Effect of fluconazole prophylaxis on Candida fluconazole susceptibility in premature infants.

Objectives: Extremely premature infants are at high risk of developing invasive candidiasis; fluconazole prophylaxis is safe and effective for reducing invasive candidiasis in this population but further study is needed. We sought to better understand the effect of prophylactic fluconazole on a selection of fluconazole-resistant Candida species. Methods: We evaluated the susceptibility to fluconazole of Candida isolates from premature infants (<750 g birth weight) enrolled in a multicentre, randomized, placebo-controlled trial of fluconazole prophylaxis. Candida species were isolated through surveillance cultures at baseline (study day 0-7), period 1 (study day 8-28) and period 2 (study day 29-49). Fluconazole MICs were determined for all Candida isolates. Results: Three hundred and sixty-one infants received fluconazole (n = 188) or placebo (n = 173). After the baseline period, Candida colonization was significantly lower in the fluconazole group compared with placebo during periods 1 (5% versus 27%; P < 0.001) and 2 (3% versus 27%; P < 0.001). After the baseline period, two infants (1%) were colonized with at least one fluconazole-resistant Candida in each group. Median fluconazole MIC was similar in both treatment groups at baseline and period 1. However, in period 2, median MIC was higher in the fluconazole group compared with placebo (1.00 versus 0.50 mg/L, P = 0.01). There was no emergence of resistance observed and no patients developed invasive candidiasis with a resistant Candida isolate. Conclusions: Fluconazole prophylaxis decreased Candida albicans and 'non-albicans' Candida colonization and was associated with a slightly higher fluconazole MIC for colonizing Candida isolates.

Periodic breathing and oxygen saturation in preterm infants at discharge.

OBJECTIVE: Periodic breathing (PB) is a common respiratory pattern in preterm infants. Our aim was to determine the influence of PB on the pattern of oxygenation in preterm infants with significant PB at discharge from hospital. STUDY DESIGN: Overnight 12-hour recordings of arterial O(2) saturation (SpO(2)), impedance breathing movement, nasal thermistor signals for airflow, and heart rate were performed in all preterm infants < or = 34 weeks' gestational age at birth, prior to hospital discharge. Infants had recovered from their neonatal complications and were not receiving methylxanthines or supplemental oxygen. Data from 28 infants who had significant PB (> or = 5% of quiet time artifact free) were further analyzed. Gestational age at birth was (median, range) 32 (27-34) weeks, and gestational age at recording was 35 (33-37) weeks. RESULTS: The baseline SpO(2) was 98% (92-100%). During PB, all infants had episodes when SpO(2) fell > or = 5%, and all except one had episodes when SpO(2) was < 90%. Sixty episodes of prolonged desaturation (SpO(2) < or = 80% for >/ or = 4 seconds) were recorded in 10 infants: 31 occurred during PB, 16 during hypopnea, 10 during apnea, and 3 occurred in the absence of these breathing patterns. During PB, nine infants (32%) had 1 to 13 episodes of prolonged desaturation, lasting 9 (4-76) seconds. CONCLUSION: We conclude that PB is a common cause of prolonged desaturation in preterm infants at discharge.