Neonatal Candidemia: Clinical Characteristics and Predictors of 28-Day Mortality

Abstract

Neonatal candidemia remains a major cause of morbidity and mortality in neonatal intensive care units, particularly among preterm and very-low-birth-weight infants. This retrospective cohort study evaluated the clinical characteristics, microbiological profiles, and factors associated with 28-day all-cause mortality in neonates with culture-proven candidemia admitted to a tertiary neonatal intensive care unit between January 2011 and December 2025. Demographic, clinical, microbiological, treatment, feeding, and outcome data were collected from medical records, and factors associated with mortality were analyzed using univariate and multivariable Firth-penalized logistic regression. A total of 48 neonates were included, with a median gestational age of 28 weeks (IQR 25–36) and a median birth weight of 967.5 g (IQR 765–2400). The incidence of candidemia was 0.4%. Candida albicans was the most frequently isolated species (66.7%). The 28-day all-cause mortality rate was 47.9% (23/48). Non-survivors had lower gestational age and birth weight and developed candidemia earlier than survivors. In the univariable analysis, breast milk exposure before the onset of candidemia was significantly more common among survivors than among nonsurvivors and should be considered a hypothesis-generating finding. In the multivariable analysis, inotropic support (aOR 14.69, 95% CI 2.66–124.74; p = 0.001) and thrombocytopenia (aOR 5.91, 95% CI 1.36–34.44; p = 0.017) were independently associated with 28-day all-cause mortality. In this cohort, inotropic support and thrombocytopenia were independently associated with 28-day all-cause mortality, whereas the association between breast milk exposure and survival was limited to the univariable analysis.