Oral Thrush in Newborns
Yes, newborns commonly develop thrush (oral candidiasis), especially in the first few weeks of life due to their immature immune systems and exposure to Candida species during birth or through breastfeeding. 1
Pathophysiology and Risk Factors
Oral thrush in newborns is primarily caused by Candida albicans, which accounts for the majority of neonatal candidal infections. Unlike in adults, Candida glabrata and Candida krusei are infrequent causes of infection in neonates 1.
Key risk factors include:
- Prematurity (especially extremely low birth weight infants <1000g)
- Exposure during vaginal delivery if mother has vaginal candidiasis
- Breastfeeding from a mother with Candida infection of the breasts
- Use of broad-spectrum antibiotics
- Compromised immune system
- Use of pacifiers or bottles that may harbor the fungus
Clinical Presentation
Thrush in newborns typically presents as:
- White, curd-like patches on the tongue, gums, inside of cheeks, or roof of the mouth
- Patches that don't wipe away easily (unlike milk residue)
- Discomfort during feeding in some cases
- Possible concurrent diaper rash with bright red, well-demarcated borders
Diagnostic Approach
Diagnosis is usually clinical, based on the characteristic appearance of white patches on oral mucosal surfaces. However, it's important to note that not all white patches in the infant's mouth are thrush. A study found that C. albicans was not discovered in some babies with clinical thrush, suggesting that the etiology of white patches can sometimes be unclear 2.
Treatment Algorithm
First-line treatment: Nystatin oral suspension
If nystatin fails or in severe cases: Fluconazole
For concurrent maternal breast infection:
- Treat both mother and infant to prevent reinfection 6
- Topical antifungal for mother's breasts may be necessary
Special Considerations
For Premature Neonates
- More vigilant monitoring is required as these infants are at higher risk for invasive candidiasis 4
- In premature neonates, cutaneous candidiasis can potentially become invasive and lead to disseminated disease 4
- For extensive rash or signs of systemic involvement, consider systemic antifungal therapy 4
For Invasive Candidiasis
If invasive disease is suspected:
- Amphotericin B deoxycholate at 1 mg/kg daily is recommended for neonates with disseminated candidiasis 1
- Lumbar puncture and dilated retinal examination are recommended if blood/urine cultures are positive for Candida species 1
- Central venous catheter removal is strongly recommended if present 1
Prevention Strategies
- Treatment of maternal vaginal candidiasis prior to delivery may prevent neonatal colonization 1
- Rigorous infection control measures in NICUs to prevent horizontal transmission 1
- Rational use of broad-spectrum antibiotics
- Keeping the diaper area clean and dry
- Addressing underlying causes of gastroesophageal reflux and vomiting 4
Common Pitfalls to Avoid
- Inadequate drying after cleaning, which promotes fungal growth 4
- Insufficient treatment duration (continue for at least 48 hours after symptoms resolve)
- Failure to treat both mother and infant in cases of breastfeeding-associated thrush
- Using occlusive barrier creams that may promote fungal growth 4
- Failing to evaluate for systemic spread in premature or immunocompromised infants
Remember that while oral thrush is common and typically benign in full-term healthy infants, it requires more careful monitoring and aggressive treatment in premature neonates due to their higher risk of developing invasive candidiasis.