Abstract 133

Limited data are available on the mortality, morbidity and long term outcome of ELBW (<1000g) infants with invasive Candida infection. Aim: To determine the outcome of ELBW infants with candidemia and/or Candida meningitis. Methods: ELBW infants with positive Candida blood and/or CSF cultures, were identified between 1988 and 1996. A chart review was performed and outcome was compared to overall outcome for ELBW infants at our centres. Outcome definitions: Intact=no CP, cognitive impairment, hearing loss (HL) requiring aids or blindness. Mild to moderate delay=mild to moderate CP and/or Mental Development Index (MDI)<1 sd from mean. Severe impairment=severe CP and/or MDI<2 sd from mean and/or blindness and/or aided HL. Results: 44 infants were identified with gestational age of 24.7±1.6 wks, 23-28 wks (mean±sd, range) and birth weight of 695±133g, 500-980g. Mortality was 36%(16/44). 44% (7/16) were neither diagnosed nor treated prior to death. 8 infants had C. meningoencephalitis, 2 diagnosed on autopsy. All but 1 had poor outcome. Cranial ultrasonographic echogenic lesions were detected in 6 infants: 4/6 survived and did poorly, only 1/6 had a positive CSF culture. All survivors with renal fungal balls had subsequently normal renal function. Follow-up information at discharge and at 2 years corrected age was obtained on 26 infants. Table No significant difference was found in mortality (36% vs 35%), grade 3/4 IVH (19% vs 16%) and PVL (23% vs 12%) incidence. Conclusions: C. infection in ELBW infants has a significant impact on outcome, mainly on morbidity and long term disabilities. Multiple lesions on neuroimaging predict adverse developmental outcome and should be considered in care management.

Table 1
Full size table