The current challenge of neonatal candidiasis arises from the increased survival of very low birthweight infants. It is important to understand those factors affecting normal colonization of the neonate, concomitant with those factors that predispose to fungal invasiveness. Disseminated candidiasis may present with subtle signs and symptoms, but has the potential for a wide variety of organ system involvement. Early initiation of aggressive therapy, with careful monitoring, can lead to a successful outcome.