Invasive fungal infections during the neonatal period: diagnosis, treatment and prophylaxis.
BACKGROUND
The incidence of preterm births seems to be increased in many countries around the world, in parallel to the advances in neonatal medicine. However, this has resulted in longer hospital stays and more exposure to invasive interventions, both of which can lead to an increase in late-onset nosocomial infections in the newborn period. In addition to bacteria, fungi are thought to be an important cause of hospital infections.


METHODS
The present article reviews the diagnosis, treatment and prophylaxis of invasive fungal infections (IFIs) during the neonatal period. IFIs are associated with high morbidity and mortality in preterm neonates. The main risk factors are multiple antibiotics, central venous catheters, parenteral nutrition, immunodepression, very low birth weight, and fungal colonization. Successful management of IFIs relies on early recognition and rapid initiation of effective treatment.


CONCLUSIONS
Invasive-fungal-infection-related morbidity and mortality is a major concern for most neonatal intensive care units worldwide. Incidence rates are increasing for preterm neonates. Preterm infants display clinical characteristics that make them prone to fungal infections, and there is a high frequency of neurodevelopmental sequelae in those who survive after neonatal fungal infections. Specific prevention - rather than treatment - should be the optimal strategy. Both ﬂuconazole and nystatin prophylaxis reduce the incidence of IFI and fungal colonization in very preterm infants.
Gazi University, Department of Pediatrics, Pediatric Infectious Disease Unit, Faculty of Medicine, Ankara, Turkey.
Hasan
H
Tezer
Fuat Emre
FE
Canpolat
Uğur
U
Dilmen
D000935:Antifungal Agents / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control
D000935:Antifungal Agents