From the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pediatrics The Moncton Hospital, Moncton, New Brunswick, Canada.
Pediatr Infect Dis J. 2018 Nov;37(11):1154-1159. doi: 10.1097/INF.0000000000001968.
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.
新生儿菌血症与不良新生儿结局和更高的整体医疗保健支出相关。我们的目的是回顾加拿大新生儿侵袭性真菌感染（IFI）的流行病学。
使用加拿大新生儿网络（CNN）收集的数据进行回顾性队列研究。使用嵌套匹配队列研究设计，比较了 2003-2013 年期间出生时胎龄<33 周的新生儿（n=39305）中在住院期间被诊断为 IFI 的新生儿与无感染对照的风险因素和结局。
所有入院新生儿的 IFI 总发生率为 0.22%（n=286），而胎龄<33 周的新生儿 IFI 发生率为 0.64%。在分离株中，170 株（59%）为白色念珠菌，59 株（21%）为近平滑念珠菌。IFI 的危险因素是胎龄较低、男性、5 分钟时 Apgar 评分<7、疾病严重程度评分较高、母亲患有糖尿病和阴道分娩。IFI 新生儿的死亡率更高[校正比值比（aOR）：1.60；95%置信区间（CI）：1.06-2.43]、坏死性小肠结肠炎（aOR：2.97；95% CI：1.76-5.01）和严重早产儿视网膜病变（aOR：2.15；95% CI：1.26-3.67）的风险更高。
与其他大型人群队列研究相比，加拿大新生儿 IFI 的总体发生率较低，但死亡率和发病率仍然很高。
