STUDY OF EARLY-ONSET NEUTROPENIA IN VERY LOW-BIRTH WEIGHT NEONATES AS A RISK FACTOR FOR CANDIDA COLONIZATION

Abstract

Introduction: Candidal colonization and subsequent invasive infection are increasingly frequent
features in preterm neonates in neonatal intensive care units (NICUs), Candida infection accounts for
1.6–9% of late-onset sepsis in very low-birth-weight neonates, and up to16% in extremely low-birthweight
.Many risk factors, mainly related to the aggressive, intensive, and invasive care received
during long stay in NICU, are associated with Candidal colonization and invasive candidal infection.
Aim of the work: To evaluate the role of early onset neutropenia as a risk factor for candida
colonization in preterm VLBW neonates in NICU and The current role of granulocyte colonystimulating
factor in treatment of neonatal neutropenia &candidiasis .
Patients and methods: This case control study was conducted on forty four very low birth weight
(VLBW) neonates during the period from April 2010 to March 2011.This study comprised two main
groups of VLBW neonates (<1500gm).
Group I: twenty two VLBW neonates with early onset neutropenia ( EON ) in the 1st week of life
and this group subdivided into two equal sub groups Group IA: received recombinant granulocyte
colony stimulating factor(G CSF) in a dose of 10 μg /kg daily SC for 3 consecutive days Group IB:
received routine treatment.
All neonates were subjected to the following Full history taking ,clinical examination, Complete blood
picture ,C Reactive protein ,Liver and kidney functions, Candida isolation and identification from
cultures and differentiation of candida species using CHROMagar candida
Results:Our case-control study demonstrates that there is significant increase in overall candida
colonization in the 2nd week in neutropenic group and this means that early onset neutropenia is a
risk factor for candida colonization in all VLBW infants in NICU and we found that rhG-CSF
increase ANC, The timing of the changes in the ANC in the rhG-CSF-treated neonates occurs sooner
and remains longer than in the conventionally-treated control neonates. And rhGCSF failed to clear
candida colonization . our study showed that there is a significant difference in risk factors in
colonized and non colonized as regard to gender increase in female (p<0.05) normal vaginal delivery,
steroids prenatal or postnatal,3rd generation cephalosporine ,decreased body weight ,gestational
age,endotracheal intubation and H2 blocker (p<0.05). no significant difference in duration of hospital
stay and survival between group treated with rhG-CSF and group receive routine treatment.
Colonization occurred in 12 patient which represent (28%) C.albicans the most commonly isolated
species in colonized preterm and rectum is the most common site
Conclusion:Early onset neutropenia is independent risk factor for candida colonization and rhGCSF
correct neutropenia sooner and remains longer
Key words : Early onset neutropenia, very low birth weight, recombinant granulocyte colony
stimulating factor