Infections In Very Low Birth Weight Infants Research Articles

Efficacy and safety of fluconazole in prophylaxis of invasive fungal infections in very low birth weight infants: a Meta analysis

To assess the efficacy and safety of fluconazole in the prophylaxis of invasive fungal infection in very low birth weight (VLBW) infants. Databases including PubMed, Embase, the Cochrane Library, Wanfang Data, Weipu, and CNKI were searched for randomized controlled trials (RCTs) of prophylactic fluconazole in VLBW infants. Review Manager 5.3 software was used to perform a Meta analysis of the included studies. A total of 12 RCTs were included, involving 1 679 VLBW infants. The Meta analysis showed that prophylactic fluconazole significantly reduced the incidence of invasive fungal infection (RR=0.44, 95%CI: 0.27-0.71, P<0.001), the incidence of fungal colonization (RR=0.31, 95%CI: 0.24-0.40, P<0.001), and the mortality during hospitalization (RR=0.74, 95%CI: 0.58-0.94, P=0.01) compared with the control group. There were no significant differences between VLBW infants using different doses of fluconazole in the incidence of invasive fungal infection and fungal colonization (P>0.05). No significant differences were found in the incidence of fluconazole resistance and complications between the fluconazole and control groups (P>0.05). Prophylactic fluconazole can effectively and safely prevent invasive fungal infection in VLBW infants, even at a small dose.

Effect of a surveillance system for decreasing neonatal nosocomial infections.

Nosocomial infection in very low birthweight (VLBW) infants is a common complication with high morbimortality. New strategies to reduce its occurrence have recently led to the development of neonatal surveillance programs. To determine whether the NeoKissEs surveillance system implementation in our neonatal unit has been associated with a decrease in nosocomial infection in VLBW infants, as well as a reduction in the use of antibiotics and central venous catheters (CVC). Retrospective and descriptive study of infants <1500 g admitted between January 2011 and December 2017. Rates of use of antibiotics and CVC were calculated, as well as late-onset sepsis incidence. Data were compared before and after the surveillance system implementation. 299 patients were recruited. We excluded seven patients, who died <72 h. Of the remainder (n = 292), 149 were in the pre-intervention period and 143 in the post-intervention period. We found a significant decrease in the incidence density of sepsis comparing these two periods (5.98 vs. 4.08) (p = 0.03). Although no differences in antibiotic and CVC rates of use between both groups were found, a significant decrease in antibiotic use was observed comparing the first and last year of the intervention (38% vs. 24%) (p = 0.03). A higher percentage of breastfed infants was observed (39% vs. 59%) (p = 0.001) in the post-intervention group. Surveillance systems are useful to reduce nosocomial infection in VLBW infants. Reduction in antibiotic and CVC use requires longer intervention time. Promotion of breastfeeding seems to be a very effective associated strategy.

Urinary tract infection is common in VLBW infants

Determine the significance of urinary tract infection (UTI) as a cause of late onset sepsis (LOS) in very low birth weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU). Analysis of blood, cerebrospinal fluid and urine culture results in VLBW infants >72-h old, admitted to the Georgetown University Hospital NICU between 2005 and 2015. Of 527 VLBW infants, 297 (56.4%) underwent 911 evaluations for LOS; only one-third included urine cultures. UTI was diagnosed in 8.5% of VLBW infants (range 2-15.9%) and in 13.8% of infants weighing < 1000 g at birth. Gram-negative infections predominated. Concomitant blood cultures were negative in 96% of infants. UTI was more common than bloodstream infection by 2015. UTI is a significant cause of infection in VLBW infants. Urine culture should be included in all LOS evaluations in order to facilitate accurate diagnosis and appropriate antibiotic therapy.

Prevalence of Congenital CMV Infection and Antiviral Therapy in Very-Low-Birth-Weight Infants: Observations of the German Neonatal Network.

