Clinical Course and In-Hospital Complications of Fungal Sepsis in a Very Preterm Infant: A Case Report

Background: . Fungal sepsis is a serious complication in premature neonates and is associated with increased morbidity, particularly in infants requiring prolonged intensive care. Premature infants are at higher risk due to immune immaturity, respiratory instability, invasive procedures, and prolonged antimicrobial therapy. Aim: To present the clinical course, complications, and therapeutic management of a very preterm neonate with severe neonatal morbidity treated in a neonatal intensive care unit. Methods: We report a case of a female preterm neonate born at 30+5 weeks of gestation by cesarean section with a birth weight of 1370 g and Apgar score 6/6/6. The infant was admitted to the neonatal intensive care unit and required respiratory support and surfactant therapy. Clinical monitoring, laboratory investigations, microbiological cultures, imaging diagnostics, and multidisciplinary consultations were performed throughout the hospitalization. Results . The neonate initially presented with respiratory distress syndrome and received surfactant therapy using the LISA technique, followed by invasive mechanical ventilation due to episodes of apnea and clinical deterioration. During hospitalization, the patient developed late-onset neonatal sepsis caused by Candida albicans , confirmed by microbiological cultures of blood and cerebrospinal fluid. Treatment included intravenous fluconazole, followed by Amphotericin B due to persistent infection risk and prolonged clinical course. The clinical course was further complicated by meningitis, intraventricular hemorrhage, posthemorrhagic hydrocephalus, anemia of prematurity, and congenital cataract of the left eye. Neuroimaging studies confirmed ventricular dilation and periventricular leukomalacia. The infant required prolonged respiratory support, multiple courses of antibiotic and antifungal therapy, blood transfusions, and multidisciplinary management involving neonatology, neurology, cardiology, ophthalmology, and neurosurgery specialists. Conclusion: This case highlights the complex clinical course of very preterm neonates and the importance of early diagnosis, intensive monitoring, and multidisciplinary management. Severe complications such as fungal sepsis, intraventricular hemorrhage, and hydrocephalus significantly influence the outcome and require timely therapeutic interventions.