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

Korean Journal of Pediatrics 2007;50(7):636-642.
Published online July 15, 2007.
Fluconazole prophylaxis in high-risk, very low birth weight infants
Soo Young Kim, Soon Joo Lee, Mi Jeong Kim, Eun Song Song, Young Youn Choi
Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea
고위험 극소저체중 출생아에서 fluconazole 예방요법
김수영, 이준수, 김미정, 송은송, 최영륜
전남대학교 의과대학 소아과학교실
Young Youn Choi, Email: yychoi@chonnam.ac.kr
: 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.
: 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').
: 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).
: 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.
Key Words: Fluconazole prophylaxis, Very low birth weight infants, Fungal infection

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