To determine the prevalence of congenital CMV infection (cCMV) in very-low-birth-weight infants (VLBWI) and to evaluate epidemiological characteristics of VLBWI with antiviral therapy (AT). CMV-specific PCR in umbilical cord tissue was performed (n=3330). Univariate analyses and logistic regression models were used to identify associations with outcome. 22/3330 VLBWI received AT (0.66%). 4 of these (0.12%) were PCR positive, with 2 VLBWI showing pathological screening for hearing loss. VLBWI with AT and negative PCR had significantly reduced mean birth weight (BW) and higher rates of small-for-gestational-age (SGA). Clinical sepsis, bronchopulmonary dysplasia (BPD), use of reserve antibiotics (RA) and treatment for retinopathy of prematurity were significantly increased. We further observed a higher need of transfusion of red blood cells (RBC), fresh frozen plasma and platelets. Logistic regression (controlled for gender, gestational age, SGA and BW) showed associations for AT and BPD (OR 3.4 [1.2-10.1], p=0.024), RA (OR 20.4 [4.2-98.9], p≤0.001), transfusions of RBC (OR 11.9 [1.3-105.7], p=0.026) and platelets (OR 8.7 [2.9-26.4], p≤0.001). All VLBWI with positive PCR received AT. We hypothesize from our data by assuming a postnatal aquired CMV infection in VLBWI with AT and negative PCR that VLBWI born SGA have a different risk profile. Further prospective studies concerning postnatal transmission should take VLBWI born SGA into account and should study the impact of infection on short- and long-term complications in this supposed vulnerable group.

Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible Staphylococcus aureus Infections in VLBW Infants

Background: Methicillin-susceptible Staphylococcus aureus (MSSA) is a major contributor to infectious episodes of very low birth weight infants (VLBWI), resulting in significant morbidity and mortality. Objective: To examine the efficacy and safety of surveillance cultures and the decolonization of MSSA-colonized VLBWI. Methods: VLBWI admitted to our neonatal wards in 2011-2016 were retrospectively analyzed. Rates of MSSA-attributable infections were compared before and after the implementation of active surveillance cultures and the decolonization of MSSA-colonized patients. The mupirocin susceptibility of isolated MSSA strains was routinely tested. Results: A total of 1,056 VLBWI were included in the study, 552 in the pre-intervention period and 504 in the post-intervention period. The implementation of surveillance cultures and decolonization of colonized patients resulted in a 50% reduction of incidence rates per 1,000 patient-days of MSSA-attributable infections (1.63 [95% CI 1.12-2.31] vs. 0.83 [95% CI 0.47-1.35], p = 0.024). No adverse effects were observed from application of the decolonization protocol with mupirocin and octenidin. No mupirocin-resistant MSSA strains were detected during the study period. Conclusion: Implementation of an active surveillance and decolonization protocol resulted in a reduction of MSSA-attributable infections in VLBWI.

Candida Colonization in Low Birth Weight and Very Low Birth Weight Infants in a Neonatal Intensive Care Unit

Background: Candida colonization is a major risk factor for invasive candidiasis in premature infants in the neonatal intensive care unit (NICU). Objectives: The purpose of this study was to determine the rate, risk factors, and sources of colonization in low birth weight (LBW) and very low birth weight (VLBW) infants in an NICU. Patients and Methods: All cases were classified in to 1 of 2 groups: LBW and VLBW. A questionnaire that collected demographic data was completed for each case. Swabs were obtained from the ear, umbilicus, and rectum, as well as catheters, tracheal tubes, and nasogastric tubes. Samples were cultured on Sabouraud dextrose agar. The data were analyzed using SPSS software. A P value < 0.05 was considered significant. Results: A total of 102 cases were examined in this study. The mean weight of the infants was 1720 ± 474 gr (range 850 - 2500 gr). Positive Candida cultures were isolated in 19 (31.7%) cases in the LBW group and 20 (47.6%) cases in the VLBW group. In addition, 36 (35.3%) cases showed signs of sepsis. The mortality rate was 1.7% (n = 1). The umbilicus and rectum were the most common sites for Candida colonization in both groups. The analysis also indicated that the duration of hospitalization, prolonged use of corticosteroids, central venous catheters, total parenteral nutrition, and mechanical ventilation were associated with candidiasis infection in VLBW infants while prolonged use of corticosteroids and central venous catheters were major risk factors associated with candidiasis infection in LBW infants. Conclusions: These results show that maturity and birth weight are related to a decrease in the risk of developing a candidiasis infection.

