Neonatal fungemia is associated with adverse neonatal outcomes and higher overall healthcare expenditure. Our objective is to review the epidemiology of invasive fungal infections (IFIs) in neonates in Canada.
A retrospective cohort study using data collected by the Canadian Neonatal Network (CNN) was conducted. Using a nested matched cohort study design, risk factors and outcomes of neonates born <33 weeks gestation (n = 39,305) during 2003–2013 were compared between neonates diagnosed with an IFI during their stay to infection-free controls.
Overall incidence of IFI among all admitted neonates was 0.22% (n = 286), while the incidence of IFI in the group of neonates born <33 weeks gestation was 0.64%. Of the isolates, 170 (59%) had Candida albicans and 59 (21%) had Candida parapsilosis. Risk factors for IFI were lower gestation, male sex, Apgar score <7 at 5 minutes, higher severity of illness score, maternal diabetes and vaginal birth. Neonates with IFI had higher odds of mortality [adjusted odds ratio (aOR): 1.60; 95% confidence interval (CI): 1.06–2.43], necrotizing enterocolitis (aOR: 2.97; 95% CI: 1.76–5.01) and severe retinopathy of prematurity (aOR: 2.15; 95% CI: 1.26–3.67).
The overall incidence of IFI in neonates was low in Canada in comparison to other large population cohort studies; however, the mortality and morbidity remained high.
From the *Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
†Department of Pediatrics The Moncton Hospital, Moncton, New Brunswick, Canada
‡Department of Pediatrics, Regina General Hospital, Regina, Saskatchewan, Canada
§Department of Pediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada
¶Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
‖Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
**The Canadian Neonatal Network Investigators are listed in the Appendix.
Accepted for publication December 22, 2017.
Organizational support was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR, FRN87518) and in-kind support from Mount Sinai Hospital. Dr. Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, analysis and interpretation of the data; the writing of the report; and the decision to submit the manuscript for publication.
The authors have no conflicts of interest to disclose.
J. Y. T. conceptualized and designed the study, contributed to the interpretation of data, drafted the initial manuscript, and approved the final manuscript as submitted. A.R., A.S., R.C., J.B. and L.M. contributed to the concept, design and interpretation of data, critically reviewed and revised the draft manuscript for intellectual content and approved the final submitted version of the article. P.S.S. conceptualized, designed and supervised the study, contributed to the interpretation of data, critically reviewed and revised the manuscript for intellectual content and approved the final manuscript as submitted. All authors agree to be accountable for all aspects of the work presented, including the accuracy and integrity of the findings reported.
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Address for correspondence: Prakesh S. Shah, MD, MSc, Department of Pediatrics, University of Toronto, 19-231F, 600 University Ave, Toronto, ON M5G 1X5, Canada. E-mail: Prakeshkumar.Shah@sinaihealthsystem.ca.