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Abstract：
BACKGROUND: Invasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future.
METHODS: The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared.
RESULTS: Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000-1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05).
CONCLUSIONS: Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.
METHODS: The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared.
RESULTS: Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000-1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05).
CONCLUSIONS: Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.
摘要：
背景：侵袭性真菌感染（FI）已成为NICU新生儿中日益严重的问题，和终末器官损害（EOD）是新生儿发病和死亡的主要原因之一。这项研究是为了总结流行病学的临床数据，危险因素，致病性病原体，为今后预防和治疗新生儿真菌感染提供参考。
方法：回顾性分析2009年1月至2022年12月在中国某三级NICU接受治疗的IMF新生儿的临床资料。包括病原体和EOD的发生率。将新生儿分为EOD组和非EOD（NEOD）组。一般特点,比较两组的危险因素和临床结局。
结果：本研究中包括223例IMF新生儿（男性137例，女性86例），中位胎龄（GA）为30.71（29,35）周，中位出生体重（BW）为1470（1120,2150）g。79.4％为早产儿，50.2％的人出生在≥28周，<32周，和37.7%，BW为1000-1499g。白色念珠菌(C.白色念珠菌）是最常见的念珠菌。在这些新生儿中，占所有病例的41.3%，其次是近平滑梭菌(30.5%)和光滑梭菌(7.2%)。223例中40例(17.9%)发生EOD。真菌性脑膜炎是最常见的EOD，占40例EOD病例的13.5%。早产率无显著差异,交货方式,EOD和NEOD组之间的GA和BW，但是有EOD的男婴比例高于没有EOD的男婴。产前使用皮质类固醇没有显着差异，气管插管,侵入性程序，使用抗生素，全胃肠外营养，输血,出生后使用皮质类固醇，两组之间的真菌预防和坏死性小肠结肠炎的发生率，但EOD组白色念珠菌感染病例的比例高于NEOD组(57.5%vs.37.7%）。与NEOD组相比,EOD组治愈或改善的婴儿比例显著降低(P<0.05),死亡或退出治疗的婴儿数量较多（P<0.05）。
结论：我们的回顾性研究表明，早产儿容易发生真菌感染，尤其是早产儿.白色念珠菌是最常见的念珠菌。对于IMF,是EOD的高危因素。EOD可发生在足月和早产儿，所以EOD的可能性应该考虑在所有的婴儿有FI。
方法：回顾性分析2009年1月至2022年12月在中国某三级NICU接受治疗的IMF新生儿的临床资料。包括病原体和EOD的发生率。将新生儿分为EOD组和非EOD（NEOD）组。一般特点,比较两组的危险因素和临床结局。
结果：本研究中包括223例IMF新生儿（男性137例，女性86例），中位胎龄（GA）为30.71（29,35）周，中位出生体重（BW）为1470（1120,2150）g。79.4％为早产儿，50.2％的人出生在≥28周，<32周，和37.7%，BW为1000-1499g。白色念珠菌(C.白色念珠菌）是最常见的念珠菌。在这些新生儿中，占所有病例的41.3%，其次是近平滑梭菌(30.5%)和光滑梭菌(7.2%)。223例中40例(17.9%)发生EOD。真菌性脑膜炎是最常见的EOD，占40例EOD病例的13.5%。早产率无显著差异,交货方式,EOD和NEOD组之间的GA和BW，但是有EOD的男婴比例高于没有EOD的男婴。产前使用皮质类固醇没有显着差异，气管插管,侵入性程序，使用抗生素，全胃肠外营养，输血,出生后使用皮质类固醇，两组之间的真菌预防和坏死性小肠结肠炎的发生率，但EOD组白色念珠菌感染病例的比例高于NEOD组(57.5%vs.37.7%）。与NEOD组相比,EOD组治愈或改善的婴儿比例显著降低(P<0.05),死亡或退出治疗的婴儿数量较多（P<0.05）。
结论：我们的回顾性研究表明，早产儿容易发生真菌感染，尤其是早产儿.白色念珠菌是最常见的念珠菌。对于IMF,是EOD的高危因素。EOD可发生在足月和早产儿，所以EOD的可能性应该考虑在所有的婴儿有FI。