PC.54 A rare presentation of Malassezia fungaemia with liver abscess in preterm neonate

We present a 24 week old male infant weighing 758 gram with significant surfactant deficient respirtory distress. He was extubated on day 19 and remained on BIPAP until he was...

The mother as most important risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum -lactamase-producing Enterobacteriaceae (ESBL-E)

This study aimed to determine the prevalence of and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and methicillin-resistant Staphylococcus aureus (MRSA) in very low birth weight (VLBW; <1500 g) infants and their mothers. This investigation was conducted in the perinatal centre at the Charité Berlin between May 2012 and June 2013. VLBW infants and their mothers were screened for colonization with ESBL-E and MRSA. Demographic and clinical data were obtained from the German nationwide surveillance system for nosocomial infections in VLBW infants (NEO-KISS) and used to perform univariate and multivariate analyses. Of 209 VLBW infants, 12 (5.7%) were colonized with ESBL-E. Eighteen of 209 (8.6%) ESBL-E-tested neonates were related to an ESBL-E-positive mother. Univariate analysis, strain typing and multivariate analysis (OR 7.4, 95% CI 2.1-26.7, P = 0.002) identified an ESBL-E-positive mother and maternal-neonatal transmission as a main source of colonization. The prevalence of MRSA was 2.3% (5 of 221) among VLBW infants. One of the 221 (0.5%) MRSA-tested neonates was related to an MRSA-positive mother. No risk factors for transmission of MRSA could be detected in this study. Our study demonstrated that maternal-neonatal transmission of ESBL-E from mother to child is an important risk factor for colonization of VLBW infants. As a consequence, routine ESBL-E screening of neonates and mothers should be considered as a means of reducing neonatal morbidity and mortality.

Toll-like receptor genetic variants are associated with Gram-negative infections in VLBW infants

To test the hypothesis that single-nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes alter susceptibility to bacterial infections and modulate white blood cell (WBC) counts during infections in very low birth weight (VLBW) infants (birth weight <1500 g). VLBW infants recruited in a multicenter study were genotyped for nine functional TLR SNPs and associations between SNPs and infection rates examined. WBC counts obtained during infections were compared among infants with and without SNPs. In our cohort (n=408), 90 infants developed bacterial infections. Presence of TLR4 (rs4986790 and rs4986791) variants were associated with Gram-negative (G-ve) infections. Female infants heterozygous for the X-linked IRAK1 (rs1059703) SNP had less G-ve infections. In regression models controlling for confounders, the TLR4 (rs4986790) SNP was associated with increased G-ve infections. The TLR5 (rs5744105) variant was associated with elevated WBC counts during infections. TLR genetic variants can contribute to increased risk of bacterial infections and altered immune responses in VLBW infants.

Human Rhinoviruses in Severe Respiratory Disease in Very Low Birth Weight Infants

