Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants

Smart Uko, Lamia M. Soghier, Melissa Vega, Jeremy Marsh, Gerald T. Reinersman, Lucille Herring, Viral A. Dave, Suhas M. Nafday, Luc P. Brion

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

OBJECTIVES. To assess whether targeted short-term fluconazole prophylaxis reduces late-onset (>3 days of age) invasive fungal infection (IFI) among very low birth weight infants and extremely low birth weight (ELBW) infants and to assess mortality rates, toxicity, and costs associated with this intervention. METHODS. An observational study of 2 subsequent epochs of inborn infants with birth weight of <1500 g or gestational age of <32 weeks, 1 before (control) and 1 after (fluconazole) initiation of routine targeted fluconazole prophylaxis in March 2003, was performed. Targeted fluconazole (3 mg/kg) prophylaxis was administered to infants for whom a decision was made to administer broad-spectrum antibiotics for >3 days. RESULTS. IFI was observed for 13 (6.3%) of 206 infants in the control epoch and 2 (1.1%) of 178 in the fluconazole epoch, with a common odds ratio of 0.166. Logistic regression analysis taking into account all published factors (except for fungal colonization) showed that the fluconazole epoch was associated significantly with lower IFI rates. We observed no change in late (>3 days) mortality rates (11 of 206 infants in the control epoch vs 8 of 178 infants in the prophylaxis epoch). The mortality rate for ELBW infants with IFI was low (15%) in our study. Fluconazole was administered to 81% of ELBW infants, who received a median of 8 doses, and 41% of larger infants, who received a median of 5 doses. The intervention was cost-effective, and the effective number needed to treat to prevent 1 IFI was 10. CONCLUSIONS. This study suggests that targeted short-course fluconazole prophylaxis in very low birth weight and ELBW infants may be efficacious and cost effective.

Original languageEnglish (US)
Pages (from-to)1243-1252
Number of pages10
JournalPediatrics
Volume117
Issue number4
DOIs
StatePublished - 2006

Fingerprint

Extremely Low Birth Weight Infant
Very Low Birth Weight Infant
Fluconazole
Costs and Cost Analysis
Mortality
Numbers Needed To Treat
Birth Weight
Observational Studies
Logistic Models
Odds Ratio
Regression Analysis
Invasive Fungal Infections

Keywords

  • Candida albicans
  • Candida lusitaniae
  • Candida parapsilosis
  • Extremely low birth weight
  • Fluconazole
  • Invasive fungal infection
  • Logistic regression analysis
  • Preterm
  • Prophylaxis
  • Very low birth weight

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Uko, S., Soghier, L. M., Vega, M., Marsh, J., Reinersman, G. T., Herring, L., ... Brion, L. P. (2006). Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants. Pediatrics, 117(4), 1243-1252. https://doi.org/10.1542/peds.2005-1969

Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants. / Uko, Smart; Soghier, Lamia M.; Vega, Melissa; Marsh, Jeremy; Reinersman, Gerald T.; Herring, Lucille; Dave, Viral A.; Nafday, Suhas M.; Brion, Luc P.

In: Pediatrics, Vol. 117, No. 4, 2006, p. 1243-1252.

Research output: Contribution to journalArticle

Uko, S, Soghier, LM, Vega, M, Marsh, J, Reinersman, GT, Herring, L, Dave, VA, Nafday, SM & Brion, LP 2006, 'Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants', Pediatrics, vol. 117, no. 4, pp. 1243-1252. https://doi.org/10.1542/peds.2005-1969
Uko, Smart ; Soghier, Lamia M. ; Vega, Melissa ; Marsh, Jeremy ; Reinersman, Gerald T. ; Herring, Lucille ; Dave, Viral A. ; Nafday, Suhas M. ; Brion, Luc P. / Targeted short-term fluconazole prophylaxis among very low birth weight and extremely low birth weight infants. In: Pediatrics. 2006 ; Vol. 117, No. 4. pp. 1243-1252.
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abstract = "OBJECTIVES. To assess whether targeted short-term fluconazole prophylaxis reduces late-onset (>3 days of age) invasive fungal infection (IFI) among very low birth weight infants and extremely low birth weight (ELBW) infants and to assess mortality rates, toxicity, and costs associated with this intervention. METHODS. An observational study of 2 subsequent epochs of inborn infants with birth weight of <1500 g or gestational age of <32 weeks, 1 before (control) and 1 after (fluconazole) initiation of routine targeted fluconazole prophylaxis in March 2003, was performed. Targeted fluconazole (3 mg/kg) prophylaxis was administered to infants for whom a decision was made to administer broad-spectrum antibiotics for >3 days. RESULTS. IFI was observed for 13 (6.3{\%}) of 206 infants in the control epoch and 2 (1.1{\%}) of 178 in the fluconazole epoch, with a common odds ratio of 0.166. Logistic regression analysis taking into account all published factors (except for fungal colonization) showed that the fluconazole epoch was associated significantly with lower IFI rates. We observed no change in late (>3 days) mortality rates (11 of 206 infants in the control epoch vs 8 of 178 infants in the prophylaxis epoch). The mortality rate for ELBW infants with IFI was low (15{\%}) in our study. Fluconazole was administered to 81{\%} of ELBW infants, who received a median of 8 doses, and 41{\%} of larger infants, who received a median of 5 doses. The intervention was cost-effective, and the effective number needed to treat to prevent 1 IFI was 10. CONCLUSIONS. This study suggests that targeted short-course fluconazole prophylaxis in very low birth weight and ELBW infants may be efficacious and cost effective.",
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AU - Uko, Smart

