Apnea and Thrombocytopenia as Important Markers for Fungal Sepsis in the Neonatal Unit and the Role of Selective Fluconazole Prophylaxis
Journal Title: Journal of Medical Research and Practice - Year 2018, Vol 7, Issue 1
Abstract
Aim Neonatal fungal septicaemia is clinically indistinguishable from any other form of septicaemia and is associated with high mortality and morbidity. This study aims at evaluating the associated risk factors in fungal sepsis in the neonates and the effect of selective fluconazole prophylaxis. In the first eight months of this year long study, invasive fungal infection was detected in newborns admitted in Neonatal Unit and risk factors identified. Subsequently, in the next four months fluconazole prophylaxis was administered to newborns presenting with the same risk factors. Result and discussion Of total 1266 newborns, Invasive fungal infection was present in 48 cases, mostly premature (34). In all cases the causative organism was Candida. Thrombocytopenia was present in 100% cases . Apnea after the first week of life was present in 44 out of 48 cases (91.6%) and was significantly higher when compared to apnea due to other causes (Fishers Exact test P < 0.0001). All cases responded to fluconazole. Incidence of fungal sepsis was significantly reduced and mortality was less after implementation of fluconazole prophylaxis . Conclusion This study concludes that Thrombocytopenia and Apnea ( occurring after 7 days of life ) are important markers for fungal infection for term and preterm. Those on antibiotics for more than 10 days are at risk for Candida infection and Prophylactic fluconazole can help in reducing incidence of invasive fungal infection without the emergence of resistant strains. Also mortality in cases of fungal septicemia( in absence of antifungal prophylaxis ) is significantly higher than the mortality in bacterial septicaemia.
Authors and Affiliations
Debadatta Mukhopadhyay, Manoj Kumar Das, Kalyanbrata Mondal, Mousumi Nandi, Shibarjun Ghosh, Tridib Kumar Banerjee
Keywords
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