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Prophylactic fluconazole protocol in very low birth weight infants: invasive candidiasis prevention in a Latin American neonatal intensive care unit

Journal of Perinatology volume 43, pages 1139–1144 (2023)Cite this article

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Abstract

Objective

To evaluate the effect of prophylactic fluconazole for very low birth weight infants (VLBWI) in a neonatal intensive care unit (NICU) with a 7.8% incidence of invasive candidiasis (IC).

Study design

Interventional pre-post cohort study comparing 2 years with and without fluconazole prophylaxis protocol (2016–2018 = 228 infants and 2019–2021 = 125 infants). Fluconazole was administered to all extremely low birth weight infants (ELBWI) and infants with BW 1001–1500 g with risk factors or positive carrier cultures. Liver function tests were performed weekly.

Results

The incidence of IC decreased from 7.8% to 2.4% (OR:0.3, p = 0.05) with the use of prophylactic fluconazole for VLBWI and in ELBWI decreased from 16,7% to 3,7% (OR:0.1, p = 0.04). No significant differences were seen in mortality.

Conclusions

Fluconazole is a safe, effective, and feasible strategy to prevent IC in a Latin American country.

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Fig. 1: Schematic representation of fluconazole prophylaxis protocol in the intervention cohort.
Fig. 2: Flowchart of enrolled patients during intervention cohort.
Fig. 3: Incidence of invasive candidiasis comparing historical and intervention cohort.
Fig. 4: Trends in LFTs during first 6 weeks after birth.

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Data availability

Raw data used for Tables 1–3, Supplementary Tables 1, 2 and Figs. 1–4 is not available to protect patient’s privacy but it may be requested for further research to the corresponding author or the unit’s email (neosotero@ssmso.cl).

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Author information

Authors and Affiliations

  1. Pediatrics Division, Pontificia Universidad Católica de Chile, Santiago, Chile

    Daniela Valenzuela-Stutman

  2. Neonatology Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile

    Andrea Maccioni Romero

  3. Neonatology Department, Pediatric Division, Pontificia Universidad Católica de Chile, Santiago, Chile

    Andrea Maccioni Romero

  4. Pediatric Infectious Disease Department, Pediatric Division, Pontificia Universidad Católica de Chile, Santiago, Chile

    Patricio Astudillo

Authors
  1. Daniela Valenzuela-Stutman
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  2. Andrea Maccioni Romero
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  3. Patricio Astudillo
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Contributions

DVS collected data and wrote the manuscript. AMR developed the protocol of fluconazole prophylaxis in the unit, collected data and reviewed the manuscript. PA conducted the statistical analysis and reviewed the manuscript.

Corresponding author

Correspondence to Andrea Maccioni Romero.

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Competing interests

The authors declare no competing interests.

Ethics approval

Institutional review board of the Medicine School of the Pontificia Universidad Católica de Chile (Institutional Review Code: 200416008) and Servicio de Salud Metropolitano Sur Oriente. The study was conducted according to the Declaration of Helsinki principles.

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Valenzuela-Stutman, D., Romero, A.M. & Astudillo, P. Prophylactic fluconazole protocol in very low birth weight infants: invasive candidiasis prevention in a Latin American neonatal intensive care unit. J Perinatol 43, 1139–1144 (2023). https://doi.org/10.1038/s41372-023-01699-0

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