Candida sepsis and association with retinopathy of prematurity.
OBJECTIVE
To assess the association of Candida sepsis with retinopathy of prematurity (ROP) in extremely low birth weight infants.


METHODS
We prospectively identified 253 infants admitted to the Critical Care Nursery at Georgetown University Hospital with birth weights </=1000 g born between January 1, 1994, and June 30, 1996. Of these 253 infants, 62 died and 55 were transferred to other institutions before ophthalmologic screening for ROP. Clinical data on 98% (133/136) infants were reviewed. Candida sepsis was defined as a positive blood culture for Candida species. Severity of ROP was staged by the International Classification for ROP. Data were analyzed using the chi2 test for nominal data, unpaired t test for continuous data, Mann-Whitney U test for ordinal data, and logistic regression.


RESULTS
The mean birth weight (+/-SD) of the population studied was 777 g (+/-136 g), and the mean gestational age at birth was 26.0 weeks (+/-1.8 weeks). The overall incidence of ROP was 74%, and it correlated significantly with birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores. The incidence of ROP was significantly higher in the infants who had Candida sepsis (21/22 [95%]) compared with those who did not (77/111 [69%]). Using logistic regression to control for the influence of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores, Candida sepsis was an independent predictor of stage 3 or worse ROP. In addition, 9 (41%) of 22 infants with Candida sepsis required laser surgery compared with 10 (9%) of 111 infants without Candida sepsis. This difference was significant independent of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores.


CONCLUSIONS
Candida sepsis is independently associated with increased severity of ROP and the need for laser surgery in extremely low birth weight infants.
Mittal
M
M
Department of Pediatrics, Division of Neonatology, Georgetown University Medical Center, Washington, District of Columbia 20007, USA.
Dhanireddy
R
R
Higgins
R D
RD
D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications*; D005260:Female; D016469:Fungemia / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000145:classification / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D018805:Sepsis / Q000150:complications*; D012720:Severity of Illness Index