Abstract:

BACKGROUND: Candida species are among the causes of late onset sepsis in very low birth weight neonates admitted in neonatal intensive care units worldwide. Candida colonization is reported to be among the major risk factor for candidiasis in neonate with low birth weight. It is estimated that of 23.5%-33% neonates with low birth weight colonized with candida species 20%-28% can be infected in their first two weeks of life and mortality rate estimated to be 30% . The stuation is worse in extremely low birth weight neonates where the mortality rate is estimated to be 50%-70% .Neonatal intensive care and premature units of Bugando Medical Center admitt approximately 40% neonates with low birth weight and approximately 10% neonates with extremely low birth weight every month with the mortality rate of 18%-19% due to sepsis like iliness.However the contribution of candida infections to the morbidity and mortality among these neonates are yet to be established.

OBJECTIVE:To determine the prevalence of Candida colonization, infection and factors associated with candida colonization among neonates with low birth weight.

METHODOLOGY: This hospital based cross sectional study was conducted between January 2019 and April 2019 among neonates with low birth weight, very low birth weight and extremely low birth weight admitted at Bugando medical center,Sekou Toure and Sengerema hospital in the neonatal wards. Clinical and social demographic data were collected using interviewee guide questionnaire. Oral and umbilical -rectum swabs were collected within 72 hours, day 7 and day 14 of life to assess colonization. Furthermore, under portable ultrasound guidance suprapubic urine sample was collected and blood from the vein for culture and sensitivity if the neonates develop clinical sign of sepsis within 14 days of life according to the World Health Organization. Data were analyzed using STATA version 13 following the study objectives.

RESULTS: A total of 320 neonates were enrolled with median age of 2days IQR (2-3) and median body weight of 1600 grams IQR (1-2). Prevalence of candida colonization was (52/320) 16.2% and candiduria was (1/320) 0.3%. Being a female neonate (OR: 0.5, 95%CI: 0.29-0.98, P=0.046), weight less than1500grams (OR: 3.9, 95%CI: 1.96-7.67, P= <0.001) and resuscitation at birth (OR: 2.5, 95%CI: 1.28-5.07, P=0.008) were factors associated with candida colonization among admitted neonates with low birth weight.

CONCLUSION AND RECOMMANDATION: A sixteen point two percent (16.2%) prevalence of candida colonization among neonates with low birth weight is alarming. Candida colonizations is more among male neonates with birth weight below 1500 grams and those who were resuscitated after delivery. A prevalence 0.3% of candiduria and no candida grew in blood. We recommend screening of candida particulary in neonates with low birth weight and those who being resuscitated after deliverly. Multicenter study utilizing advance techniques like PCR in identification of fungal pathogen from blood is recommended to unveil the contribution of fungi infections in neonatal sepsis.