Invasive candidiasis in infants weighing more than 2500 grams at birth admitted to a neonatal intensive care unit.

BACKGROUND: Because invasive candidiasis in newborn infants admitted to a neonatal intensive care unit (NICU) occurs most frequently in very low birth weight infants, the incidence of invasive candidiasis and its clinical features in infants > 2500 g birth weight have not been well-described. METHODS: We retrospectively reviewed the medical records of all infants with birth weight > 2500 g admitted to our NICU from 1986 through 1993 who developed invasive candidiasis during their hospitalization. RESULTS: Seventeen of 3033 (0.6%) infants with birth weights > 2500 g admitted to the NICU developed invasive candidiasis. All 17 infants had a condition that required prolonged NICU hospitalization; 13 of 17 (76%) had a major congenital malformation. CONCLUSION: The incidence of invasive candidiasis in infants with birth weights > 2500 g requiring admission to a NICU was much less than has been reported for very low birth weight infants. This review points out that in infants with birth weights > 2500 g who develop invasive candidiasis, major congenital malformations are the most frequent underlying conditions responsible for prolonged NICU hospitalization.

Measured energy expenditure in mechanically ventilated very low birth weight infants.

Forty-nine calorimetric studies were performed on 24 very low birth weight infants with respiratory distress syndrome on mechanical ventilation during the first seven postnatal days. Mean resting energy expenditure for the entire study was 59 +/- 21 kilocalories/kg daily, with a respiratory quotient of 0.93 +/- 0.1, reflecting the predominance of carbohydrate calories. A comparison of mean energy intake with mean resting energy expenditure showed a mean caloric deficit of 31 kcal/k daily during the first 4 postnatal days, followed by 3 days where resting energy expenditure was met by equivalent caloric intake. Wide variation was noted in resting energy expenditure.

Vitamin A in cystic fibrosis: case report and review of the literature.

Much has been learned about vitamin A physiology in the last 50 years, yet few changes have been made in therapy. Unfamiliarity with vitamin A bioavailability and distribution may inadvertently result in toxicity. A literature search demonstrates that hypovitaminosis A has rarely been reported in patients with cystic fibrosis, and may manifest very differently in children of different ages. Furthermore, hypervitaminosis A may present with similar features, and can result from correction of deficiency. We report such a case in a 4.5-month-old infant, newly diagnosed with cystic fibrosis, who suffered first from vitamin A deficiency and then vitamin A toxicity. A brief review of vitamin A physiology, deficiency, and toxicity is presented.