Routinary fluconazole prophylaxis in VLBW neonates: Is a right choise?

This is a retrospective cohort study with the aim of evaluating fluconazole efficacy in preventing invasive fungal infections in very low birth weight newborns, in our NICU setting. Neonates weighing less than 1500g at birth, born between January 2013 and Decem-ber 2014, were enrolled in the study. The primary aim was to assess the prevalence of fungal infections. The secondary aim was to identify newborns with a higher risk of invasive fungal infections as well as the incidence of complications after invasive fungal infection. 59 newborns were included in the study. Routine fluconazole prophylaxis at the dose of 3mg/kg i.v. every 72 hours was administered to 47/59 (79,7%). The overall pro-portion of invasive fungal infections was 17%, with no significant difference between neonates who underwent fluconazole prophylaxis (19,1%) and those who did not (8,3%) (p = 0,4). Candida parapsilosis was the most common isolated strain (90%). Lower gestational age, lower birth weight, surgery interventions and delayed initiation of enteral feeding were associated with invasive fungal infections. All septic newborns developed complications: bronchopulmonary dysplasia, retinopa-thy of prematurity and periventricular leukomalacia. None died due to Candida infec-tion. Our findings do not appear to support routine fluconazole prophylaxis in very-low-birth-weight infants.