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Candidal infections are one of the common causes of late-onset sepsis (LOS) among very low birthweight (VLBW) infants, and are associated with substantial morbidity and mortality. The aim of this study was to evaluate the perinatal and neonatal risk factors for fungal LOS compared with bacterial LOS in VLBW infants. This was a population-based observational study of VLBW infants in 28 neonatal intensive care units across Israel, with information on 11,830 infants born between 1995 and 2002 from the Israeli National VLBW infant database. The study population comprised 3054 infants with one or more episodes of LOS. Univariate analysis and logistic regression models were used to compare perinatal and neonatal risk factors between infants with fungal sepsis only (N=179) and those with bacterial sepsis only (N=2630). The mean birthweight and gestational age of infants with candidal LOS were significantly lower (940 g; 27.1 weeks) than those in the bacterial LOS group (1027 g; 28.3 weeks) (P<0.001). Logistic regression analysis showed that candidal sepsis, in contrast to bacterial sepsis, was independently associated with decreasing gestational age and bronchopulmonary dysplasia (BPD). In addition, BPD only [odds ratio (OR) 1.84; 95% confidence intervals (CI) 1.03-3.23] and BPD with postnatal steroid therapy (OR 2.66; 95% CI 1.59-4.46) were independently associated with an increased risk for candidal sepsis.

Ureaplasma urealyticum has been recognized as an important potential pathogen in premature neonates. Reported rates of colonization of the respiratory tract vary. Data on neonatal ureaplasma colonization outside the United States and Western Europe are rare. Therefore we prospectively studied nasopharyngeal and endotracheal colonization in a cohort of 114 preterm and 100 full term infants within 48 hours of birth. The colonization rate was 24% in the premature infants and zero in the full term infants. Bronchopulmonary dysplasia developed in 19% of infants with nasopharyngeal Ureaplasma colonization and in 4.6% of noncolonized infants (P < 0.03). Bronchopulmonary dysplasia developed in 40% of intubated infants with positive endotracheal Ureaplasma cultures and only in 9.8% of infants with negative endotracheal cultures (P < 0.04). Thus Ureaplasma colonization of either the nasopharynx or the trachea was associated with an increased risk for the development of bronchopulmonary dysplasia (relative risk, 4.0 and 4.1, respectively).