The rising of Candida species as important pathogens in Neonatal Intensive Care Units following the increased survival of preterm (PT) infants is now already established. The progress in understanding and dealing with this infection is revealing focal, and sometimes silent complications of candidiasis.

After initiating echocardiogram studies in all patients with candidiasis in our unit we were able to detect right atrial masses in 6 cases, 5 of whom were PT. All patients shared some degree of perinatal asphyxia, needed mechanical ventilation, received broad spectrum antibiotics and parenteral nutrition with lipid emulsions. All cases also had central intravascular catheters and its maintenance after Candida isolation was the strongest predictor for atrial mass development.

Clinical treatment using extended doses of Amphotericin B (up to 50 mg/kg accumulated dose) was considered effective in 5 of this patients, with echocardiographic detection of masses involution from 20 mg/kg accumulated dose. One patient failed medical treatment and died of congestive complications attributed to the thrombus. Candida was isolated from this mass at necropsy.

The authors point out this complication as a potential source of associated morbidity in neonatal candidiasis and call attention to the need of routine echocardiographic evaluation and withdrawal of central catheters after diagnosis of this entity.