To assess incidence, burden of illness, and risk factors for human rhinoviruses (HRVs) in a cohort of very low birth weight (VLBW) infants. A 2-year prospective cohort study was conducted among VLBW premature infants in Buenos Aires, Argentina. Infants were enrolled in the NICU from June 1, 2003, to May 31, 2005, and managed monthly and with every acute respiratory illness (ARI) during the first year of life. Nasal wash samples were obtained during every respiratory episode and tested for HRV, respiratory syncytial virus (RSV), human parainfluenza viruses, influenza viruses, and human metapneumovirus using reverse transcriptase-polymerase chain reaction. Of 119 patients, 66 (55%) had HRV-associated ARIs. The incidence of HRV-associated ARI was 123 events per 100 child-years of follow-up. Of those infants experiencing an episode of bronchiolitis, 40% had HRV versus 7% with RSV. The incidence of HRV-associated bronchiolitis was 75 per 100 infant-years of follow-up. HRV was associated with 12 of 36 hospitalizations (33%), and RSV was associated with 9 of 36 hospitalizations (25%). The incidence of HRV-associated hospitalization was 12 per 100 infant-years of follow-up. The risk of HRV-associated hospitalization was higher for infants with bronchopulmonary dysplasia and those who were not breastfed. HRV is an important and frequent pathogen associated with severe respiratory infections in VLBW infants. Bronchopulmonary dysplasia and the absence of breastfeeding are risk factors for hospitalization. The results of our study reveal that HRV is the predominant pathogen of respiratory infections in premature infants.

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison

Background Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction. Objectives We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections. Design Observational study with two pretests and two posttest measurements and interrupted time series analysis. Setting A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands. Participants Healthcare professionals who had physical contact with very low birth weight (VLBW) infants. Methods The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis. Results During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% ( p < 0.001). Median (interquartile range) drying time increased from 4 s (4–10) to 10 s (7–14) ( p < 0.001). The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p = 0.03) and from 17.3% to 13.5% (22.0%, p = 0.03), respectively. At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI −1.41 to +1.60) per month and decreased with −1.25% (95% CI −4.67 to +2.44) after the intervention ( p = 0.51). The level of instant change was −14.8% ( p = 0.48). Conclusions The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.

A randomized controlled evaluation of absorption of silver with the use of silver alginate (Algidex) patches in very low birth weight (VLBW) infants with central lines

To measure systemic silver absorption when using silver-impregnated alginate central catheter dressings in very low birth weight (VLBW) neonates and to monitor blood stream infection. Fifty infants were enrolled in a prospective, randomized controlled trial lasting 28 days. Each patient was assigned to standard dressing or silver alginate (Algidex) group. Serum silver concentrations were obtained on day 1, 7, and 28. Significant differences in mean serum silver concentrations for the treatment versus standard dressing group were observed using student's t-test analysis. The silver alginate group had a 45.8% reduction in infection/1000 line days, although too few patients were enrolled to draw meaningful efficacy conclusions about prevention of blood stream infection. Mean serum silver concentrations in the treatment group were significantly higher than controls although below levels anticipated to result in toxicity. A large study evaluating reduced blood stream infections in VLBW infants is warranted.

The effect of fluconazole prophylaxis in very low birthweight infants is overestimated by before-after studies

BackgroundThe validity and applicability of before-after studies compared to randomised controlled trials (RCTs) of fluconazole prophylaxis for very low birthweight (VLBW) infants is uncertain.ObjectivesThe aim was to examine whether the...

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

Primary objective was to identify clinical factors and outcomes associated with leukocytosis in very low birth weight (VLBW) neonates. Secondary objective was to compare outcomes between infants with early-onset (<or=72 h of age) and late-onset leukocytosis (>72 h). A retrospective matched cohort study of VLBW neonates born at <or=30 weeks of gestation identified with a white blood cell count of >or=40,000 was undertaken. Matched infants had no leukocytosis and were of similar gestational age. Data on common neonatal morbidities were collected from charts. Leukocytosis was identified in 96 infants giving an incidence rate of 6.1%. Of all, 94 matched infants without leukocytosis were identified. There were no differences in the demographic features and risk factors between the two groups. The incidence of confirmed infection among infants with leukocytosis was 22%. No differences in common neonatal morbidities and mortality were identified between two groups. Late-onset leukocytosis (>or=72 h of age) was associated with sepsis and necrotizing enterocolitis. No differences in any of the other outcomes between early-onset and late-onset leukocytosis were identified. Leukocytosis, especially late onset, was associated with infection in VLBW infants. Late-onset leukocytosis was also associated with necrotizing enterocolitis indicating that postnatal age at time of leukocytosis should be considered when formulating clinical decisions.

