Intraveneous fluconazole in prevention of infection in neonates under 1200 grams admitted to NICU

Background: With the increase in the number of premature neonates, there are concerns about the complications of this group. One of the common complications of preterm neonates is fungal sepsis. Therefore, this study was conducted to evaluate the efficacy of intravenous fluconazole on fungal sepsis and other complications related to premature newborns under 1200 g in a neonatal intensive care unit. Methods: The study was conducted by field trial. The intervention included intravenous injection of fluconazole (3 mg/kg, twice per week for 6 weeks) in neonates weighing less than 1200 gr in the Izadi Hospital in Qom, Iran. The intervention was conducted on September 2016 in entire population of the study. The control group was retrospective and from neonates admitted to Izadi Hospital, which were hospitalized before intervention. The outcomes (such as the need for amphotericin injection, death, fungal sepsis, time taken to reach enteral feeding and length of stay) were compared between the two groups. Results: There was no significant difference between the two groups regarding their sex ratio (P=0.139), gestational age (P=0.834), type of delivery (P=0.841) and birth weight (P=0.458). After the intervention, fungal sepsis (from 65% to 48.3%) and the need for amphotericin injection (from 27.1% to 5%) were significantly reduced, and the mortality rate decreased from 40% to 28.3%, but this decline was not statistically significant (P=0.178). After the intervention, the length of stay in hospital (P=0.142) and neonatal intensive care unit (P=0.422), time to reach the weight of 1500 gr (P=0.717), and time taken to reach enteral feeding (P=0.289) did not change significantly. Proportion of pneumothorax, apnea, necrotizing enterocolitis, retinopathy of prematurity and need for respiratory support did not change significantly. Conclusion: The present study showed that administration of venous fluconazole could reduce fungal sepsis in neonates weighing less than 1200 grams in the intensive care unit. However, this study failed to demonstrate the effect of fluconazole on death, pneumothorax, apnea and need for respiratory support.