From the Guidelines
Environmental humidification should be discontinued in an infant with extensive candida skin infection covering over 40% of body surface area, as moisture promotes fungal growth and can worsen the infection. According to the most recent guidelines, neonatal candidiasis is a significant concern, especially in premature or low-birth-weight infants, and can lead to severe complications, including death and neurodevelopmental impairment 1. The primary goal is to create an environment that inhibits fungal growth while maintaining the infant's comfort and supporting skin healing.
To manage the infection, focus on treating the infection with topical antifungal medications, such as nystatin cream applied 3-4 times daily or miconazole 2% cream twice daily to affected areas after gentle cleansing. For severe or systemic infections, fluconazole may be prescribed at 12mg/kg daily, as recommended by population pharmacokinetic studies 1. It is essential to keep the infant's skin clean and dry, using gentle, fragrance-free cleansers and patting the skin dry rather than rubbing. Dressing the infant in loose-fitting, breathable cotton clothing and changing diapers frequently can also help reduce moisture.
Monitoring the infant's temperature closely after discontinuing humidification and adjusting environmental conditions accordingly is crucial. The guidelines emphasize the importance of prompt removal or replacement of central venous catheters (CVCs) in infants with candidemia to prevent prolonged infection, mortality, and long-term irreversible neurodevelopmental impairment 1. By following these recommendations and prioritizing the infant's comfort and skin healing, the risk of complications associated with neonatal candidiasis can be minimized.
From the Research
Environmental Humidification and Candida Skin Infection
- The decision to stop environmental humidification in an infant with a candida skin infection covering over 40% of their body should be based on the specific clinical context and the infant's overall health status.
- There is no direct evidence from the provided studies that addresses the use of environmental humidification in the treatment of candida skin infections in infants 2, 3, 4, 5, 6.
- However, it is known that high humidity can contribute to the growth of fungi, including Candida species 4.
- The treatment of candida skin infections typically involves the use of antifungal medications, such as clotrimazole, nystatin, and miconazole, which have been shown to be effective in treating cutaneous candidiasis 2, 3, 4.
- In severe cases of invasive candidiasis, systemic antifungal treatment may be necessary, and the choice of treatment should be guided by the susceptibility of the Candida isolate to different antifungal agents 5, 6.
Considerations for Infant Care
- Infants, especially those in critical care, are vulnerable to invasive Candida infections, and the use of antifungal prophylaxis may be considered in high-risk cases 5.
- The management of candida skin infections in infants should involve a comprehensive approach, including the use of antifungal medications, proper skin care, and measures to reduce the risk of infection spread.
- The role of environmental humidification in the management of candida skin infections in infants is not well established, and further research is needed to determine its potential impact on infection outcomes.