目的：分析新生儿念珠菌血症发生危险因素及预后不良危险因素，为临床诊治提供依据。方法：2017年1月至2024年12月，收集在上海市儿童医院新生儿病区通过血培养检出念珠菌确诊的感染时日龄≤28 d的57例新生儿念珠菌血症连续病例，分析患儿的临床特点、实验室检测和治疗情况。根据结局，将患儿分为死亡组（5例）和好转组（52例），分析新生儿念珠菌血症发生及预后不良危险因素。结果：57例新生儿念珠菌血症病例中，男性30例，女性27例，发生念珠菌血症时的中位日龄为14 d（四分位距10，20）。48例（84.21%）为早产儿（<37周），46例（80.7%）为低出生体重儿（<2 500 g），54例（94.7%）在发生念珠菌感染前有侵入性检查治疗操作史，55例（96.5%）在念珠菌感染前有抗菌药物使用史。病原学分析显示，患儿感染的念珠菌以近平滑念珠菌（46例，80.7%）为主，之后依次为白念珠菌（6例，10.53%）、光滑念珠菌（3例，5.26%）和季也蒙念珠菌（2例3.51%）。药敏检测结果显示无抗真菌药物耐药株。患儿从临床发生症状到确诊并进行抗真菌治疗的时长为（2.3±1.2） d，抗真菌治疗时长为29 d（四分位距23，37）。单因素分析显示，感染性休克、气管插管/机械通气、血小板计数（platelet，PLT）降低及降钙素原（procalcitonin，PCT）升高是新生儿念珠菌血症患儿死亡的危险因素（P<0.05）。结论：新生儿念珠菌血症发生的危险因素包括早产、低出生体重、有侵入性检查治疗操作史以及抗菌药物使用史，患儿感染的念珠菌以近平滑念珠菌为主。感染性休克、气管插管/机械通气是念珠菌血症新生儿死亡的危险因素，PLT和PCT可作为评估患儿预后的重要参考指标。

Objective This study aims to analyze the risk factors for the occurrence of neonatal candidemia and those associated with poor prognosis, thereby providing evidence for clinical diagnosis and treatment. Methods This retrospective study enrolled consecutive 57 cases of neonatal candidemia diagnosed by blood culture in the neonatal ward of Shanghai Children's Hospital between January 2017 and December 2024. All included neonates aged ≤28 days at the time of infection. The clinical features, laboratory findings, and treatment outcomes were analyzed. According to outcomes, the neonates were divided into death group (5 cases) and improved group (52 cases), and the risk factors for poor prognosis were analyzed. Results Among the 57 neonates with candidemia, 30 were male and 27 were female. The median postnatal age at the onset of candidemia was 14 days (interquartile range, 10, 20). Forty-eight cases (84.21%) were preterm infants (<37 weeks), 46 cases (80.7%) were low birth weight infants (<2 500 g), 54 cases (94.7%) had a history of invasive examination and treatment procedures before the onset of candidiasis, and 55 cases (96.5%) had a history of antimicrobial agent use prior to candidiasis. Etiological analysis showed that the predominant Candida species infecting the neonates was Candida parapsilosis (46 cases, 80.7%), follower by Candida albicans (6 cases, 10.53%), Candida glabrata (3 cases, 5.26%), and Candida guilliermondii (2 cases, 3.51%). Drug susceptibility test results indicated there was no antifungal drug-resistant strains. The time from the onset of clinical symptoms to confirmed diagnosis and initiation of antifungal therapy was (2.3±1.2) days, and the duration of antifungal treatment was 29 days (interquartile range, 23, 37). Univariate analysis showed that septic shock, tracheal intubation/mechanical ventilation, decreased platelet (PLT) count, and elevated procalcitonin (PCT) were risk factors for poor prognosis of neonatal candidemia (P<0.05). Conclusions The risk factors for neonatal candidemia include prematurity, low birth weight, a history of invasive examination and treatment procedures, and a history of antimicrobial drug use. The predominant pathogenic Candida species is Candida parapsilosis. Septic shock and endotracheal intubation/mechanical ventilation are risk factors for poor prognosis of neonatal candidemia. PLT and PCT can serve as important reference indicators for evaluating the prognosis of neonatal candidemia.