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. 2023 Apr 20:11:1145252.
doi: 10.3389/fped.2023.1145252. eCollection 2023.

Fungal infection and neurodevelopmental outcomes at 18-30 months in preterm infants

Qi Zhou  1 , Edmond Kelly  2 , Thuy Mai Luu  3 , Xiang Y Ye  4 , Joseph Ting  5 , Prakesh S Shah  2 , Shoo K Lee  2
Affiliations

Fungal infection and neurodevelopmental outcomes at 18-30 months in preterm infants

Qi Zhou et al. Front Pediatr. .

Abstract

Background: Invasive fungal infection (IFI) is associated with significant mortality and morbidity among preterm infants but there has been no population-based study of long-term neurodevelopmental outcomes. The objective of this study was to examine population-based incidence trends as well as mortality, short term in-hospital morbidity and long-term neurodevelopmental outcomes among preterm infants with IFI, non-fungal infections (NFI) and no infections in Canada.

Methods: We conducted a retrospective cohort study of 8,408 infants born at <29 weeks gestational age (GA), admitted to Canadian Neonatal Network neonatal intensive care units (NICU) from April 2009 to December 2017, and followed up at 18-30 months corrected age (CA) in Canadian Neonatal Follow-Up Network clinics. We compared mortality, long term neurodevelopmental outcomes and short term in-hospital morbidity among 3 groups of infants (IFI, NFI, and no infections).

Results: The incidence of IFI was 1.3%, non-IFI 26.9% and no infections 71.7%. IFI incidence varied between 0.93% and 1.94% across the study period with no significant trend over time. Infants of higher gestational age were significantly (p < 0.01) less likely to have IFI. Among infants with IFI, NFI and no infections, the incidence of the significant neurodevelopmental impairment (sNDI) was 44.26%, 21.63% and 14.84% respectively, while mortality was 50%, 25.35% and 22.25% respectively. Even after risk adjustment for confounders (GA, Score for Neonatal Acute Physiology Version II, ruptured membranes >24 h, maternal antibiotic treatment, antenatal steroid use, cesarean section), infants with IFI had significantly higher odds of sNDI than NFI (aOR: 2.19; 95% CI: 1.23, 3.91) or no infections (aOR: 2.97; 95% CI: 1.55, 5.71), and higher odds of mortality than NFI (aOR: 1.55; 95% CI: 1.07, 2.26) or no infections (aOR: 1.45; 95% CI: 0.97, 2.17).

Conclusions: Preterm infants with invasive fungal infections have significantly higher incidence of mortality and adverse neurodevelopmental outcomes than those with non-invasive fungal infections and no infections.

Keywords: fungal; morbidity; mortality; neurodevelopment; preterm.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart diagram for study population.
Figure 2
Figure 2
Rates of Invasive Fungal Infection (IFI) by year. No significant trend was observed (Armitage trend test: p = 0.27).
Figure 3
Figure 3
Decreasing rates of Invasive Fungal Infection (IFI) and mortality with increasing gestational age. (Armitage trend test: p < 0.0001).
See this image and copyright information in PMC

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