Earlier Treatment of Fungal Infections in Neonatal ICU Babies Can Mean the Difference Between Life and Death

LOS ANGELES -- 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, 2004 at the Pediatric Academic Societies' annual meeting in San Francisco, 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," said Dr. Heather 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 baby's outcome."

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," Cahan said. "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."

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.

Source: University of California, Los Angeles (UCLA), Health Sciences