Abstract
Objective: To assess the impact of a medical practice intervention on the incidence of Candida spp. sepsis among neonates with a birth weight ofH 750 grams admitted to a level 3 neonatal intensive care unit (NICU). Methods: In July 1996 implementation of medical practice included;(1) administration of oral nystatin (every 6 hours for the first week of life and with each antibiotic course during the first four weeks of life). (2) Modifying parameters for extubation, (3) Early discontinuation of central lines (UAC, UVC, PCVC, CL), (4) Parenteral nutrition (PN) and antibiotics. We reviewed charts and collected data from January 1, 1995 to December 31, 1998. Neonates who died atH 3days of age or were admitted atG 7days of age were excluded. The intervention group consisted of 69 neonates, admitted between July 1, 1996 and December 31, 1998 and the control group consisted of 45 neonates, admitted between January 1, 1995 and June 30, 1996. We measured the outcome by using student t test and standard logistic regression techniques. The above management plan was continued after the study period. Retrospective analysis of the incidence of Candida infection in NICU was followed for 1999 to 2004. Results: The intervention group experienced fewer episodes of Candida spp. sepsis, OR 0.07 (p=<0.0002) adjusting for gestational age, mode of delivery and number of days of central vascular access. The estimated gestational age was longer (EGA) (24.9 vs. 24.4 p=<0.05) and more neonates received feedings (93% vs. 73%, p=<0.05). Within the intervention group, exposure to high humidity environment was associated with a higher risk of Candida spp. sepsis, OR 10.5 (p<0.06). The incidence of candida spp. During 1999 to 2004 remained between 0% to 3%. Conclusion: Oral nystatin administration substantially reduced the risk of Candida spp. sepsis among neonates with birth weightH 750g, while vaginal delivery was an independent risk factor. High humidity environment may be an additional risk factor for developing Candida spp. sepsis. Table 1
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