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Neonatal Fungal Sepsis
Care Guideline
Recommendations/Considerations
Inclusion Criteria:
New onset signs and symptoms of infection presence of ventilator, & candidacolonization.
Duration of therapy
Assessment
Vital signs, cardiac/respiratory/neuro status Presence of central catheters (inspect sites) and/or signs/symptoms, CSF, & radiologic abnormalities are resolved Interventions
Labs: CBC w/ manual differential, CRP, CMP, blood culture & Gram stain (central & peripheral), urine fungal cultureLumbar punctureID consult if blood culture is positive for Candida spp, or if the use of echinocandins or other Safety Monitoring
Fluconazole
Hepatotoxicity: Monitor liver
function enzymes at least weekly.
Amphotericin B products
Empiric Antifungal Therapy
Fluconazole 6 mg/kg IV q 24 hrs < 30 wks calculated gestational age (CGA) or < 28 days old
Fluconazole 6mg/kg IV q 12hrs > 30 wks CGA and > 28 days Alternatives
Consider alternative antifungal if previous use of fluconazole prophylaxis or previously colonized with candida glabrata respiratory rate) at baseline and observe first 5 minutes; record Consider amphotericin B deoxycholate - 1 mg/kg/day for hepatic dysfunction and urinary tract involvement Consider liposomal amphotericin B - 3 mg/kg/day for hepatic dysfunction without urinary tract involvement Renal effects: Hypokalemia, nephrotoxicity, hypomagnesemia. Monitor laboratory values (BUN, creatinine, and electrolytes) at Continued Considerations
Adjust antifungals per culture results, clinical status, and For documented candidemia, obtain echocardiogram, abdominal ultrasound, and Ophthalmology consult for retinal common in neonates than in older children and adults. Echinocandins
DC antifungal therapy if culture negative at 48-72 hrs and based Remove central catheters (when possible) if infection related.
Reassess the appropriateness of Care Guidelines as condition changes and 24 hrs after admission. This guideline is a tool to aid clinical decision making. It is not a standard of care. The physician should deviate from the guideline when clinical judgment so indicates. Approved Care Guidelines Committee 7-15-09 2009 Children’s Hospital of Orange County

Source: http://www.choc.com/careguidelines/NeonatalFungalSepsisCareGuideline.pdf

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