title: Risk Factors for Invasive Fungal Infection in Premature Infants: Enhancing a Targeted Prevention Approach.
abstract: BACKGROUND
  Premature infants are at high risk of developing invasive candidal infections (ICI). We investigated maternal and perinatal risk factors for ICI that may help in defining at-risk infants, allowing more targeted antifungal prophylaxis to prevent morbidity and mortality.
  
  
  METHODS
  Maternal and neonatal data from infants with a birthweight between 500 and 1250 g admitted across 95 neonatal intenisve care units were analyzed for risk factors for ICI.
  
  
  RESULTS
  Data from 1890 infants were analyzed, 78 of whom had ICI. Overall mortality was 20.5% for all cases of ICI, 18.8% with candidemia, 17.2% with candiduria, and 75% when Candida was isolated in both the blood and urine. Birthweight, gestational age, male sex, and vaginal delivery were predictors of infection on univariate analysis. After logistic regression, gestational age (P < .01) and male sex (P < .01) remained significant. Vaginal birth and receiving antibiotics during the first week of life increased the risk for ICI in the 22-25 weeks' and 26-28 weeks' gestation subgroups.
  
  
  CONCLUSIONS
  Gestational age and male gender are risk factors for the development of ICI, whereas vaginal delivery and antibiotics during the first week further increase the incidence in the more premature infants. Knowing maternal and perinatal risk factors for ICI allows more targeted antifungal prophylaxis in at-risk infants.
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville jswanson@virginia.edu.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Swanson
authors.affiliation: Department of Biostatistics, West Virginia University, Morgantown.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gurka
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville.
authors.forename: David A
authors.initials: DA
authors.lastname: Kaufman
keywords: invasive fungal infection; premature infant; risk factor; very low birthweight