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

Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management?

The effectiveness of “inadequate” intrapartum antibiotic prophylaxis (IAP administered E. coli culture-confirmed EOS cases. IAP was defined “active” when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an “inactive” IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP “adequate” seems the pathogen’s antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond

Lumbar Puncture and Meningitis in Infants with Proven Early- or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study

Background: To evaluate the rates of lumbar puncture (LP) in infants with culture-proven sepsis. Study design: We prospectively enrolled 400 infants with early- or late-onset sepsis due to Group B streptococcus (GBS) or Eschericha coli, diagnosed within 90 days of life. Rates of LP and potential variables associated with LP performance were evaluated. Moreover, cerebrospinal fluid (CSF) characteristics and results of the molecular analysis were investigated. Results: LP was performed in 228/400 (57.0%) infants; 123/228 LPs (53.9%) were performed after antibiotic initiation, hampering the ability to identify the pathogen in the CSF culture. However, polymerase chain reaction increased the probability of positive results of CSF analysis compared to microbiological culture (28/79, 35.4% vs. 14/79, 17.7%, p = 0.001). Severe clinical presentation and GBS infection were associated with higher LP rates. The rate of meningitis was 28.5% (65/228). Conclusions: Rates of LP are low in culture-proven neonatal sepsis and antibiotics are frequently given before LP is carried out. Thus meningitis may be underestimated, and the chances of giving an effective therapy to the newborn are reduced. LP should be performed before the start of antibiotics when there is a clinical suspicion of infection