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Invasive fungal infection in very low birthweight infants: national prospective surveillance study
  1. L Clerihew1,
  2. T L Lamagni2,
  3. P Brocklehurst3,
  4. W McGuire4
  1. 1Tayside Institute of Child Health, Ninewells Hospital, Dundee, Scotland, UK
  2. 2Communicable Diseases Surveillance Centre, Health Protection Agency, London, UK
  3. 3National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  4. 4Centre for Newborn Care, ANU Medical School, Canberra, Australia
  1. Correspondence to:
    Dr McGuire
    Centre for Newborn Care, Canberra Hospital, ACT 2606, Australia; william.mcguire{at}


Objective: To describe the epidemiology of invasive fungal infection in very low birthweight (VLBW: <1500 g) infants in the United Kingdom.

Design: National prospective surveillance study between February 2003 and February 2004 using the British Paediatric Surveillance Unit reporting system reconciled with cases identified through routine laboratory reporting to the Health Protection Agency (England, Wales, and Northern Ireland), the Scottish Centre for Infection and Environmental Health, and the UK Mycology Reference Laboratory.

Results: Ninety four confirmed cases of invasive fungal infection were identified during the surveillance period giving an incidence of estimated annual incidence of 10.0 (95% confidence interval (CI) 8.0 to 12.0) cases per 1000 VLBW live births. Eighty one (86%) of the infants were of extremely low birth weight (ELBW: <1000 g), incidence 21.1 (95% CI 16.5 to 25.7) per 1000 ELBW live births. Candida species, predominantly C albicans and C parapsilosis, were isolated in 93% of cases. Most organisms were isolated from the bloodstream and urinary tract. Death occurred in 41% of the infected infants before 37 weeks postconceptional age.

Conclusions: The incidence of invasive fungal infection in VLBW and ELBW infants in the United Kingdom is lower than reported in previous studies from tertiary centres in North America and elsewhere. The associated late neonatal and post-neonatal death rates are substantially higher than expected in infants without invasive fungal infection. These data may inform decisions about the evaluation and use of antifungal infection control strategies.

  • ELBW, extremely low birth weight
  • VLBW, very low birth weight
  • very low birth weight
  • candida
  • surveillance
  • fungal infection

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  • Published Online First 6 December 2005

  • Competing interests: this study was partly supported by an educational grant provided by Pfizer UK Ltd. The company had no role in the collection, analysis, and interpretation of data, or in the writing of the report and the decision to submit the paper for publication

    Funding: partly supported by an educational grant provided by Pfizer UK Ltd

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