[Controversies about the management of invasive fungal infections in very low birth weight infants].

OBJECTIVE This review encompasses the most recent publications about fungal infection in very low birth weight infants, keeping health professionals updated about this growing problem observed in neonatal units. SOURCES OF DATA Original and review articles published over the past 15 years were searched in MEDLINE and Lilacs, using the following keywords: preterm infant, very low birth weight infants, sepsis, fungal infection, antifungal, Candida, amphotericin and fluconazole. SUMMARY OF THE FINDINGS Invasive fungal infections affect especially preterm infants. Although new drugs (echinocandins) to treat fungal infection are available, amphotericin is the most widely used drug for the treatment of systemic candidiasis at this stage of life. Currently, there are four types of antifungal agents used in the treatment of fungal infections in neonates: polyene macrolides (amphotericin B deoxycholate and lipid preparations), azoles (triazoles), fluorinated pyrimidines (flucytosine) and echinocandins (caspofungin and micafungin). Two drugs capable of preventing invasive fungal infection are described: nystatin and fluconazole. The pharmacokinetics of fluconazole in the neonatal period is widely known and its prophylactic administration during the first six weeks of life has been associated with less invasive fungal infection in infants weighing less than 1,000 g at birth. CONCLUSIONS Fungal infections constitute an important problem in the neonatal intensive care unit and a better understanding of the incidence, diagnosis, clinical management, treatment, and prophylaxis is important in order to reduce morbidity and mortality. The identification of high-risk preterm infants and the implementation of prophylactic measures and early treatment may improve the outcome of these patients.