[Clinical significance of oral fluconazole prophylaxis against invasive fungal infection in preterm neonates with peripherally inserted central catheters].

Objective: With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions.

Method: This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions (alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis.

Result: Except for the proportion of infants born via vaginal delivery in the control group (56/118, 47.5%) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either. Nine infants developed invasive fungal infection in control group (7.6%), while no invasive fungal infection was found in prophylaxis group (0%, P = 0.01). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8.5% (10/118) and 6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks (P = 0.47 and 0.63); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5% (9/106) in prophylaxis group after 4 weeks (P = 0.62 and 0.15).

Conclusion: For infants with PICC insertions and gestational ages at birth ≤ 32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.