Neonatal Candidiasis: Clinical Manifestations, Management, and Prevention Strategies

Invasive fungal infection in neonatal intensive care units remains a substantial health problem. Neonatal candidiasis is associated with substantial morbidity and mortality rates. This overview focuses primarily on invasive Candida infections in neonates and includes in-depth discussion of the clinical manifestations, risk factors, and treatments for candidiasis in this high-risk population. Strategies for prevention and management of invasive Candida infection, are addressed in the context of clinical studies and trials that have tested the benefits and risks of such therapeutic strategies. When new antifungal agents become available, further studies must be conducted to determine the optimal dosage, emergence of resistance, and safety in neonates. It is critical that each neonatal intensive care unit examine its invasive fungal infection rates and institute evidence-based prevention, including antifungal prophylaxis, in its high-risk patients and to have guidelines for appropriate antifungal dosing for treatment with central line removal to reduce the incidence and severity of invasive fungal infection in neonates. (J Pediatr 2010; 156: S53-67).