71. Neonatal Candidiasis: Treatment and Prevention
Session: Symposium: Invasive Fungal Infections in Children
Thursday, October 18, 2012: 9:35 AM
Room: SDCC 33 ABC
Neonatal Candidiasis is associated with significant mortality and neurodevelopmental impairment especially for extremely low birth weight (ELBW, <1000g at birth) infants. Early treatment and central line removal improves survival and decreases end organ dissemination.  Prevention remains key as despite these measures, mortality is high and neurodevelopmental impairment still occurs in survivors. Strong evidence supports the use of both fluconazole and nystatin for prophylaxis.

The Red Book 2012 (The Report of the Committee on Infectious Diseases) recently released (June 15, 2012) guidelines that included updated information regarding antifungal prophylaxis for preterm infants <1000 grams. This report states that on the basis of current data, fluconazole is the preferred agent for prophylaxis and is recommended for ELBW infants.  

intravenous (IV) fluconazole prophylaxis has greater efficacy compared with enteral nystatin prophylaxis, is effective in the most immature patients, is less expensive, requires fewer doses, and can be administered to infants who have gastrointestinal disease or hemodynamic instability. Antifungal prophylaxis should be targeted to the the highest risk preterm infants which includes those <1000g and/or ≤27 weeksg gestation and started shortly after birth.  Delaying prophylaxis until additonal risk factors are present is not as effective.  Targeted fluconazole prophylaxis administered at 3 mg/kg twice a week, starting after birth until central or peripheral access is not longer required, appears to be the safest and most effective schedule in preventing invasive Candida infections while attenuating the emergence of fungal resistance.  This dosage and duration of chemoprophylaxis has not been associated with emergence of fluconazole-resistant Candida species.

With targeted antifungal prophylaxis, neonatal candidiasis and its associated mortality can be nearly eliminated in every NICU.

David A. Kaufman, MD, Pediatrics, University of Virginia School of Medicine, Charlottesville, VA

David Kaufman, MD is currently a Professor of Pediatrics at the University of Virginia School of Medicine. He graduated from the University of Pittsburgh School of Medicine (1990) and completed his Pediatric Residency at Albert Einstein Medical Center (1993) and a Fellowship in Neonatology at Children's Hospital of Philadelphia and the University of Pennsylvania (1996). He has published randomized controlled studies of fluconazole prophylaxis in preterm infants. Additionally, he has done basic science work examining the preterm immune system and has been involved in multicenter studies in the area of bacterial infection prevention in the NICU. He is the Chair of the Neonatal Sepsis Club at the Pediatric Academic Society Annual Meetings.

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