Introduction Invasive fungal infections (IFI) in preterm neonates are rare, but associated with increased mortality and morbities, both short and long term. IFIs in preterms are also increasing globally.

Aims To review the epidemiology, risk factors, clinical course and outcomes of all IFIs in newborns at Singapore General Hospital for the period 1/1/2002 to 31/7/2012.

Methods Retrospective matched case-control study. Cases of IFI were matched 1:1 with another neonate of the same gestation in the same year of birth.

Results 6 cases of IFI were matched with 6 controls. All were extremely low birth weight (ELBW) infants. Many IFI cases had risk factors for sepsis perinatally.

Significant risk factors associated with IFI include surgery (OR 25.000 95% CI 1.200–520.734), more than 35 days of conventional ventilation (OR 25.000 95% CI 1.200–520.734), 9 lots of platelet transfusion or more (OR 7.000 95% CI 1.140–42.969), vancomycin (OR 25.000 95% CI 1.200–520.734) and cephalosporins (OR 6.000 95% CI 1.003–35.908).

5 out of 6 IFI presented with thrombocytopenia with elevated C-reactive protein. Other presentations included hypotension (3 out of 6), increased ventilation settings (2 out of 6) and leucopenia (2 out of 6).

All IFIs were Candida albicans. Multiorgan involvement is prevalent. All 6 IFIs had positive endotracheal as well as urine cultures. 3 had positive catheter tip cultures, 2 had positive peritoneal fluid cultures, and 1 had positive blood culture.

Conclusion Classical presentations and significant risk factors for IFI in ELBWs were identified which allowed earlier identification and possible modification of risks.