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


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


METHODS
ELBW infants (BW<or=1,000 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).


CONCLUSIONS
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.
Aghai
Z H
ZH
Department of Pediatrics, Division of Neonatology, Cooper University Hospital-Robert Wood Johnson Medical School, One Cooper Plaza, Camden, NJ 08103, USA. aghai-zubair@cooperhealth.edu
Mudduluru
M
M
Nakhla
T A
TA
Amendolia
B
B
Longo
D
D
Kemble
N
N
Kaki
S
S
Sutsko
R
R
Saslow
J G
JG
Stahl
G E
GE
D000469:Alkaline Phosphatase / Q000097:blood; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D002177:Candidiasis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D016022:Case-Control Studies; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D012189:Retrospective Studies
D000935:Antifungal Agents; D015725:Fluconazole; D000469:Alkaline Phosphatase; D001663:Bilirubin