the early onset of these infections.

Main Methods:

• Retrospective case series analysis over an 18-month period.
• Inclusion criteria: neonates < 26 weeks gestation and < 0.75 kg birth weight with severe Candida infection.
• Data collection focused on age at onset and clinical features.

Main Results:

• Seven cases of severe Candida infection were identified in extremely preterm infants (< 26 weeks gestation, < 0.75 kg).
• The median age of onset was significantly earlier at 7 days (range 0-17 days) compared to classical presentation.
• Prominent clinical features included thrombocytopenia, coagulopathy, hypotension, edema, and skin breakdown.

Conclusions:

• Extremely preterm infants, particularly those with a compromised cutaneous barrier, are susceptible to early-onset systemic Candida infections.
• Characteristic skin manifestations may serve as an early diagnostic clue for invasive candidiasis in this vulnerable population.