Korean J Pediatr.  2007 Jul;50(7):636-642. 10.3345/kjp.2007.50.7.636.

Fluconazole prophylaxis in high-risk, very low birth weight infants

• Kim SY
• Lee SJ
• Kim MJ
• Song ES
• Choi YY

• KMID: 2278458
• DOI: http://doi.org/10.3345/kjp.2007.50.7.636

Abstract

PURPOSE: Fluconazole prophylaxis for very low birth weight (VLBW) infants has been shown to reduce invasive fungal infection and its mortality. This study aims to evaluate the effect of fluconazole prophylaxis in VLBW infants on the incidence and mortality of fungal infection.
METHODS
VLBW infants with endotracheal intubation and central vascular access admitted to the Neonatal Intensive Care Unit (NICU) at Chonnam University Hospital were enrolled. Twenty eight infants of 7-month baseline period from January to July 2005 ('non-fluconazole group') were compared with 29 infants of a 7-month fluconazole period from January to July 2006 ('fluconazole group').
RESULTS
Gestational age, birth weight, sex, mode of delivery, frequency of twin pregnancy, chorioamnionitis, antenatal steroid and rupture of membranes were similar between the fluconazole and non- fluconazole groups. The rate of extremely low birth weight (ELBW) infants, frequency and duration of prophylactic antibiotics, total parenteral nutrition and umbilical catheters, duration of intralipid, mechanical ventilation and nasal continuous positive airway pressure (CPAP) were also not significant. However, frequency of percutaneous central venous catheterization (PCVC) and intralipid administration, and duration of PCVC were significant between the two groups. The overall incidence and mortality of fungal infection were not different between the two groups. Although the Malassezia infection was increased in the fluconazole group (P<0.05), candida was significantly decreased compared to the non- fluconazole group (P<0.05).
CONCLUSION
Fluconazole prophylaxis in high risk VLBW infants decreased the candida infection significantly. Antifungal prophylaxis is recommended in terms of cost effectiveness, but further study is needed to clarify the reason for the increase of Malassezia infection.

Keyword

Fluconazole prophylaxis; Very low birth weight infants; Fungal infection

MeSH Terms

Anti-Bacterial Agents
Birth Weight
Candida
Catheterization, Central Venous
Catheters
Central Venous Catheters
Chorioamnionitis
Continuous Positive Airway Pressure
Cost-Benefit Analysis
Female
Fluconazole*
Gestational Age
Humans
Incidence
Infant*
Infant, Low Birth Weight
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care, Neonatal
Intubation, Intratracheal
Jeollanam-do
Malassezia
Membranes
Mortality
Parenteral Nutrition, Total
Pregnancy
Pregnancy, Twin
Respiration, Artificial
Rupture
Anti-Bacterial Agents
Fluconazole