Neonatal Gram Negative and Candida Sepsis Survival and Neurodevelopmental Outcome at the Corrected Age of 24 Months

Abstract

ObjectivesTo evaluate the long term neurodevelopmental outcome of premature infants exposed to either gram- negative sepsis (GNS) or neonatal Candida sepsis (NCS), and to compare their outcome with premature infants without sepsis.MethodsHistorical cohort study in a population of infants born at <30 weeks gestation and admitted to the Neonatal Intensive Care Unit (NICU) of the Academic Medical Center in Amsterdam during the period 1997–2007. Outcome of infants exposed to GNS or NCS and 120 randomly chosen uncomplicated controls (UC) from the same NICU were compared. Clinical data during hospitalization and neurodevelopmental outcome data (clinical neurological status; Bayley –test results and vision/hearing test results) at the corrected age of 24 months were collected. An association model with sepsis as the central determinant of either good or adverse outcome (death or severe developmental delay) was made, corrected for confounders using multiple logistic regression analysis.ResultsOf 1362 patients, 55 suffered from GNS and 29 suffered from NCS; cumulative incidence 4.2% and 2.2%, respectively. During the follow-up period the mortality rate was 34% for both GNS and NCS and 5% for UC. The adjusted Odds Ratio (OR) [95% CI] for adverse outcome in the GNS group compared to the NCS group was 1.4 [0.4–4.9]. The adjusted ORs [95% CI] for adverse outcome in the GNS and NCS groups compared to the UC group were 4.8 [1.5–15.9] and 3.2 [0.7–14.7], respectively.ConclusionsWe found no statistically significant difference in outcome at the corrected age of 24 months between neonatal GNS and NCS cases. Suffering from either gram –negative or Candida sepsis increased the odds for adverse outcome compared with an uncomplicated neonatal period.

Clinical profile of neonatal candidiasis in newborn nursery

“…4,5,7 A 4.9% candidemia incidence was documented in the neonatal intensive care unit. This was higher than in the study conducted by Celebi S et al and Jinjian Fu et al where the incidence documented was 1.1%.…”

“…2,3 Invasive candidiasis in neonates is a serious and common cause of late onset sepsis and has a high mortality (25 to 35%). 4 The incidence of such fungal infections has increased 11 fold over the past 15 years. Preterm infants are predisposed to Candida infections because of immaturity of their immune system and invasive interventions.…”

Evaluation of Panfungal Marker (1,3)-⃞-D-Glucanin Diagnosis of Invasive Infections with Candida Species

“…In our study we had few patients who presented with clinical signs of sepsis, with negative blood culture for fungi, but positive blood culture for bacteria (data not shown). There is a high probability that these were polymicrobial infections that were also described in many studies and could be an additional reason for false positive results of the BDG test [28]. For all these reasons, BDG assay must be used and interpreted with a great caution.…”

Correlation of blood culture and band cell ratio in neonatal septicaemia.

“…(2) A rising trend of the role of Candida species in the pathogenicity of neonatal sepsis has also been observed by several workers. (3)(4)(5)(6)(7) Incidence differs among hospitals depending on various factors such as obstetric and nursery practices, perinatal care, health and nutrition of mother and incidence of prematurity. Though a positive blood culture is the gold standard for the diagnosis of neonatal septicaemia, it does not provide a rapid diagnosis.…”

“…Though a positive blood culture is the gold standard for the diagnosis of neonatal septicaemia, it does not provide a rapid diagnosis. (3,8) Hence, there is a need to look for a reliable surrogate marker for neonatal septicaemia to start an empirical treatment till culture report is awaited. (8) The band cell ratio (ratio of mature to immature neutrophils) can be included in rapid diagnosis of neonatal septicaemia.…”