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Empirical Therapy of Fungal Infections in the Neonate
Neonates, especially low birth weight infants, are at high risk to develop certain invasive fungal infections. Among them, neonatal candidiasis explains the large majority of cases [163, 164, 350, 1128]. Many of the therapeutic interventions these babies require are among the usual risk factors for invasive candidiasis. Other fungal agents causing invasive diseases in neonates include Aspergillus fumigatus and Trichosporon beigelii [1278, 1977].
Unfortunately, there are no diagnostic tools that allow a clear and early identification of the sepsis syndrome produced by invasive fungal infections in this population. Therefore, even when empirical therapy to treat early occult fungal infections seems attractive, there is no data on when and how to administer appropriately antifungal therapy in these populations at risk [1915]. See our discussion of neonatal candidiasis for more details.
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References
163. Baley, J. E., R. M. Kliegman, and A. A. Fanaroff. 1984. Disseminated fungal infections in very low-birth-weight infants: therapeutic toxicity. Pediatrics. 73:153-7.
164. Baley, J. E., T. M. Kliegman, and A. A. Fanaroff. 1984. Disseminated fungal infections in very low-birth eight infants: clinical manifestations and epidemiology. Pediatrics. 72:144-152.
350. Butler, K. M., and C. J. Baker. 1988. Candida: an increasingly important pathogen in the nursery. Pediatr Clin North Am. 35:543-63.
1128. Johnson, D. E., T. R. Thompson, T. P. Green, and P. Ferrieri. 1984. Systemic candidiasis in very low-birth-weight infants (less than 1,500 grams). Pediatrics. 73:138-43.
1278. Lackner, H., W. Schwinger, C. Urban, W. Muller, E. Ritschel, F. Reiterer, M. Kuttnig-Haim, B. Urlesberger, and C. Hauer. 1992. Liposomal amphotericin-B (AmBisome) for treatment of disseminated fungal infections in two infants of very low birth weight [see comments]. Pediatrics. 89:1259-61.
1915. Rex, J. H., T. J. Walsh, J. D. Sobel, S. G. Filler, P. G. Pappas, W. E. Dismukes, and J. E. Edwards. 2000. Practice guidelines for the treatment of candidiasis. Clin. Infect. Dis. 30:662-678.
1977. Rowen, J. L., J. T. Atkins, M. L. Levy, S. C. Baer, and C. J. Baker. 1995. Invasive fungal dermatitis in the <1000-gram neonate. Pediatrics. 95:682-687.
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