Fluconazole For Prevention Of Fungal Infection In Very Low Birth Weight Infants: A Clinical Retrospective Trial

Objective: 1)To analyze high risk factors,clinical manifestation and laboratory examination characteristics of fungal infection for very low birth weight infants(VLBWI)in neonatal intensive unit.2)To Explore the efficacy and safety of fluconazole against fungal infection for very low birth weight infants(VLBWI).Methods: We enrolled 60 VLBWI from the Neonatal Intensive Care Unit of the Second Hospital of Hebei Medical University in a clinical retrospective trial from March 2014 to October 2015.Eligibility criteria were gestational age(GA)<32 weeks,birth weight(BW)<1500g,hospital stay ?4 weeks.Infants in experimental group and control group received low-dosage fluconazole for prevention of fungal infection or matched placebo respectively.There were no difference in gestational age(GA),birth weight(BW),apgar score,basic condition,central venous catheter retention time,antibiotic use and other aspects in two groups.Total Bilirubin(TBIL),Direct Bilirubin(DBIL),Alanine aminotransferase(ALT),total bile acids(TBA)and Creatinine(Cr)of subjects were assayed in the second week,the fourth week of hospitalization.We observed the characteristics of clinical manifestation and laboratory examination of fungal infections cases.Statistical method: Statistical calculations were made with SPSS 21.0.Datas were expressed as the means ± SD or median(quarter).T test,rank test and X2 test were used for statistical analysis.Differences were considered statistically significant at P<0.05.Results:1 There were 2 cases suffered fungal infection in the experimental group,in which the incidence was 6.67%(2/30).Mean while there were 8 cases of fungal infection in control group,in which the incidence was 26.67%(8/30).There was statistically difference between two groups(P<0.05).There was 1 case of superficial fungal infection(thrush)and 1 case of deep fungal infection(fungal septicemia)in the experimental group.However,There was 2 cases of superficial fungal infection(thrush)and 6 cases of deep fungal infection(fungal septicemia in 6 cases,complicated with fungal pneumonia in 4 cases,fungal meningitis in 3 cases)in the control group.There was statistically difference between two groups(P<0.05);2 We compared 10 cases of fungal infection and 50 cases of non-fungal infection.Gestational age,birth weight,gender,Apgar score,mechanical ventilation,use of antibiotics,PICC retention time and other aspects were incorporated into single factor analysis.The result showed that the infection cases had lower gestational age,birth weight and apgar score than those in the non infection cases.While the infection cases had higher antibiotics use,mechanical ventilation,PICC retention time and parenteral nutrition time than those in the non infection cases.There was statistically difference between two groups(P<0.05);3 We compared total bilirubin,direct bilirubin and creatinine in the second week with time before treatment in the experimental group.There was no statistically difference(P>0.05).We compared these datas in the fourth week with time before treatment.There was statistically difference(P <0.05).We compared total bilirubin,direct bilirubin and creatinine in the second week with the fourth week.There was statistically difference(P<0.05).We compared aminotransferase and total bile acids levels between in the second week,time before treatment and in the fourth week.There was no statistically difference(P>0.05);4 The clinical manifestations of 10 fungal infection cases performed feeding intolerance in 7 cases,poor response in 5 cases,cyanosis in 4 cases,apnea in 3 cases,abdominal distension in 3 cases.The laboratory examination performed white blood cells increased(20*10^9/L in 1 cases),white blood cells decreased(<2.0*10^9/L in 4 cases),thrombocytopenia(<150*10^12/L in 6 cases),increased hsCRP(>8mg/dl in 7 cases).7 cases were positive for fungal G experimental,blood culture was positive in 1 case,sputum culture,catheter culture and CSF fungal culture were negative.Conclusions:1 The use of fluconazole could significantly reduce the incidence of fungal infection in VLBWI who have high risk factors for fungal infection;2 Preterm birth,low birth weight,asphyxia,use of PICC,mechanical ventilation,and long-term use of broad-spectrum antibiotics were high risk factors for low birth weight infant with fungal infections;3 Early administration of low-dose fluconazole in the prevention of fungal infection in very low birth weight infants had no significant adverse effect on liver and kidney;4 Early diagnosis of very low birth weight infants with fungal infection in clinical manifestations lacks of specificity.The common clinical manifestations performed feeding intolerance,poor response,cyanosis,apnea and abdominal distention.In laboratory examination fungal G test positive rate was higher,so it can be used as a fungal infection index;...