Fungal infections in neonates

2017 ◽  
Author(s):  
Adilia Warris
Keyword(s):  
Invasive Candidiasis ◽  
Neonatal Intensive Care ◽  
Fungal Infections ◽  
Invasive Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Extremely Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Optimal Dosing ◽  
Neurodevelopmental Impairment

Fungal infections in the neonatal population are caused predominantly by Candida species and invasive fungal disease mainly affects extremely low birth weight infants. The vast majority of Candida infections are due to C. albicans and C. parapsilosis, while the more fluconazole-resistant Candida species are only sporadically observed. Invasive candidiasis typically occurs during the first month of life and presents with non-specific signs of sepsis. Despite antifungal treatment, 20% of neonates developing invasive candidiasis die and neurodevelopmental impairment occurs in nearly 60% of survivors. Antifungal prophylaxis reduces the incidence in neonatal intensive care units with high rates of invasive candidiasis (>10%). Amphotericin B, fluconazole, micafungin, and caspofungin can be used to treat neonatal candidiasis, although optimal dosing for fluconazole and the two echinocandins has not yet been established.

scholarly journals Advances in the Treatment of Mycoses in Pediatric Patients

2018 ◽  
Vol 4 (4) ◽  
pp. 115 ◽  
Author(s):  
Elias Iosifidis ◽  
Savvas Papachristou ◽  
Emmanuel Roilides
Keyword(s):  
Antifungal Therapy ◽  
Invasive Candidiasis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Empiric Therapy ◽  
Antifungal Prophylaxis ◽  
Neonatal Intensive Care Units ◽  
First Line ◽  
Fluconazole Resistance ◽  
High Incidence

The main indications for antifungal drug administration in pediatrics are reviewed as well as an update of the data of antifungal agents and antifungal policies performed. Specifically, antifungal therapy in three main areas is updated as follows: a) Prophylaxis of premature neonates against invasive candidiasis; b) management of candidemia and meningoencephalitis in neonates; and c) prophylaxis, empiric therapy, and targeted antifungal therapy in children with primary or secondary immunodeficiencies. Fluconazole remains the most frequent antifungal prophylactic agent given to high-risk neonates and children. However, the emergence of fluconazole resistance, particularly in non-albicans Candida species, should be considered during preventive or empiric therapy. In very-low birth-weight neonates, although fluconazole is used as antifungal prophylaxis in neonatal intensive care units (NICU’s) with relatively high incidence of invasive candidiasis (IC), its role is under continuous debate. Amphotericin B, primarily in its liposomal formulation, remains the mainstay of therapy for treating neonatal and pediatric yeast and mold infections. Voriconazole is indicated for mold infections except for mucormycosis in children >2 years. Newer triazoles-such as posaconazole and isavuconazole-as well as echinocandins, are either licensed or under study for first-line or salvage therapy, whereas combination therapy is kept for refractory cases.

Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units

2016 ◽  
Vol 61 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Jadwiga Wójkowska-Mach ◽  
T. Allen Merritt ◽  
Maria Borszewska-Kornacka ◽  
Joanna Domańska ◽  
Ewa Gulczyńska ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants

Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants

2021 ◽  
Author(s):  
Daniel Nakhla ◽  
Alla Kushnir ◽  
Rafat Ahmed ◽  
Vineet Bhandari ◽  
Krystal Hunter ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Reticulocyte Count ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Positive Trend ◽  
Reference Ranges ◽  
Low Birth Weight Infants ◽  
Packed Red Blood Cells

Objective Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells (PRBCs). Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant's chronologic age or corrected gestational age (GA) generates a specific trend in the RCs. Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization. Study Design A retrospective chart review of ELBW infants treated in the neonatal intensive care unit (NICU) and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected GA. Results A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32 to 34 weeks' corrected GA and then experienced a downward trend was observed. Conclusion Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants. Key Points

Unsuspected Hyperosmolality of Oral Solutions Contributing to Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 535-538
Author(s):  
DIANA M. WILLIS ◽  
JOANN CHABOT ◽  
INGEBORG C. RADDE ◽  
GRAHAM W. CHANCE
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Umbilical Vessel ◽  
Causative Factors ◽  
Nutritional Studies

In recent years necrotizing enterocolitis (NEC) has become a major problem in neonatal intensive care units. Recent incidences as high as 8% in all infants with a birth weight less than 2.5 kg and 14% in those with a birth weight less than 1.5 kg have been reported from one center.1Despite intensive searches for possible causative factors, no definite entity has been identified, but asphyxia,2 circulatory changes associated with exchange transfusion,3 umbilical vessel catheterization,4 immature immune status,5infection,6-8 and hypertonic feedings9 have all been implicated. In the course of a series of nutritional studies involving thriving very-low-birth-weight infants we

Morbidity and Mortality Among Low Birth Weight Infants Exposed to an Intravenous Vitamin E Product, E-Ferol

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. 244-249
Author(s):  
Janet B. Arrowsmith ◽  
Gerald A. Faich ◽  
Dianne K. Tomita ◽  
Joel N. Kuritsky ◽  
Franz W. Rosa
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Vitamin E ◽  
Low Birth Weight ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Morbidity And Mortality ◽  
Neonatal Intensive Care Units ◽  
Low Birth Weight Infants ◽  
Intravenous Vitamin

In April 1984, the US FDA was notified of an unusual clinical syndrome consisting of ascites, liver and renal failure, thrombocytopenia, and death among low birth weight infants exposed to an intravenous vitamin E preparation, E-Ferol. The product, which had not been tested for safety prior to marketing, was voluntarily withdrawn from the market in early April. To further investigate the reported associations, the FDA conducted a retrospective cohort study among seven neonatal intensive care units where the product had been used. Standardized abstraction forms were completed for infants admitted to a unit between Nov 1, 1983, and April 30, 1984. Included in the study were 379 infants weighing 2,000 g or less and surviving at least two days; 148 (39%) had been exposed to E-Ferol. Compared with the unexposed infants, the exposed infants were more likely to die and to have ascites, hepatomegaly, thrombocytopenia, and a combination of clinical events similar to the syndrome initially reported. We conclude that the use of E-Ferol in these neonatal intensive care units was associated with increased morbidity and mortality among exposed infants.

scholarly journals Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

2019 ◽  
Vol 5 (3) ◽  
pp. 67 ◽  
Author(s):  
Friedman ◽  
Schwartz
Keyword(s):  
North America ◽  
Fungal Pathogens ◽  
Fungal Infections ◽  
Trichophyton Mentagrophytes ◽  
Invasive Fungal Disease ◽  
Multidrug Resistant ◽  
Antifungal Prophylaxis ◽  
Candida Spp ◽  
Sporothrix Brasiliensis ◽  
Emerging Fungal Infections

: The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus Aspergillus species, Mucorales, and Scedosporium/Lomentospora spp. The agricultural application of triazole pesticides has driven an emergence of azole-resistant A. fumigatus in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in Trichophyton mentagrophytes causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including Emergomyces, which cause disseminated mycoses globally, primarily in HIV infected patients, and Blastomyces helicus and B. percursus, causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as an important disease of felines and people.

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