Fungal Infections in Premature Infants

To the Editor.— Baley et al, in "Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Etiology" (Pediatrics 1984;73:144-152), provided a wealth of clinical detail about systemic candidiasis in very low-birth-weight infants and emphasized the increased risk in infants with a prolonged period of parenteral alimentation via central lines. They observed late-onset carbohydrate intolerance in these infected infants and imply that fungal sepsis may precipitate hyperglycemia. The causal relationship and temporal sequence of such insidious conditions as hyperglycemia and candidemia may be difficult to establish in retrospect.

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Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Epidemiology

PEDIATRICS ◽

10.1542/peds.73.2.144 ◽

1984 ◽

Vol 73 (2) ◽

pp. 144-152

Author(s):

Jill E. Baley ◽

Robert M. Kliegman ◽

Avroy A. Fanaroff

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Fungal Infection ◽

Very Low Birth Weight ◽

Fungal Infections ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Abdominal Distension ◽

Acute Onset ◽

Low Birth Weight Infants

In 1979 and 1980, an apparent increase in the occurrence of disseminated fungal infections was observed. The clinical features of such infections in very low-birth weight infants are poorly described, and diagnosis is often delayed. Over a 24-month period, a discrete group of ten clinically diagnosed and four autopsy-diagnosed cases of systemic fungal infections in very low-birth-weight infants was observed. Prior to developing systemic fungal illness, these infants required prolonged total parenteral nutrition, central arterial or venous catheters, and multiple courses of broad-spectrum antibiotics for documented or suspected bacterial sepsis. The clinically diagnosed disseminated fungal infection (ten infants) was noted at a mean age of 33 days with one or more of the following: respiratory deterioration, abdominal distension, guaiac positive stools, carbohydrate intolerance, candiduria, endophthalmitis, meningitis, abscesses, erythematous rash, temperature instability, and hypotension. These signs and symptoms were seen as chronic or were intermittent in clinical course. In contrast, the autopsy-diagnosed disseminated fungal infection (four infants) was present at an earlier age with fewer recognizable predisposing factors and a more acute onset of infection. Nevertheless, in both groups the diagnosis of systemic candidal infection was delayed, due to an inability to consistently recover the organism from blood, CSF, or urine. The neonatologist caring for the very low-birth-weight infant needs to become more aware of these clinical entities. A high index of suspicion and ancillary diagnostic evaluation, such as retinoscopy or tissue biopsy, may be indicated in the critically ill, culture-negative patient.

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Late-Onset Neutropenia in Very Low Birth Weight Infants

PEDIATRICS ◽

10.1542/peds.106.4.e55 ◽

2000 ◽

Vol 106 (4) ◽

pp. e55-e55 ◽

Cited By ~ 26

Author(s):

S. A. Omar ◽

A. Salhadar ◽

D. E. Wooliever ◽

P. K. Alsgaard

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Late Onset ◽

Low Birth Weight Infants

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Urinary Neutrophil Gelatinase-Associated Lipocalin Is a Promising Biomarker for Late Onset Culture-Positive Sepsis in Very Low Birth Weight Infants

Pediatric Research ◽

10.1203/pdr.0b013e3181da75c1 ◽

2010 ◽

Vol 67 (6) ◽

pp. 636-640 ◽

Cited By ~ 29

Author(s):

Elvira Parravicini ◽

Sheri L Nemerofsky ◽

Kenneth A Michelson ◽

Trang K Huynh ◽

Meghan E Sise ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Late Onset ◽

Low Birth Weight Infants ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase ◽

Culture Positive

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The concomitant use of vancomycin and piperacillin-tazobactam is associated with acute kidney injury (AKI) in extremely low birth weight infants (ELBW)

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-210866 ◽

2021 ◽

pp. 1-7

Author(s):

Y. Al-Jebawi ◽

K. Karalic ◽

P. Shekhawat ◽

M.J. Mhanna

Keyword(s):

Acute Kidney Injury ◽

Birth Weight ◽

Low Birth Weight ◽

Late Onset ◽

Kidney Injury ◽

Extremely Low Birth Weight ◽

Retrospective Case ◽

Low Birth Weight Infants ◽

Late Onset Sepsis ◽

Increased Risk

BACKGROUND: Late-onset sepsis is common in extremely low birth weight (ELBW) infants, and it leads to the use of antibiotics to cover resistant organisms, which can be nephrotoxic. Here we have investigated the role of vancomycin plus piperacillin-tazobactam on the rate of acute kidney injury (AKI). METHODS: In a retrospective case-control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) with late onset sepsis who were prescribed vancomycin plus piperacillin-tazobactam were reviewed for demographics, clinical characteristics, use of potential nephrotoxic medications and outcomes. RESULTS: During the study period, 264 patients were admitted, of whom 28.4%(75/264) received vancomycin plus piperacillin-tazobactam and were matched with 64 controls. There were no differences in gestational age or birth weight between cases and controls [688±160 vs. 689±162 grams (p = 0.99), and 24.7±1.8 vs. 24.7±1.6 weeks (p = 0.99) respectively]. There was no difference in the rate of sepsis between cases and controls [76%(55/72) vs. 64%(41/64) respectively, p = 0.11]. Infants exposed to vancomycin plus piperacillin-tazobactam had a higher percentage of concomitant use of vasopressors and amphotericin. To adjust for confounders, a logistic regression analysis was conducted with AKI as the dependent variable. Use of vasopressors and vancomycin plus piperacillin-tazobactam were the only risk factors associated with AKI with an adjusted OR (95%CI) of 4.08 (1.90–8.74), p < 0.001; and 2.87 (1.26–6.53), p = 0.01 respectively. CONCLUSION: The use of vancomycin plus piperacillin-tazobactam in ELBW infants is associated with an increased risk for AKI.

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