Neonatal candidiasis among extremely low birth weight infants: Risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months
Neonatal candidiasis among extremely low birth weight infants: Risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months
复制标题
DOI：
10.1542/peds.2004-2292
复制
发表时间：
2006-01-01
期刊：
影响因子：
8
通讯作者：
Goldberg, R
中科院分区：
文献类型：
--
作者：
Benjamin, DK;Stoll, BJ;Goldberg, R
背景新生儿念珠菌病的发病率和死亡率很高。一个大型多中心队列的神经发育随访数据尚未公布。前瞻性地收集了1998年9月1日至2001年12月31日期间在国家儿童健康和人类发育研究所赞助的新生儿研究网络站点出生的< 1000 g的新生儿的数据。统一的后续评估，包括心理和运动发育的贝利婴儿发育量表II的评估，完成了所有幸存者在校正年龄为18至22个月。我们评估了新生儿念珠菌病发生的危险因素，抗真菌治疗的反应，以及念珠菌病与随后的发病率和死亡率之间的关系。该队列由4579名婴儿组成; 4579名婴儿中有320名（7%）患念珠菌病; 320名中有307名从血液中分离出念珠菌，320名中有27名从脑脊液中分离出念珠菌，27名脑膜炎患者中有13名（48%）血培养阴性。在对出生第3天的危险因素的多变量分析中，出生体重、头孢菌素、性别和缺乏肠道喂养与念珠菌病的发生相关。诊断后，尽管进行了抗真菌治疗，大多数新生儿仍有多个阳性培养物，10%的新生儿有念珠菌血症>= 14天。在发生念珠菌病的极低出生体重儿中，观察到73%的死亡或神经发育障碍（NDI）。与及时拔除或更换中心静脉导管的婴儿相比，延迟拔除或更换中心静脉导管的婴儿（开始抗真菌治疗后>= 1天）的死亡率和NDI率更高。大约一半的念珠菌性脑膜炎婴儿的血培养呈阴性。持续性念珠菌感染是常见的。延迟导管移除与死亡和NDI率增加相关。
BACKGROUND. Neonatal candidiasis is associated with substantial morbidity and mortality rates. Neurodevelopmental follow-up data for a large multicenter cohort have not been reported.METHODS. Data were collected prospectively for neonates born at < 1000 g at National Institute of Child Health and Human Development-sponsored Neonatal Research Network sites between September 1, 1998, and December 31, 2001. Uniform follow-up evaluations, including assessments of mental and motor development with the Bayley Scales of Infant Development II, were completed for all survivors at corrected ages of 18 to 22 months. We evaluated risk factors for the development of neonatal candidiasis, responses to antifungal therapy, and the association between candidiasis and subsequent morbidity and death.RESULTS. The cohort consisted of 4579 infants; 320 of 4579 (7%) developed candidiasis; 307 of 320 had Candida isolated from blood, 27 of 320 had Candida isolated from cerebrospinal fluid, and 13 (48%) of 27 of those with meningitis had negative blood cultures. In multivariate analysis of risk factors on day of life 3, birth weight, cephalosporins, gender, and lack of enteral feeding were associated with development of candidiasis. After diagnosis, most neonates had multiple positive cultures despite antifungal therapy, and 10% of neonates had candidemia for >= 14 days. Death or neurodevelopmental impairment (NDI) was observed for 73% of extremely low birth weight infants who developed candidiasis. Death and NDI rates were greater for infants who had delayed removal or replacement of central catheters (>= 1 day after initiation of antifungal therapy), compared with infants whose catheters were removed or replaced promptly.CONCLUSIONS. Blood cultures were negative for approximately one half of the infants with Candida meningitis. Persistent candidiasis was common. Delayed catheter removal was associated with increased death and NDI rates.