HI all

what the indication to give antifungal medication for premature baby as prevention?when you start ?dose?duration?which medication?

thank

Hi there, we don't give any antifungal preventatively except Nystatin drops orally when the baby is on antibiotics. We do not have a problem with fungal infections.

Hi,

The incidence of fungal sepsis in VLBW infants varies 1. worldwide and 2.from NICU to NICU eg 2.1 in UK and 7-9% in USA

The above should dictates your local policy. So it'll be very helpful to go through say all your fungal sepsis for over say a 5yr period and make comparisons.

For prophylaxis, most places use: Nystatin or Fluconazole

Can l interest you in some very important articles along your line of enquiry?

1. Clerihew, L. Austin, N. McGuire, W. Prophylactic Systemic Antifungal Agents to Prevent Mortality and Morbidity in Very Low Birth Weight Infants. Cochrane Database Syst Rev 2007; 4.

2. Clerihew, L. McGuire, W. Antifungal Prophylaxis for Very Low Birth Weight Infants: UK National Survey. Archives of Disease in Childhood Fetal and Neonatal Edition 2008; 93: F238-9.

3. Brecht M, Clerihew, L. McGuire, W. Prevention and treatment of invasive fungal infections in very low birth weight Infants. Archives of Disease in Childhood Fetal and Neonatal Edition 2009; 94: F65-69

4. Benjamin D, Stoll B, Gantz M et al. Neonatal Candidiasis: Epidemiology, risk factors and Clinical judgement. Pediatrics 2010; 126(4):e865-e873

Kindly get these and have a read, they'll really help you make up your mind etc

Regards

J

We use fluconazole 3mg/kg q72h in VLBW started on first day of life until CVC is needed

Prophhylactic Antifungals indicated only if there is increase incidence of fungal sepsis( culture positive) in unit.

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