Findings Call for Earlier Treatment of Fungal Infections in NICU Babies

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Findings Call for Earlier Treatment of Fungal Infections in NICU

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FUNGAL INFECTIONS, NICU

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Released: Wed 21-Apr-2004, 02:00 ET

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A new UCLA study shows that 'time matters' when treating fungal

infections in neonates and that earlier treatment can mean the

difference between life and death.

Newswise ? A new UCLA study shows that �time matters� when

treating fungal infections in neonates and that earlier treatment

can mean the difference between life and death.

The findings, being presented May 1 at the Pediatric Academic

Societies� annual meeting in San Francisco, Calif., concluded that

while mortality rates in neonates were comparable regardless of the

location of the infection, the likelihood of death increased with

each day there was a delay in starting antifungal therapy after the

first positive culture.

�Fungal infections are an emerging health threat in neonates and

more research is needed to learn how to effectively treat them.

Traditionally, since fungal infections are considered �slow-

moving,� the standard protocol has been to wait for the laboratory

results before starting treatment,†explained Dr. Cahan,

neonatology Fellow at UCLA�s Mattel Children�s Hospital. �

There is already a known association between the delay of starting

antifungal treatment and mortality in adults. We wanted to

investigate how long physicians are waiting to start therapy in

neonates, and if it adversely affects the babyâ€?s outcome.â€

UCLA researchers conducted a retrospective study of neonatal

invasive fungal infections at a single neonatal intensive care unit

from 1998 to 2002. They examined the histories of 68 patients with

77 episodes of clinical sepsis in which a fungal pathogen was

isolated from blood, urine, fluid around the abdomen or lungs, or

breathing tube. The overall mortality rate was 34 percent.

Researchers determined that it took an average of almost 10 days

before antifungal treatment was started after a positive culture was

confirmed. Each day of delay in starting therapy was associated with

a 10.9 percent increase in risk of death. Adjustments to this

percentage were made for variables including culture site,

mechanical ventilation, use of central venous catheter access,

antibacterial drug usage and duration of hospitalization.

�Given all of the factors involved in the mortality rate of

neonates with fungal infections, we found that the most important

factor was delay of treatment,†said Cahan. �Our recommendation

is that neonatologists approach fungal infections the same as

bacterial infections and start treatment within 48 hours of drawing

cultures in high risk infants.â€

This research was partially sponsored by a training grant from the

National Institutes of Health.

Mattel Children�s Hospital at UCLA offers a full spectrum of

primary and specialized medical care for infants, children and

adolescents. Its mission is to provide treatment for children in a

compassionate atmosphere, as well as to conduct research that

improves the understanding and treatment of pediatric cases. For

more information, please visit http://www.mattel.ucla.edu.