Risk factors for fungal infection in extremely low birthweight infants registered in the Korean neonatal network from 2013 to 2015: Male sex and hypotension.

BACKGROUND

In Korea, improvement in the survival rates of extremely low birthweight (<1,000 g) infants has led to neonatal infection, especially fungal infection (FI), in the neonatal intensive care unit. The purpose of this study was to determine the risk factors for FI by analyzing the incidence of FI in extremely low birthweight infants in Korea.

METHODS

Data from 5,320 very low birthweight (<1,500 g) infants registered from 2013 to 2015 in the Korean Neonatal Network were analyzed. The infants were divided into two groups based on the presence or absence of FI.

RESULTS

Among infants, 1,524 with gestational ages of <27 weeks and birthweights of <1,000 g were included. The incidence of FI was 7.3% (111/1,524) and mortality of the infants with FI was 40% (44/111). The mean gestational age of infants with FI was 24.8 ± 1.0 weeks, which was significantly lower than those without FI. After logistic regression, being male, and having hypotension within 7 days of birth were independent risk factors for FI. Moreover, hypotension was strongly associated with mortality in FI. Adverse outcomes such as severe bronchopulmonary dysplasia, bacteremia, and abnormal hearing test occurred more frequently in infants with FI than non-FI.

CONCLUSIONS

As male sex and hypotension within 7 days of birth increased the risk of developing FI in infants with gestational ages of <27 weeks and birthweights of <1,000 g, preventive strategies to reduce the incidence of FI are required for infants with risk factors for the development of FI.