Dexamethasone therapy and Candida sepsis in neonates less than 1250 grams

Objective: To determine whether dexamethasone use increases the risk for Candida sepsis (CS) in very low birth weight premature infants (< 1250 g). Design: Retrospective chart review of all infants with a birth weight < 1250 g, admitted to the neonatal intensive care unit of the MetroHealth Medical Center, Cleveland, Ohio between January 1, 1996 and December 31, 1999. Infant groups with (n=65) and without (n=229) CS were compared. Results: Two hundred and ninety four infants with a birth weight < 1250 g were identified. CS was diagnosed at a median age of 18 days, and 6 of 65 (10%) infants died directly from Candida-related complications. Candida albicans (n=30, 60%) and Candida parapsilosis (n=14, 25%) were the predominant isolates. Use of dexamethasone in infants at risk for chronic lung disease before 14 days of age (p=0.001), duration of antibiotics (p=0.001), and total duration of parenteral nutrition and intralipid (p=0.0001) were all significantly greater in infants who developed CS. Regression analysis showed that duration of antibiotics before the diagnosis of Candida infection (r²=0.69, p=0.0002) and duration of dexamethasone (r²=0.93, p=0.0002) correlated with Candida infection. Early dexamethasone use was also related to the age at diagnosis of Candida infection (r²=0.51, p=0.01). Conclusions: Dexamethasone therapy and prolonged duration of antibiotics are associated with Candida infection in premature infants.