Candidíase invasiva e alterações bucais em recém-nascidos prematuros

Abstract

Objective:To investigate prevalence of invasive candidiasis in a Neonatal Intensive Care Unit and to evaluate oral diseases and Candida spp. colonization in low birth weight preterm newborns.Methods:A descriptive epidemiological study performed in two stages. First, prevalence of candidiasis was analyzed in a database of 295 preterm patients admitted to hospital for over 10 days and birth weight less than 2,000g. In the second stage, oral changes and Candida spp. colonization were assessed in 65 patients weighing less than 2,000g, up to 4 week-old, hospitalized for over 10 days and presenting oral abnormalities compatible with fungal lesions. Swab samples were collected in the mouth to identify fungi.Results:Prevalence of candidiasis was 5.4% in the database analyzed. It correlated with prolonged hospital length of stay (p<0.001), in average, 31 days, and 85% risk of developing infection in the first 25 days. It correlated with low birth weight (p<0.001), with mean of 1,140g. The most frequent alterations were white soft plaques, detachable, in oral mucosa and tongue. Intense oral colonization by Candida spp was observed (80%).Conclusions:The frequency of invasive candidiasis was low and correlated with low birth weight and prolonged hospital stay. The most common oral changes were white plaques compatible with pseudomembranous candidiasis and colonization by Candida spp. was above average.

Oral care in prevention of ventilator-associated pneumonia in neonatal and pediatric intensive care unit: protocol proposal

“…1,4,6,19,25,[27][28][29]36 The use of sterile gauze can also be used for oral hygiene. 14,24,32,35,36,38 We do not recommend the use of cotton rods, as those used by Tinoco et al, 32 due to the risk of detachment of the cotton and difficulty of removal from the oral cavity.…”

“…Among the most recommended substances for toothless newborns and babies, we have: bicarbonate water at 3%, 24,34 enzymatic solution based on lactoperoxidase, 24,32 hydrogen peroxide, 24,35 distilled or sterile water 14,15,34,35,37 and saline solution. 14,29 It is crucial to be careful on the guidance on adjuvant solutions to the mechanical methods used in the cleaning of the oral cavity due to risk of damage to the oral mucosa.…”

“…It induces the formation of foam, which can, besides causing discomfort to the patient, be inhaled due to the swallowing reflex. 24,32,35 The use of distilled or sterile water showed no undesired effect and was indicated for being an effective method in assisting the removal of residues that may be in the oral cavity, in a safely manner since they occur in their neutral form and free from impurities. 5,14,15,34,35,37 In adults, we observed that the main substance used and recommended was the 0.12% chlorhexidine digluconate due to its bactericidal and bacteriostatic effects for up to 12 hours, and with wide range of bacterial reduction both aerobic and anaerobic, Gram-positive and Gram-negative.…”

“…Several products may be recommended for this purpose, such as lanolin, 24,32 petrolatum, 14,15 5% dexpanthenol, 36,38 essential fatty acids 36 and oral water-based lubricant. 24,36 We indicate the use of the gel of carboxymethylcellulose (CMC) at 3% due to the good results in relation to the hydration of oral mucosae.…”

“…The drooling can be treated with administration of scopolamine, and has been shown to be a safe and effective method, 32 avoiding rashes of the skin in the perioral region, decreasing the risk of infections and inhalation of the oropharyngeal contents.…”