II. Epidemiology
- Rare, but serious infection with risk of disseminated candidemia
- Onset at birth or in the first week of life
III. Pathophysiology
- Neonatal infection occurs from Candidal Chorioamnionitis
- Rare, despite the common Prevalence of Candida Vulvovaginitis in pregnancy (up to one third of women)
IV. Risk Factors
- Gestational age <27 weeks
- Birth weight <1 kg
- Intrauterine Device or other invasive/extensive procedures or instrumentation
- Cervical cerclage
V. Signs
- Diffuse desquamating dermatitis
- Diffuse erythema or
- Maculopapular or
- Papulopustular
- Distribution
- Involves back, skin folds, palms and soles
- Umbilical Cord may demonstrate white Plaques
- Diaper area is often spared (contrast with Neonatal Candidiasis)
VI. Labs
-
Potassium Hydroxide preparation (KOH prep)
- Pseudohyphae or spores
VII. Differential Diagnosis
- See Newborn Rash
- See Neonatal Pustules and Vessicles
-
Neonatal Candidiasis
- Common Diaper Rash occurs after first week of life
- Typically limited to the diaper area (or thursh)
VIII. Management
- Early systemic Antifungals (continue for 21 to 28 days)
- Amphotercin B 0.5-1 mg/kg/day OR
- Fluconazole 6-12 mg/kg/day
-
Topical Antifungals (combined with systemic above)
- Continue until skin lesions resolve
IX. Complications
- Disseminated Candidemia
- Increased risk with delayed diagnosis
- Mortality in newborns 8 to 40%