High-dose (5-7 mg/kg/day) liposomal amphotericin B was evaluated prospectively during the period 1995-2001 in 41 episodes of systemic candidiasis occurring in 37 neonates (36 of the 37 were premature infants with very low birth weights). Median age at the onset of systemic candidiasis was 17 days. Candida spp. were isolated from blood in all patients and from urine, skin abscesses and peritoneal fluid in 6, 5 and 1 neonates, respectively. Candidiasis was due to Candida parapsilosis in 17 cases, Candida albicans in 15 cases, Candida tropicalis in 5 cases, Candida guilliermondii in 2 cases, Candida glabrata in 2 cases and an unidentified Candida sp. in 1 case. Twenty-eight, five and eight infants received 7, 6-6.5 and 5 mg/kg/day, respectively. Median duration of therapy was 18 days; median cumulative dose was 94 mg/kg. Fungal eradication was achieved in 39 of 41 (95%) episodes; median duration of therapy until fungal eradication was 8.7+/-4.5 days. Fungal eradication was achieved after 10.9+/-4.8 days in patients who had received previous antifungal therapy compared to 8.2+/-4.3 days in those treated with liposomal amphotericin B as first-line therapy. One patient died due to systemic candidiasis on day 12 of therapy. High-dose liposomal amphotericin B was effective and safe in the treatment of neonatal candidiasis. Fungal eradication was more rapid in patients treated early with high doses and in patients who received high-dose liposomal amphotericin B as first-line therapy.
Outcomes, both short and long term, differ between singletons and multiplets. Recently, a number of large, well-designed studies have clarified these differences, particularly in light of major changes in perinatal and neonatal care that have influenced changing outcomes. Accordingly, this article will review risks for singletons, twins and higher-order multiples as whole groups and also after correction for gestational age and other potential confounding variables that differ markedly between the groups. In addition, we will focus on the effects of certain factors such as antenatal steroid therapy and gender. Finally, we will detail the specific long-term risks for multiples in terms of growth and neurodevelopmental disabilities.
Overall, it is clear that we must continue to investigate the most appropriate doses of the ideal preparation in the most appropriate target populations before we can let the steroid issues rest.
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