Original Article

Journal of Perinatology (2006) 26, 550–555. doi:10.1038/sj.jp.7211570

Fluconazole prophylaxis in extremely low birth weight infants: association with cholestasis

Z H Aghai1, M Mudduluru1, T A Nakhla1, B Amendolia1, D Longo1, N Kemble1, S Kaki1, R Sutsko1, J G Saslow1 and G E Stahl1

1Department of Pediatrics, Division of Neonatology, Cooper University Hospital-Robert Wood Johnson Medical School, One Cooper Plaza, Camden, NJ, USA

Correspondence: Dr ZH Aghai, Department of Pediatrics/Neonatology, Cooper University Hospital-UMDNJ, 755 Dorrance Bldg, One Cooper Plaza, Camden, NJ 08103, USA. E-mail: aghai-zubair@cooperhealth.edu

Received 20 February 2006; Revised 16 June 2006; Accepted 6 July 2006.

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Abstract

Background:

 

Extremely low birth weight (ELBW) infants are at increased risk for invasive candidiasis and associated morbidity and mortality. The use of fluconazole prophylaxis in this population has raised a benefit versus risk concern among clinicians.

Objectives:

 

To evaluate the effectiveness and safety of fluconazole prophylaxis in ELBW infants.

Study design:

 

ELBW infants (BWless than or equal to1000 g) born during the pre-prophylaxis era (PPE, January 1998–February 2002) were compared with prophylaxis era (PE, March 2002–September 2005). Infants born during PE received fluconazole prophylaxis for 6 weeks, as long as they had intravenous access. Demographic and clinical data were collected. The two groups were compared for baseline demographics, risk factors for candidiasis, the incidence of invasive candidiasis, liver enzymes, alkaline phosphatase, and bilirubin (total and direct).

Results:

 

Nine out of 137 infants (6.6%) developed invasive candidiasis during PPE compared to none of 140 (0%) during PE (P=0.006). During PE, 60/140 (42.9%) infants developed conjugated hyperbilirubinemia compared to 12/137 (8.8%) during PPE (P<0.001).

Conclusion:

 

Although a fluconazole prophylaxis regimen for ELBW infants was effective in preventing invasive candidiasis, an increase in the incidence of conjugated hyperbilirubinemia was observed. Further studies are needed to evaluate the safety of fluconazole prophylaxis in this population.

Keywords:

fluconazole, candida, prophylaxis, extremely low birth weight, conjugated hyperbilirubinemia

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