Neonatal Fungal Sepsis Care Guideline Recommendations/Considerations Inclusion Criteria:
New onset signs and symptoms of infection
presence of ventilator, & candidacolonization. Duration of therapy Assessment
Vital signs, cardiac/respiratory/neuro status
Presence of central catheters (inspect sites) and/or
signs/symptoms, CSF, & radiologic abnormalities are resolved
Interventions
Labs: CBC w/ manual differential, CRP, CMP,
blood culture & Gram stain (central & peripheral), urine fungal cultureLumbar punctureID consult if blood culture is positive for Candida spp, or if the use of echinocandins or other
Safety Monitoring Fluconazole Hepatotoxicity: Monitor liver function enzymes at least weekly. Amphotericin B products Empiric Antifungal Therapy
Fluconazole 6 mg/kg IV q 24 hrs < 30 wks calculated
gestational age (CGA) or < 28 days old
Fluconazole 6mg/kg IV q 12hrs > 30 wks CGA and > 28 days
Alternatives
Consider alternative antifungal if previous use of fluconazole
prophylaxis or previously colonized with candida glabrata
respiratory rate) at baseline and observe first 5 minutes; record
Consider amphotericin B deoxycholate - 1 mg/kg/day for
hepatic dysfunction and urinary tract involvement
Consider liposomal amphotericin B - 3 mg/kg/day for hepatic
dysfunction without urinary tract involvement
Renal effects: Hypokalemia, nephrotoxicity, hypomagnesemia. Monitor laboratory values (BUN, creatinine, and electrolytes) at
Continued Considerations
Adjust antifungals per culture results, clinical status, and
For documented candidemia, obtain echocardiogram,
abdominal ultrasound, and Ophthalmology consult for retinal
common in neonates than in older children and adults.
Echinocandins
DC antifungal therapy if culture negative at 48-72 hrs and based
Remove central catheters (when possible) if infection related.
Reassess the appropriateness of Care Guidelines as condition changes and 24 hrs after admission. This guideline is a tool to aid clinical decision making. It is not a standard of care. The physician should deviate from the guideline when clinical judgment so indicates.
Approved Care Guidelines Committee 7-15-09
2009 Children’s Hospital of Orange County
(Computational Prediction of Drug Cardiac Toxicity) Predicting Drug Interactions The preDiCT project will model and ultimately predict the impact of pharmaceutical compounds on the heart’s rhythm using computer simulation. Using this information, the project hopes to identify new biomarkers which will provide more reliable indication of harmful drug side effects. Problem or Conte
IL BUON SCORRERE DELLA VITA. La felicità come fine etico supremo dentro il sistema dello stoicismo antico Emidio Spinelli Invitato a riflettere sul tema “Il concetto di felicità nella filosofia antica: dentro ils i s t e m a ? ” , mi sono trovato di fronte a un difficile bivio. Da una parte il pri m i s s i m opensiero è andato alla complessa e storicamente proficua trattazione dedic
Neonatal Fungal Sepsis