A Comparison of AmBisome® to Amphotericin B for Treatment of Systemic Candidiasis in Very Low Birth Weight Infants

PurposeAmphotericin B is considered the treatment of choice for systemic candidiasis, but adverse effects may limit its use. An alternative option for the treatment of candidiasis includes lipid preparations of amphotericin B. This study investigated the safety and efficacy of AmBisome®, a lipid formulation of amphotericin B containing liposomal structures, for the treatment of systemic candidiasis in very low birth weight infants (VLBWI).Materials and MethodsData from 26 VLBWI treated with AmBisome® in the study group (AmBisome group) from October 2003 to July 2006 were compared with data from 20 VLBWI treated with amphotericin B as a historical control (Amphotericin group). This study was a prospective, historical control, multi-center trial.ResultsCandida spp. was isolated in 73% (19/26) of the cases for the AmBisome group and 90% (18/20) of the cases for the Amphotericin group. The fungal eradication rate and the time to eradication was 84% (16/19) and 9 ± 8 days in the AmBisome group, and 89% (16/18) and 10 ± 9 days in the Amphotericin group, respectively (p = 0.680 vs p = 0.712). The major adverse effects were lower in the AmBisome group (renal toxicity, 21% vs 55%, p = 0.029; hepatotoxity, 25% vs 65%, p = 0.014, AmBisome group vs Amphotericin group, respectively). There was no significant difference in mortality attributed to systemic candidiasis (12% in the AmBisome group, 10% in the Amphotericin group, p = 0.868).ConclusionAmBisome® is effective and safe for treating systemic fungal infections in VLBWI.

Fluconazole Prophylaxis Prevents Invasive Fungal Infection in High-risk, Very Low Birth Weight Infants

To evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight (VLBW) infants with central vascular access. A 3-year baseline period (1998 to 2000) was compared with a subsequent 3-year period (2001 to 2003) during which a different protocol for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fluconazole (Diflucan R) was administered for 28 days at a dose of 6 mg/kg every third day during the first week and daily after the first week. There were no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infection developed in 9 of the infants in the baseline group and in none of those in the fluconazole group (P=.003). A trend of decreasing mortality rate between the 2 groups (12.6% vs 8.1%; P=.32) was observed but was not statistically significant. No adverse effects of fluconazole therapy were documented. Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.

Monocyte switch in neonates: high phagocytic capacity and low HLA‐DR expression in VLBWI are inverted during gestational aging

Pre-term neonates are at high risk to develop early-onset sepsis which possibly is caused by an immature immune system. Monocytes play a pivotal role as professional phagocytic and antigen-presenting cells in the innate immunity. In the present study, we investigated in monocytes from cord blood the expression of human leukocyte antigen (HLA)-DR as a marker for antigen-presenting capability, the expression of the high-affinity receptor for IgG (FcgammaRI/CD64), and the capacity to phagocytize non-opsonized Escherichia coli. We compared 70 infants in three groups according to their gestational age (group I: 20 very low birth weight infants (VLBWI), 24-31 weeks of gestation; group II: 25 pre-term infants, 32-36 weeks of gestation, and group III: 25 term neonates). The expression of CD64 as well as the phagocytic capacity of monocytes from cord blood were highest in VLBWI (p < 0.05 and p < 0.01, respectively). In contrast, HLA-DR expression was significantly (p < 0.05) diminished in VLBWI, which possibly leads to a reduced antigen-presenting capacity. We conclude that monocytes have different functional properties during gestational aging, which perhaps participate in the high incidence of infections in VLBWI.

