Neonatal Med.  2013 Aug;20(3):361-368.

Prevention of Fungal Infection in Neonatal Intensive Care Unit

• Choi YY

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.

Keyword

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

MeSH Terms

Birth Weight
Candidiasis
Central Venous Catheters
Cephalosporins
Colon
Critical Illness
Female
Fluconazole
Gestational Age
Hospitalization
Humans
Incidence
Infant
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight
Infant, Newborn
Infant, Very Low Birth Weight
Infection Control
Intensive Care, Neonatal
Lactoferrin
Malassezia
Milk, Human
Obstetric Labor, Premature
Pregnancy
Probiotics
Proton Pump Inhibitors
Survival Rate
Survivors
Cephalosporins
Fluconazole
Lactoferrin
Proton Pump Inhibitors