title: Adrenocortical insufficiency is not a problem in preterm infants treated with antifungal prophylaxis with fluconazole.
abstract: OBJECTIVE
  Fluconazole prophylaxis of invasive fungal infections is a cornerstone of neonatal care, but in vitro studies have shown that it inhibits corticosteroid production. This study assessed whether preterm infants demonstrated an association between fluconazole administration, and its duration, and symptoms of adrenocortical insufficiency.
  
  
  METHODS
  We compared two groups who were treated before and after we introduced the use of fluconazole to our neonatal intensive care unit. Infants with a gestational age of ≤27 weeks or with a birth weight of ≤750 g were considered for the retrospective analysis. In order to assess whether the duration of prophylaxis was related to adrenocortical insufficiency, regression models were performed in all preterm infants in the fluconazole group.
  
  
  RESULTS
  The fluconazole group (n = 37) and nonfluconazole group (n = 41) were compared. No differences were found in the percentage of infants with symptoms of adrenocortical insufficiency, such as hypotension or need of vasopressor therapy. The incidence of hypotension and the use of vasopressor therapy were not related to duration of fluconazole prophylaxis.
  
  
  CONCLUSIONS
  Fluconazole and it duration were not associated with the incidence of symptoms related to adrenocortical insufficiency. Further prospective trials are needed to better define the relationship between fluconazole and adrenocortical insufficiency.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Costa
authors.forename: G
authors.initials: G
authors.lastname: Barone
authors.forename: G
authors.initials: G
authors.lastname: Vento
authors.forename: C
authors.initials: C
authors.lastname: Tirone
authors.forename: S
authors.initials: S
authors.lastname: Perelli
authors.forename: C
authors.initials: C
authors.lastname: Romagnoli
mesh_terms: D000666:Amphotericin B / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000302:isolation & purification; D001034:Apgar Score; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002175:Candida / Q000302:isolation & purification; D018890:Chemoprevention / Q000379:methods; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006994:Hypoaldosteronism / Q000139:chemically induced*; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000517:prevention & control*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; C041989:amphotericin A; D000666:Amphotericin B; D015725:Fluconazole
keywords: Adrenocortical insufficiency; Fluconazole prophylaxis; Fungal infections; Preterm infants