Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS

Objective. To determine factors predictive of obstructive neonatal cholestasis among Filipino infants and to describe their outcome.

Methods. Jaundiced infants within the first eight weeks of life with liver biopsy were included. Excluded were cholestasis secondary to metabolic or infective causes. Retrospective chart review (2009-2012) and prospective recruitment of patients (2013) were done. A final diagnosis of non-obstructive or obstructive neonatal cholestasis was made on clinical, biochemical, ultrasonographic, and histologic findings, using histology and/or operative cholangiogram as the gold standard. The outcome was assessed on the 6th and 12th months from diagnosis. The crude odds ratio for obstructive jaundice was computed. Multiple logistic regression on significant variables (p-value <0.05) was done.

Results. Two hundred sixty-three (263) patients were included: 161 with non-obstructive and 102 with obstructive cause. Mean age at first consult was higher in those with obstruction. On logistic regression, females (OR:2.3), absence of a family history of idiopathic neonatal hepatitis (OR:4), and persistently pale/acholic stools (OR:13) were predictive of obstruction. 85% of patients with a non-obstructive cause are alive and well, while 80% of patients with obstruction have died.

Conclusion. Among jaundiced infants females, the absence of a family history of idiopathic neonatal hepatitis and persistently pale yellow/acholic stools were predictive of obstruction. The outcome was poor in patients with obstructive jaundice.