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NEURODEVELOPMENTAL OUTCOME OF
EXTREMELY LOW BIRTH WEIGHT INFANTS
WITH CANDIDA INFECTION

Source: The Journal of Pediatrics

Presented by: Juan Carlos Leon
Candida remains an important cause of lateonset infection in preterm infants. Mortality and
neurodevelopmental outcome of extremely low
birth weight (ELBW < 1000g) infants enrolled in
the Candida study were evaluated based on
infection status.

STUDY


ELBW infants born between March 2004 and July 2007 at Eunice
Kennedy Shriver National Institute of Child Health and Human
Development Neonatal Research Network (NRN)



Screened for suspected sepsis were eligible for inclusion in the Candida
study.



Primary outcome data for neurodevelopmental impairment (NDI) or
death were available for 1317 of the 1515 infants (87%) enrolled in the
Candida study.



The Bayley Scales of Infant Development-II or -III was administered at 18
months’ adjusted age.



A secondary comparison was performed with 864 infants enrolled in the
NRN Generic Database during the same cohort who were never
screened for sepsis and therefore not eligible for the Candida study.

DESIGN


ELBW infants enrolled in the Candida study, 31% with Candida
and 31% with late-onset non-Candida sepsis had NDI at 18
months.



Infants with Candida sepsis and/or meningitis had an increased
risk of death and were more likely to have the composite
outcome of death and/or NDI compared with uninfected infants
in adjusted analysis.



The 105 infants with Candida were more likely to have moderate
to severe cerebral palsy (CP) and neurodevelopmental
impairment (NDI) compared with uninfected infants



Meningitis was defined as a positive cerebrospinal fluid (CSF)
culture for Candida or bacterial organisms

RESULTS


In this cohort of ELBW infants, those with infection and/or meningitis
were at increased risk for death and/or NDI. This risk was highest
among those with Candida sepsis and/or meningitis. (J Pediatr
2013;163:961-67).



Preterm infants are predisposed to Candida infections because of
immaturity of their immune system and invasive interventions.



Transmission of Candida may be vertical (from maternal vaginal
infection).



All extremely preterm infant survivors have a substantial likelihood of
developing moderate to severe NDI.



NDI declines with increasing of gestation

CONCLUSION

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NDI

  • 1. NEURODEVELOPMENTAL OUTCOME OF EXTREMELY LOW BIRTH WEIGHT INFANTS WITH CANDIDA INFECTION Source: The Journal of Pediatrics Presented by: Juan Carlos Leon
  • 2. Candida remains an important cause of lateonset infection in preterm infants. Mortality and neurodevelopmental outcome of extremely low birth weight (ELBW < 1000g) infants enrolled in the Candida study were evaluated based on infection status. STUDY
  • 3.  ELBW infants born between March 2004 and July 2007 at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN)  Screened for suspected sepsis were eligible for inclusion in the Candida study.  Primary outcome data for neurodevelopmental impairment (NDI) or death were available for 1317 of the 1515 infants (87%) enrolled in the Candida study.  The Bayley Scales of Infant Development-II or -III was administered at 18 months’ adjusted age.  A secondary comparison was performed with 864 infants enrolled in the NRN Generic Database during the same cohort who were never screened for sepsis and therefore not eligible for the Candida study. DESIGN
  • 4.  ELBW infants enrolled in the Candida study, 31% with Candida and 31% with late-onset non-Candida sepsis had NDI at 18 months.  Infants with Candida sepsis and/or meningitis had an increased risk of death and were more likely to have the composite outcome of death and/or NDI compared with uninfected infants in adjusted analysis.  The 105 infants with Candida were more likely to have moderate to severe cerebral palsy (CP) and neurodevelopmental impairment (NDI) compared with uninfected infants  Meningitis was defined as a positive cerebrospinal fluid (CSF) culture for Candida or bacterial organisms RESULTS
  • 5.  In this cohort of ELBW infants, those with infection and/or meningitis were at increased risk for death and/or NDI. This risk was highest among those with Candida sepsis and/or meningitis. (J Pediatr 2013;163:961-67).  Preterm infants are predisposed to Candida infections because of immaturity of their immune system and invasive interventions.  Transmission of Candida may be vertical (from maternal vaginal infection).  All extremely preterm infant survivors have a substantial likelihood of developing moderate to severe NDI.  NDI declines with increasing of gestation CONCLUSION