Abstract
OBJECTIVE: To determine whether dexamethasone use increases the risk for Candida sepsis (CS) in very low birth weight premature infants (<1250 g).
DESIGN: 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 (r2=0.69, p=0.0002) and duration of dexamethasone (r2=0.93, p=0.0002) correlated with Candida infection. Early dexamethasone use was also related to the age at diagnosis of Candida infection (r2=0.51, p=0.01).
CONCLUSIONS: Dexamethasone therapy and prolonged duration of antibiotics are associated with Candida infection in premature infants.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Johnson DE, Thompson TR, Green TP, Ferrari P . Systemic Candidiasis in very low birth weight infants (<1500 grams) Pediatrics 1984 73: 138–43
Baley JE, Kliegman RM, Boxerbaum B, Fanaroff AA . Fungal colonization in the very low birth weight infant Pediatrics 1986 78: 225–32
Baley JE, Kliegman RM, Fanaroff AA . Disseminated fungal infections in very low birth weight infants: clinical manifestations and epidemiology Pediatrics 1984 73: 144–52
Faix RG, Kovarik SM, Shaw TR, Johnson RV . Mucocutaneous and invasive Candidiasis among very low birth weight (<1500 grams) infants in intensive care nurseries: a prospective study Pediatrics 1989 83: 101–7
Huang YC, Li CC, Lin TY, Lien et al. Association of fungal colonization and invasive disease in very low birth weight infants Pediatr Infect Dis J 1998 17: 819–22
Kossoff EH, Buescher ES, Karlowicz MG . Candidiasis in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases Pediatr Infect Dis J 1998 17: 504–8
Bektas S . Decreased adherence, chemotaxis and phagocytic activities of neutrophils from preterm neonates Acta Pediatr Scand 1990 79: 1031
Blaschke-Hellmessen R . Vertical transmission of Candida and its consequences Mycoses 1998 41: 2 31–6
Stark AR, Carlo WA, Tyson JE et al. Adverse effects of early dexamethasone in extremely-low-birth-weight infant. National Institute of Child Health and Human Development Neonatal Research Network N Engl J Med Jan 11, 2001 344: 2 95–101
Stoll BJ, Temprosa M, Tyson JE et al. Dexamethasone therapy increases infection in very low birth weight infant Pediatrics Nov 1999 104: 5 e63
Lortie C, King GM, Adamson IY . Effects of dexamethasone on macrophages in fetal and neonatal rat lung Pediatr Pulmonol 1990 8: 3 138–44
Parimi PS, Birnkrant DJ, Rao LV, Diaz G, Moore JJ . Effect of dexamethasone lymphocyte subpopulations in premature infants with bronchopulmonary dysplasia J Perinatol 1999 19: 347–51
Bessler H, Straussberg R, Gurary N, Aloni D, Sirota L . Effect of dexamethasone on IL-2 and IL-3 production by mononuclear cell in neonates and adults Arch Dis Child Fetal Neonatal Ed 1996 Nov 75: 3 F197–201
Scwarze J, Bartmann P . Influence of dexamethasone on lymphocyte proliferation in whole blood cultures of neonates Biol Neonate 1994 65: 5 295–301
Botas CM, Kurlat I, Young SM, Sola A . Disseminated Candidal infections and intravenous hydrocortisone in preterm infants Pediatrics June 1995 95: 6 883–7
Xanthou M, Valassi-Adam E, Kintsonidou E, Matsaniotis N . Phagocytosis and killing ability of Candida albicans by blood leucocytes of healthy term and preterm babies Arch Dis Child 1975 50: 1 72–5
Katikaneni LD, Mathur S . Humoral immunity to Candida albicans (anti-candida antibody titers) in premature infants Am J Reprod Immunol 1990 May 23: 1 1–3
Shareef MJ, Myers TF, Mathews HL, Witek-Janusek L . Reduced capacity of neonatal lymphocytes to inhibit growth of Candida albicans Biol Neonate 1999 75: 1 31–9
Bektas S, Goetze B, Speer CP . Decreased adherence, chemotaxis and phagocytic activities of neutrophils of preterm neonates Acta Pediatr Scand 1990 Nov 79: 11 1031–8
Peng CT, Lin HC, Lin YJ, Tsai CH, Yeh TF . Early dexamethasone therapy and blood cell count in preterm infants Pediatrics Sep 1999 104: 3 Pt 1 476–81
Singh K, Chakrabarti A, Narang A, Gopalan S . Yeast colonization and fungemia in preterm neonates in a tertiary care unit Indian J Med Res Nov 1999 110: 169–73
Saiman L, Ludington E, Pfaller M . Risk factors for Candidemia in neonatal intensive care unit patients Pediatr Infect Dis J 2000 19: 4 319–24
Benjamin DK, Ross K, Mickenney R, Auten R, Fischer RG . When to suspect fungal infection in neonates; a clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase negative staphylococcal bacteremia Pediatrics 2000 106: 712–8
Seelig MS . The role of antibiotics in the pathogenesis of Candidal infections Am J Med 1966 40: 887–917
Mullett MD, Cook EF, Gallagher R . Nosocomial sepsis in the neonatal intensive care unit J Perinatol Mar–Apr 1998 18: 2 112–5
Leibovitz E, Iuster-Reicher A, Amitai M, Mogilner B . Systemic Candidal infection associated with use of peripheral vascular catheter in neonates — a 9-year experience Clin Infect Dis Feb 1992 14: 2 485–91
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pera, A., Byun, A., Gribar, S. et al. Dexamethasone Therapy and Candida Sepsis in Neonates Less Than 1250 Grams. J Perinatol 22, 204–208 (2002). https://doi.org/10.1038/sj.jp.7210699
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7210699
This article is cited by
-
IL-23 signaling prevents ferroptosis-driven renal immunopathology during candidiasis
Nature Communications (2022)
-
Risk factors and clinical analysis of peripherally inserted central catheter-related fungal colonization in premature infants
Scientific Reports (2021)
-
Is There Still a Place for Conventional Amphotericin B in the Treatment of Neonatal Fungal Infections?
Current Fungal Infection Reports (2012)
-
An Update on the Epidemiology of Candidemia in Children
Current Fungal Infection Reports (2012)
-
Recent Advances in the Detection of Neonatal Candidiasis
Current Fungal Infection Reports (2010)