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Oral nystatin prophylaxis and neonatal fungal infections
  1. Alison J Howell (a.j.howell{at}doctors.org.uk)
  1. John Radcliffe Hospital, Oxford, United Kingdom
    1. David Isaacs (davidi{at}chw.edu.au)
    1. Children's Hospital at Westmead, Australia
      1. Robert Halliday (roberth{at}chw.edu.au)
      1. Children's Hospital at Westmead, Australia

        Abstract

        Background: The value of antifungal prophylaxis depends partly on the incidence of neonatal fungal infection. We compared the incidence of fungal infection in babies in neonatal units which do and do not give antifungal prophylaxis using oral nystatin.

        Methods: Prospective, multi-centre surveillance study from 1993-2006 of invasive fungal infection, defined as positive blood or CSF culture, in babies <1500g birth weight in neonatal units in Australia and New Zealand.

        Results: There were 118 episodes of invasive fungal infection (IFI) in 14,778 babies <1500g, an incidence of 0.80% (95% CI 0.66-0.94%). All infections were due to Candida species, mostly C. albicans (74, 62.7%) and C. parapsilosis (39, 33.1%). The mortality was 16.5%. The incidence was 0.54% (0.38-0.70%) for babies <1500g in units using selective or universal oral nystatin prophylaxis and 1.23% (0.84-1.62%) in units using no prophylaxis (P<0.0001). The incidence of infection in babies <1000g was 1.78% (106/5948) (95% CI 1.44-2.12%). The incidence was 1.23% (0.92-1.54%) for babies <1000g in units using nystatin prophylaxis and 2.67% (1.97-3.37%) in units using no prophylaxis (P<0.0001).

        Conclusions: The incidence of neonatal fungal infection was low in Australia and New Zealand, even without antifungal prophylaxis. Antifungal prophylaxis with oral nystatin was associated with a significantly lower incidence of fungal infection compared with no prophylaxis.

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