The Effect of Prophylactic Intravenous Fluconazole on the Clinical Outcome of Preterm Infants During Hospitalization

Objectives: Systemic fungal infection (SFI) is one of the most common causes of mortality, especially in preterm neonates. This fact necessitates the need to pay more attention to the prophylactic role of antifungal therapy in these neonates. The aim of this study was to evaluate the effect of intravenous fluconazole prophylaxis on the clinical outcome of preterm neonates during hospitalization. Materials and Methods: In a randomized, double-blind clinical trial, 93 preterm neonates with birth weight less than 1250 g without any major congenital anomalies were divided into control and case groups. Gestational week, birth weight, history of antenatal antibiotics and steroids administration and central venous catheter usage were recorded. During hospitalization, 3 mg/kg dose of fluconazole was administered for the case group for 6 weeks: in the first 2 weeks every 3 days, in the second 2 weeks every 2 days, and in the third 2 weeks every day; however, the control group did not receive fluconazole. The outcomes, including duration of mechanical ventilation, in-hospital mortality, and duration of oxygen requirement were ultimately recorded. The data from both groups were analyzed using statistical tests and compared to each other. Results: There were not significant differences in both groups in terms of gestational week of childbirth (P = .059), birth weight (P=.342) and antenatal steroids administration (P = .221); while duration of mechanical ventilation, duration of hospitalization and the mortality rate were significantly higher in the control group compared with the case group (P = .002), (P = .011) and (P = .045), respectively. Conclusion: The results show IV fluconazole administration for very low birth weight preterm neonates can improve the prognosis of fungal infection and reduce mortality.