Infections in VLBW infants: studies from the NICHD neonatal research network

Infection is a serious complication among very low birth weight (VLBW) preterm infants hospitalized in neonatal intensive care units. This article reviews studies from the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network including infection data from observational studies and randomized controlled trials. Blood culture-proven early-onset sepsis (≤ 72 hours) was found in less than 2% of VLBW infants, but was associated with substantial morbidity and mortality. A change in pathogens causing early-onset sepsis among Network patients has been observed over the past decade, with a significant reduction in early-onset group B streptococcal infections, but also a significant increase in early-onset Escherichia coli infections. This change is particularly worrisome, because of the high death rate associated with gram-negative infections, including E coli. Late-onset (> 72 hours) sepsis developed in almost a quarter of infants. The vast majority of infections were caused by gram-positive agents, especially coagulase-negative staphylococci. The risk of late-onset sepsis was inversely related to birth weight and gestational age. Infants with late-onset sepsis were at increased risk for a number of neonatal morbidities, for prolonged hospitalization, and for death. The percentage of deaths attributed to infection increased with increasing postnatal age. The increasing survival of extremely immature infants has resulted in a cohort of infants at prolonged risk for acquired infection. Successful strategies to reduce infections among VLBW infants would improve survival, reduce neonatal morbidity, and reduce the high medical and social costs of VLBW infant care.

Low-dose vancomycin prophylaxis reduces coagulase-negative staphylococcal bacteraemia in very low birthweight infants

Very low birthweight (VLBW) infants undergoing neonatal intensive care are at risk of infection with coagulase-negative staphylococci (CONS). This study investigates the efficacy of twice daily, 1 h infusions of vancomycin (5 mg kg) in reducing CONS infection in VLBW infants receiving parenteral nutrition. Of 72 infants in the study, 37 were randomized to vancomycin and 35 to the control group. Clinical variables and mortality were similar in both groups. In the vancomycin group, 11 infants had one or more episodes of CONS bacteraemia compared with 17 in the control group. Two babies in the treatment group had more than one episode of CONS bacteraemia, compared with nine in the control group ( P = 0·02). There were 13 episodes of CONS bacteraemia in the vancomycin group compared with 29 in the control group. When only positive blood-cultures associated with a rise in C-reactive protein were considered, there were six episodes of CONS bacteraemia in the vancomycin group compared with 18 in the control group. Similarly there were five infants with one or more CONS infections compared with 11 in controls and one with more than one episode compared with six in the control group ( P = 0·05). Prophylaxis with intermittent low-dose vancomycin infusions may help reduce recurrent CONS bacteraemia in VLBW infants receiving parenteral nutrition.

Systemic fungal infection in very low-birth-weight infants.

This retrospective study was designed to investigate the related factors and outcome of systemic fungal infection in very low-birth-weight (VLBW) infants. Medical records of infants admitted to the neonatal intensive care unit of National Cheng Kung University Hospital between January 1990 and June 1994 were reviewed. Of the 262 VLBW infants, 15 (5.7%) had fungemia (14 Candida 1 Cryptococcus) during the study period. Among the fungemic infants, 60% also had urinary tract infection; 18% had central nervous system infection. Their mean birth weight was 1079 +/- 78 g (504-1474 g), and the gestational age was 28.6 +/- 0.6 weeks (23-32 weeks). Thirteen of them (87%) had respiratory distress syndrome and patent ductus arteriosus, while 60% had chronic lung disease. The percentage of antibiotic usage, parenteral hyperalimentation, endotracheal intubation, placement of central venous line and steroid therapy were 100%, 100%, 73%, 67% and 36% respectively. The mean age at diagnosis of fungemia was 40.5 +/- 4.8 days (10-76 days). Common clinical manifestations were respiratory deterioration (93%), poor feeding (58%) and fever (53%). The frequency of side effects of amphotericin B in decreasing order were: hypokalemia (54%), hyponatremia (31%) and decreased urine amount (23%). The mortality rate was 40%. It was concluded that systemic fungal infection in VLBW infants might result in high mortality and the side effects were high in the treated infants.