Analysis Of Clinical Features On Invasive Fungal Infection In The Preterm Infants

Objective:Invasive Fungal infection in neonatal intensive care unit is a serious problem around the world, that is rare in full-term infants but in the high rate of preterm infants. The statistical data were different among different care units at home and abroad, the morbidity was increasing year by year. The influencing factors of the disease are many and complex, pathogen distribution is also in constant change. The early clinical manifestations of this disease is not typical, the relative specific and sensitive testing method is limited and less, this has brought huge difficulty to the early diagnosis and treatment, and once the disease progress the mortality and risk of complications is higher. This study collected the premature infants with invasive fungal infection from the second hospital of Jilin University from October 1st, 2013 to December 31 st, 2015, analyzing the morbidity, pathogens, risk factors, clinical signs and symptoms, treatment and prognosis, clarifying the occurrence regularity, and puts forward 10 suspected risk factors and 1 protective mean, selected a number of preterm infants with invasive fungal infection during the same period as a control group, analysis the related factors with the statistical method. To determine the independent risk factor for the disease, provide basis for clinical diagnosis and treatment, and make it possible to prevent the occurrence of the disease early.Methods: A retrospective case analysis study of 35 cases. Collecting the premature infants with invasive fungal infection from the Second hospital of Jilin University from October 1st, 2013 to December 31 st, 2015, analyzing and elaborating the characteristic of morbidity, pathogens, risk factors, clinical signs and symptoms, treatment and prognosis, clarifying the occurrence regularity, and puts forward 10 suspected risk factors and 1 protective mean, selected 105 cases of preterm infants with invasive fungal infection during the same period as a control group, analyzing the related factors with the statistical method, the data was analyzed by Chi square test and Logistic regression.Results: The incidence of the invasive fungal infection in our center was 1.89%, which is 6.18% in VLBW infants,18.75% in ELBW infants. The average gestational age was 31.1±2.6 weeks, birth weight was1462.2±509.2g, neonatal asphyxia, neonatal respiratory distress syndrome and bacterial infection were the common basis disease. The hospitalization time was 64.0±25.8 days. In 35 cases the mortality rate of 22.8%. Clinical symptoms occurred on 19.9±9.8 days. Fever(88.6%), feeding intolerance(74.3%) and poor response(68.6%), fluctuating Sa O2(51.4%) were common clinical symptoms, CNS was the common system in the infected organs and system, platelet reducing(43.3%) was meaningful. Candida albicans(62.9%) is the most common pathogen, followed by Candida parapsilosis(31.4%).The risk factors of premature infant invasive fungal infection were being used more than 2 kinds of antibiotics before blood culture. The use of probiotic maybe was not protective factor.Conclusions:1.The incidence of the invasive fungal infection in our center was 1.89%, which is 6.18% in VLBW infants,18.75% in ELBW infants.2.The invasive fungal infection was association with the significant high mortality(22.8%).3.In our center,the most frequently isolated species were Candida albicans(62.9%), followed by Candida parapsilosis(31.4%).4.Small gestational age, low birth weight, more than 2 kinds of antibiotics application, PICC, tracheal intubation, with asphyxia, RDS, bacterial infection, long time parenteral nutrition, the late Initial feeding were related to premature infants with invasive fungal infection, which being used more than two kinds of antibiotics successively or combined before the blood culture is an independent risk factor for the disease.5. There is no significant preventive effect of probiotics on invasive fungal infection in preterm infants.