Eletel Lucy, Thomas Talia, Berry Emily A, Kearns Gregory L
Department of Medical Education, Anne Marion Burnett School of Medicine at Texas Christian University, Fort Worth, TX, USA.
Department of Pediatrics, Anne Marion Burnett School of Medicine at Texas Christian University, 1100 W. Rosedale St., Fort Worth, TX, 76104, USA.
Paediatr Drugs. 2025 Mar 21. doi: 10.1007/s40272-025-00688-4.
Fungal infections in neonates are potentially life threatening. The differential diagnosis for neonatal rashes is extensive, with common culprits including both bacteria and fungi. Candida albicans is the predominant fungal pathogen, causing infections that range from superficial disease to severe systemic conditions, including sepsis and meningitis. Neonates, especially those who are preterm, are particularly susceptible because of developmentally immature immune systems and the use of invasive procedures and devices in neonatal intensive care units. Congenital cutaneous candidiasis, acquired in utero or during delivery, can lead to disseminated infection with high mortality rates. Early diagnosis and prompt antifungal treatment are crucial but challenging because of subtle clinical presentations, making accurate identification of the offending organism essential for selecting the appropriate treatment. Candida species account for the majority of neonatal fungal infections, with different species necessitating distinct treatments because of varying susceptibility profiles. Aspergillus, another significant pathogen, poses high mortality risks and can present either cutaneously or systemically. Malassezia, though less common, primarily affects preterm infants with catheter-related fungemia. Other fungal species, including Zygomycetes, Trichosporon, and Cryptococcus, rarely produce neonatal infections but are noteworthy for consideration. Treatment of fungal infection is critical despite the relative paucity of information regarding the clinical pharmacology of many antifungal drugs in neonates. We review the major antifungal agents (e.g., amphotericin B, the echinocandins, the azoles) and provide pharmacologic and dosing information. Finally, preventive strategies, including the use of stringent aseptic techniques and careful clinical monitoring, are essential to mitigate both the incidence and severity of these infections in neonates and infants in the first months of life.
新生儿真菌感染可能危及生命。新生儿皮疹的鉴别诊断范围广泛，常见的病原体包括细菌和真菌。白色念珠菌是主要的真菌病原体，可引起从浅表疾病到严重全身感染的各种感染，包括败血症和脑膜炎。新生儿，尤其是早产儿，由于免疫系统发育不成熟以及在新生儿重症监护病房中使用侵入性操作和设备，特别容易受到感染。先天性皮肤念珠菌病，在子宫内或分娩期间获得，可导致播散性感染，死亡率很高。早期诊断和及时的抗真菌治疗至关重要，但由于临床表现不明显而具有挑战性，因此准确识别致病微生物对于选择合适的治疗方法至关重要。念珠菌属占新生儿真菌感染的大多数，由于敏感性不同，不同的菌种需要不同的治疗方法。曲霉是另一种重要的病原体，具有很高的死亡风险，可表现为皮肤或全身感染。马拉色菌虽然不太常见，但主要影响患有导管相关真菌血症的早产儿。其他真菌种类，包括接合菌、毛孢子菌和隐球菌，很少引起新生儿感染，但值得考虑。尽管关于许多抗真菌药物在新生儿中的临床药理学信息相对较少，但真菌感染的治疗仍然至关重要。我们回顾了主要的抗真菌药物（如两性霉素B、棘白菌素类、唑类），并提供了药理学和给药信息。最后，预防策略，包括使用严格的无菌技术和仔细的临床监测，对于降低新生儿和婴儿在生命最初几个月中这些感染的发生率和严重程度至关重要。
