Abstract 1276 Poster Session II, Sunday, 5/2 (poster 3)

Background: Vaginal colonization by Candida is common during pregnancy and has been shown to penetrate intact fetal membranes under in vitro conditions. Previous reports (Bailey et al. 1986) have documented that 30% of very low birth weight infants colonized by Candida at birth developed systemic infection. No differences could be demonstrated with respect to route of delivery and Candida sepsis.

Objective: To assess whether route of delivery has any impact on the incidence of systemic Candida infection in very-low birth weight infants (≤1250g).

Methods: Medical records of all infants with a birth weight ≤ 1250g admitted to the neonatal intensive care unit (NICU) between 1996-1998 were reviewed. Candida sepsis (CS) was defined as at least one positive blood culture or urine culture obtained by catheterization. In addition to route of delivery (Vaginal / Cesarean section), data on demographics, relevant antenatal and postnatal risk factors were collected.

Statistical analysis: Data was analyzed using χtest for nominal, unpaired t-test for continuous data and multiple logistic regression.

Results: Two hundred and four infants with birth weight ≤1250g were admitted during the study period. Infants with (n= 57) and without (n= 147) CS were compared. 3/57 (5.3%) infants with CS died during the study period. The mean age of onset of CS was 21±14 days. Candida albicans was the predominant isolate (40/57)= (70.0%). Birth weight (749 ±194 v 913±217g) and gestational age (25 ±1.7 v 27 ±2.3 wks) correlated significantly with CS. Significantly greater number of VLBW infants delivered vaginally (60% v 40%, p= .02) developed CS. Using logistic regression to control for birth weight, cerclage, total antibiotic days, duration of parenteral nutrition, intralipids, umbilical catheters and central lines, vaginal route of delivery (p= .03) was an independent predictor for the development of CS in infants ≤1250g. Antenatal steroid use, PROM and chorioamnionitis were identical between the groups. (Table)

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Conclusions: These results demonstrate that infants ≤1250g delivered vaginally were at increased risk for the development of CS. This select group of infants may benefit from oral nystatin prophylaxis shortly after birth. Prospective, randomized studies are needed to determine efficacy of oral nystatin prophylaxis in reducing colonization as well as Candida sepsis in premature infants ≤1250g.