AU - Soghier, Lamia M.

AU - Vega, Melissa

AU - Marsh, Jeremy

AU - Reinersman, Gerald T.

AU - Herring, Lucille

AU - Dave, Viral A.

AU - Nafday, Suhas M.

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N2 - OBJECTIVES. To assess whether targeted short-term fluconazole prophylaxis reduces late-onset (>3 days of age) invasive fungal infection (IFI) among very low birth weight infants and extremely low birth weight (ELBW) infants and to assess mortality rates, toxicity, and costs associated with this intervention. METHODS. An observational study of 2 subsequent epochs of inborn infants with birth weight of <1500 g or gestational age of <32 weeks, 1 before (control) and 1 after (fluconazole) initiation of routine targeted fluconazole prophylaxis in March 2003, was performed. Targeted fluconazole (3 mg/kg) prophylaxis was administered to infants for whom a decision was made to administer broad-spectrum antibiotics for >3 days. RESULTS. IFI was observed for 13 (6.3%) of 206 infants in the control epoch and 2 (1.1%) of 178 in the fluconazole epoch, with a common odds ratio of 0.166. Logistic regression analysis taking into account all published factors (except for fungal colonization) showed that the fluconazole epoch was associated significantly with lower IFI rates. We observed no change in late (>3 days) mortality rates (11 of 206 infants in the control epoch vs 8 of 178 infants in the prophylaxis epoch). The mortality rate for ELBW infants with IFI was low (15%) in our study. Fluconazole was administered to 81% of ELBW infants, who received a median of 8 doses, and 41% of larger infants, who received a median of 5 doses. The intervention was cost-effective, and the effective number needed to treat to prevent 1 IFI was 10. CONCLUSIONS. This study suggests that targeted short-course fluconazole prophylaxis in very low birth weight and ELBW infants may be efficacious and cost effective.

AB - OBJECTIVES. To assess whether targeted short-term fluconazole prophylaxis reduces late-onset (>3 days of age) invasive fungal infection (IFI) among very low birth weight infants and extremely low birth weight (ELBW) infants and to assess mortality rates, toxicity, and costs associated with this intervention. METHODS. An observational study of 2 subsequent epochs of inborn infants with birth weight of <1500 g or gestational age of <32 weeks, 1 before (control) and 1 after (fluconazole) initiation of routine targeted fluconazole prophylaxis in March 2003, was performed. Targeted fluconazole (3 mg/kg) prophylaxis was administered to infants for whom a decision was made to administer broad-spectrum antibiotics for >3 days. RESULTS. IFI was observed for 13 (6.3%) of 206 infants in the control epoch and 2 (1.1%) of 178 in the fluconazole epoch, with a common odds ratio of 0.166. Logistic regression analysis taking into account all published factors (except for fungal colonization) showed that the fluconazole epoch was associated significantly with lower IFI rates. We observed no change in late (>3 days) mortality rates (11 of 206 infants in the control epoch vs 8 of 178 infants in the prophylaxis epoch). The mortality rate for ELBW infants with IFI was low (15%) in our study. Fluconazole was administered to 81% of ELBW infants, who received a median of 8 doses, and 41% of larger infants, who received a median of 5 doses. The intervention was cost-effective, and the effective number needed to treat to prevent 1 IFI was 10. CONCLUSIONS. This study suggests that targeted short-course fluconazole prophylaxis in very low birth weight and ELBW infants may be efficacious and cost effective.

KW - Candida albicans

KW - Candida lusitaniae

KW - Candida parapsilosis

KW - Extremely low birth weight

KW - Fluconazole

KW - Invasive fungal infection

KW - Logistic regression analysis

KW - Preterm

KW - Prophylaxis

KW - Very low birth weight

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DO - 10.1542/peds.2005-1969

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