title: Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome.
abstract: BACKGROUND
  Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days).
  
  
  METHODS
  All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined.
  
  
  RESULTS
  Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007).
  
  
  CONCLUSIONS
  ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.
authors.affiliation: Hospital for Sick Children, University of Toronto, Ontario.|Department of Paediatrics, London Health Sciences Centre, University of Western Ontario.
authors.forename: Michelle
authors.initials: M
authors.lastname: Barton
authors.affiliation: Hospital for Sick Children, University of Toronto, Ontario.
authors.forename: Alex
authors.initials: A
authors.lastname: Shen
authors.affiliation: Mount Sinai Hospital, University of Toronto, Ontario.
authors.forename: Karel
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Robinson
authors.affiliation: Foothills Hospital, University of Calgary, Alberta.|University of Nebraska Medical Center, Omaha.
authors.forename: H Dele
authors.initials: HD
authors.lastname: Davies
authors.affiliation: Hospital for Sick Children, University of Toronto, Ontario.
authors.forename: Kim
authors.initials: K
authors.lastname: Simpson
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Ontario.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Asztalos
authors.affiliation: IWK Health Centre, Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Langley
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa.
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Saux
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton.
authors.forename: Reginald
authors.initials: R
authors.lastname: Sauve
authors.affiliation: British Columbia Women's Hospital, University of British Columbia, Vancouver.
authors.forename: Anne
authors.initials: A
authors.lastname: Synnes
authors.affiliation: Royal University Hospital, University of Saskatchewan, Saskatoon.
authors.forename: Ben
authors.initials: B
authors.lastname: Tan
authors.affiliation: CHU Sainte-Justine, Université de Montréal, Quebec.
authors.forename: Louis
authors.initials: L
authors.lastname: de Repentigny
authors.affiliation: Montreal Children's Hospital, McGill University, Montreal, Quebec.
authors.forename: Earl
authors.initials: E
authors.lastname: Rubin
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa.|Hamilton Health Sciences McMaster University, Hamilton, Ontario, and.
authors.forename: Chuck
authors.initials: C
authors.lastname: Hui
authors.affiliation: Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Lajos
authors.initials: L
authors.lastname: Kovacs
authors.affiliation: Hospital for Sick Children, University of Toronto, Ontario.
authors.forename: Yvonne C W
authors.initials: YC
authors.lastname: Yau
authors.affiliation: Hospital for Sick Children, University of Toronto, Ontario.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Richardson
mesh_terms: D017668:Age of Onset; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012307:Risk Factors
keywords: ELBW; congenital candidiasis; invasive candidiasis; neonatal candidiasis; systemic candidiasis