Fluconazole prophylaxis prevents invasive fungal infection in very low birth weight preterm infants

ABSTRACT

Neonatal candidiasis is associated with substantial morbidity and mortality rates. Despite the promising preliminary results observed in low birth weight [LBW] populations, the use of fluconazole to prevent fungal colonization and infection in preterm neonates in the NICU is still an open question and not yet recommended as a standard of care. The aim of the present work is to evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight [VLBW] infants and extremely LBW. We conducted a randomised clinical trial to evaluate the efficacy of fluconazole prophylaxis in VLBW preterm infants. There were two study groups Fluconazole group All preterm infants with birth weight less than 1500 grams admitted to Kasr El Aini Cairo University neonatal intensive care unit during a period from January 2006 to September 2006 were given prophylactic Fluconazole. This group was compared with a control group; All preterm infants [birth weight less than 1500gm] admitted to Kasr El Aini Cairo University neonatal intensive care unit during a period from April 2005 to December 2005 who did not receive fluconazole. There were no significant differences between the control and fluconazole groups in the base-line demographic characteristics or risk factors for fungal infection. Eight patients from the control group developed systemic fungal infection which was diagnosed by positive blood culture for candida. On the other hand none of the neonates receiving fluconazole developed candida infection. There was no significant difference in mortality between the two groups [38 infants in the fluconazole group died, as compared with 31 in the control group]. Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants. Further studies involving larger numbers are necessary