Hemodynamic profile of neonatal fungal sepsis with insights into the disease spectrum: a retrospective study.

BACKGROUND: Neonatal fungal sepsis is a significant contributor to late-onset sepsis in neonatal intensive care units, particularly among preterm and low-birth-weight infants. While its epidemiology and microbiology are well described, the hemodynamic profile remains poorly characterized. This study aimed to evaluate the clinical spectrum with a focused assessment of cardiovascular alterations using functional echocardiography. METHODS: Data for this retrospective observational study were collected from a tertiary care neonatal intensive care unit over a three-year period. Neonates with culture-proven fungal sepsis were included. Demographic, clinical, microbiological and outcome data were analyzed. Functional echocardiography was performed during active infection and repeated after microbiological clearance according to unit protocol. Paired hemodynamic comparisons were performed among survivors. RESULTS: Twenty-six neonates with fungal sepsis were included, of whom 73.1% were preterm and predominantly low birth weight. Non-Candida albicans species were the predominant isolates. Respiratory deterioration, feed intolerance and thrombocytopenia were common clinical manifestations, with frequent exposure to prolonged antibiotics, parenteral nutrition and central venous access. Functional echocardiography demonstrated significant cardiovascular involvement during active infection. Survivors showed reduced tricuspid annular plane systolic excursion (6.4 ± 1.2 vs. 7.8 ± 2.4 mm), elevated pulmonary artery systolic pressure (28.5 ± 17.3 vs. 12.8 ± 4.2 mmHg), and increased right ventricular output (315.0 ± 49.4 vs. 246.0 ± 27.1 mL/kg/min), suggesting right ventricular dysfunction with pulmonary vascular involvement and a hyperdynamic circulatory state. Diastolic dysfunction was reflected by lower tricuspid and mitral E/A ratios. Hemodynamic parameters improved following antifungal therapy and microbiological clearance, while left ventricular systolic function remained relatively preserved. Mortality was 19.2%. CONCLUSION: In this cohort, neonatal fungal sepsis was associated with reversible hemodynamic alterations, predominantly involving right ventricular function and the pulmonary circulation. Functional echocardiography may provide valuable physiological insights and assist targeted hemodynamic management. Although our study did not include a bacterial sepsis comparator cohort, the observed cardiovascular alterations are broadly consistent with those reported in published neonatal bacterial sepsis studies. CLINICAL TRIAL REGISTRATION: This study was registered with the Clinical Trials Registry of India (CTRI/2025/03/083270) on 23rd march 2025. Trial details are publicly accessible at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=127824.