II. Epidemiology

  1. Rare, but serious infection with risk of disseminated candidemia
  2. Onset at birth or in the first week of life

III. Pathophysiology

  1. Neonatal infection occurs from Candidal Chorioamnionitis
    1. Rare, despite the common Prevalence of Candida Vulvovaginitis in pregnancy (up to one third of women)

IV. Risk Factors

  1. Gestational age <27 weeks
  2. Birth weight <1 kg
  3. Intrauterine Device or other invasive/extensive procedures or instrumentation
  4. Cervical cerclage

V. Signs

  1. Diffuse desquamating dermatitis
    1. Diffuse erythema or
    2. Maculopapular or
    3. Papulopustular
  2. Distribution
    1. Involves back, skin folds, palms and soles
    2. Umbilical Cord may demonstrate white Plaques
    3. Diaper area is often spared (contrast with Neonatal Candidiasis)

VI. Labs

  1. Potassium Hydroxide preparation (KOH prep)
    1. Pseudohyphae or spores

VII. Differential Diagnosis

  1. See Newborn Rash
  2. See Neonatal Pustules and Vessicles
  3. Neonatal Candidiasis
    1. Common Diaper Rash occurs after first week of life
    2. Typically limited to the diaper area (or thursh)

VIII. Management

  1. Early systemic Antifungals (continue for 21 to 28 days)
    1. Amphotercin B 0.5-1 mg/kg/day OR
    2. Fluconazole 6-12 mg/kg/day
  2. Topical Antifungals (combined with systemic above)
    1. Continue until skin lesions resolve

IX. Complications

  1. Disseminated Candidemia
    1. Increased risk with delayed diagnosis
    2. Mortality in newborns 8 to 40%

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