title: Dexamethasone therapy and Candida sepsis in neonates less than 1250 grams.
abstract: OBJECTIVE
  To determine whether dexamethasone use increases the risk for Candida sepsis (CS) in very low birth weight premature infants (<1250 g).
  
  
  METHODS
  Retrospective chart review of all infants with a birth weight <1250 g, admitted to the neonatal intensive care unit of the MetroHealth Medical Center, Cleveland, Ohio between January 1, 1996 and December 31, 1999. Infant groups with (n=65) and without (n=229) CS were compared.
  
  
  RESULTS
  Two hundred and ninety four infants with a birth weight <1250 g were identified. CS was diagnosed at a median age of 18 days, and 6 of 65 (10%) infants died directly from Candida-related complications. Candida albicans (n=30, 60%) and Candida parapsilosis (n=14, 25%) were the predominant isolates. Use of dexamethasone in infants at risk for chronic lung disease before 14 days of age (p=0.001), duration of antibiotics (p=0.001), and total duration of parenteral nutrition and intralipid (p=0.0001) were all significantly greater in infants who developed CS. Regression analysis showed that duration of antibiotics before the diagnosis of Candida infection (r(2)=0.69, p=0.0002) and duration of dexamethasone (r(2)=0.93, p=0.0002) correlated with Candida infection. Early dexamethasone use was also related to the age at diagnosis of Candida infection (r(2)=0.51, p=0.01).
  
  
  CONCLUSIONS
  Dexamethasone therapy and prolonged duration of antibiotics are associated with Candida infection in premature infants.
authors.affiliation: Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Angelina
authors.initials: A
authors.lastname: Pera
authors.forename: Angela
authors.initials: A
authors.lastname: Byun
authors.forename: Steven
authors.initials: S
authors.lastname: Gribar
authors.forename: Rama
authors.initials: R
authors.lastname: Schwartz
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Prabhu
authors.initials: P
authors.lastname: Parimi
mesh_terms: D002177:Candidiasis / Q000139:chemically induced*; D016022:Case-Control Studies; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D008171:Lung Diseases / Q000517:prevention & control; D018805:Sepsis / Q000139:chemically induced* / Q000382:microbiology
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone