Necrotizing enterocolitis and systemic candida infection in newborn with birth weight under 750 g

Background: Recent literature shows the association between necrotizing enterocolitis (NEC), extremely low birth weight and fungal infection. Numerous studies reports very severe prognosis (100% mortality). Because of this we decided to analyze all babies with NEC. Our aim was to show the correlation between Candida species and gastrointestinal perforation in premature infants and to value the outcome. Methods: We analyzed prospectively 41 infants admitted to the NICU and treated for invasive NEC from July 2006 to December 2017. Gender, gestational age, birth weight, perinatal asphyxia, umbilical catheter, intubation at birth, anti-fungal treatment, patent Botallo arterial duct, blood tests, urine, stool and blood cultures, bronchial washing, type of surgery and histological examination were evaluated in all patients. Results: Of 41 patients 12 (29%) had a birth weight between 450 and 750 g and gestational age between 23 and 25 weeks. Of these 7 (58%) had systemic candidiasis. All these patients were intubated and submitted to gentamicin-ampicillin sublactam-fluconazole prophylaxis. In all 7 patients bowel resection and ileostomy were performed. All infants (100%) had blood culture positive for Candida parapsilosis; 2 patients (28%) presented co-infection with Candida albicans and 1 (14%) with Candida tropicalis. Spore of Candida parapsilosis were found in bowel lumen. 3 patients (43%) died for fungal sepsis and multi-organ failure. Conclusion: Fungal sepsis is a source of significant morbidity and mortality in the newborn. Systemic candidiasis, especially by Candida parapsilosis, in ELBW with invasive NEC is a prognostic negative factor. So when early detected and appropriately treated the prognosis can be improved.