Prevention of Fungal Infection in Neonatal Intensive Care Unit.

Choi,  Young Youn

doi:2013.20.3.361

Neonatal Med > Volume 20(3); 2013 > Article

Review

Neonatal Medicine 2013;20(3):361-368.
DOI: https://doi.org/10.5385/nm.2013.20.3.361 Published online October 29, 2013.

Prevention of Fungal Infection in Neonatal Intensive Care Unit.

Young Youn Choi

Department of Pediatrics, Chonnam University Medical School, Gwangju, Korea. yychoi@chonnam.ac.kr

Abstract

Although advances in neonatal intensive care have led to an improved survival rate of extremely low birth weight infants, prolonged hospitalization of these critically ill infants has rendered them to be vulnerable to fungal infection in NICU. Because the incidence of fungal infection with related mortality and morbidity is inversely related to gestational age and birth weight, preventive measure is imperative to improve the survival rate and the outcome. There are many evidence-based reports for antifungal prophylaxis with fluconazole target infants <1,000 g and/or < or =27 weeks, because this group has a high infection-related mortality and neurodevelopmental impairment among survivors. However, interventions should begin with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor. Furthermore, policies for restrictive use of third-generation cephalosporins, H2-antagonists, proton pump inhibitors, and postnatal dexamethasone; follow of the guideline for central venous catheter care and removal; and feeding practices, with promotion of early feedings and breast milk, and supplementation with lactoferrin and or probiotics, may reduce the fungal infection. In conclusion, prophylactic systemic antifungal therapy along with comprehensive infection control measures, restrictive use of drugs and proper feeding practice reduce the incidence of invasive fungal infection in high risk very low birth weight infants in NICU. However, further study is needed for the routine use of prophylactic antifungal therapy because the effect on mortality rate was not significant and the data on the long-term neurodevelopmental consequences were limited. In addition, further data on the emergence of resistant organisms and Malassezia colonization are needed.

Key Words: Extremely low birth weight infant; Fungal infection; NICU; Mortality; Morbidity; Fluconazole; Prophylaxis