Invasive fungal infections in newborns and current management strategies

Abstract

Invasive fungal infections due to Candida are the third most common late-onset infection in infants born with birth weight <1500 g. Invasive candidiasis in infants born with birth weight <1000 g is associated with a 30% mortality and with neurodevelopmental impairment in more than half the survivors. A high degree of suspicion and a thorough multisystem evaluation is necessary for diagnosis of invasive fungal infections and to detect complications or sequalae. Amphotericin B deoxycholate is the mainstay in the treatment of invasive fungal infections in newborns. Early initiation of enteral feeds with human milk, decreasing dependence on catheters and avoidance of antacids, steroids and broad-spectrum antibiotics are the recommended preventive measures. Fluconazole prophylaxis should be targeted towards neonates born with <1000 g in neonatal units where baseline rates of invasive candidiasis are more than 5%.