The Use of Antifungal Therapy in Neonatal Intensive Care

Testoni, Daniela; Smith, P. Brian; Benjamin, Daniel K.

doi:10.1016/j.clp.2011.12.008

Cited by 21 publications

(10 citation statements)

References 115 publications

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“…26,27 In ELBW, IFI is associated with poor outcome, with neurodevelopment impairment (NDI) over 70% and mortality rates ranging from 23 to 66%. [1][2][3] We report a lower case fatality rate (13.8%) than in other recent studies. [14][15][16] The presence of disseminated disease was reported in 20% of the cases (lower than 46% in recent reports 24 ), and it did not increase the case fatality rate significantly.…”

Section: Discussioncontrasting

confidence: 74%

“…4 Amphotericin B remains the gold standard for antifungal therapy in the neonate. 2,3 Liposomal formulations are widely used in neonates, in spite of the scarce published evidence of its advantages. [5][6][7][8][9][10] Prospective multicenter clinical studies to determine the epidemiology of fungal infection at NICUs are very important and extremely necessary.…”

Section: Introductionmentioning

confidence: 99%

“…Despite prompt and appropriate treatment, invasive candidiasis in extremely premature infants is the second most common cause of infectious disease related death. 3 Invasive fungal infection represents a significant financial burden to the health system related with long-term sequelae and increase length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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Invasive fungal infection in neonatal intensive care units: a multicenter survey

Baptista

Nona

Ferreira

et al. 2016

Journal of Chemotherapy

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This study assesses the epidemiology of invasive fungal infection (IFI) in Portuguese Neonatal Intensive Care Units (NICUs) and compares the effectiveness and safety of antifungal therapies. A survey concerning the period 2005-2010 was carried out in NICUs of Greater Lisbon. Among 10 473 admitted neonates, 44 cases were identified, 29 among extreme low birth weight neonates (65.9%). Cumulative incidence rate was 0.42% (95%CI 0.309-0.559). A central vascular catheter was present before IFI in all cases. Candida albicans and Candida parapsilosis were the most frequent isolates. The initial antifungic was fluconazole in 22 cases and liposomal amphotericin B (L-AmB) in 18. Therapy was switched in 10 patients on fluconazole and 3 on L-AmB. Case fatality rate was 11.4% (95%CI 4.39-23.91). No serious adverse drugs reactions (SADRs) or clinical side effects were observed. The knowledge of the local epidemiology helps to identify adequate prophylactic and treatment strategies.

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Section: Discussioncontrasting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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Invasive fungal infection in neonatal intensive care units: a multicenter survey

Baptista

Nona

Ferreira

et al. 2016

Journal of Chemotherapy

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“…La FDA aprobó el uso de L-amB (AmBisome ® ) para el lactante mayor de un mes de vida, ABCL (Abelcet ® ) sobre los 16 meses y ABDC (Amphotec ® ) para niños mayores y adultos 30 . La mayoría de los estudios disponibles en la literatura médi-ca, sobre el uso comparativo de anfo B-d y formulaciones lipídicas de anfotericina corresponden a publicaciones de series de casos o trabajos retrospectivos [31][32][33] .…”

Section: Tratamientounclassified

“…No está recomendado el uso de formulaciones lipídicas de anfotericina B en caso de urocultivos positivos a Candida spp. debido a la mala penetración de éstas en el tejido renal 30 .…”

Section: Tratamientounclassified

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

Izquierdo

Santolaya

2014

Rev. chil. infectol.

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Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey

Arribas,

Decembrino,

Raffaeli

et al. 2024

Eur J Pediatr

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Background. Neonates face heightened susceptibility to drug toxicity, often exposed to off-label medications with dosages extrapolated from adult or pediatric studies. Premature infants in Neonatal Intensive Care Units (NICUs) are particularly at risk due to underdeveloped pharmacokinetics and exposure to multiple drugs. The study aimed to survey commonly used medications with a higher risk of ototoxicity and nephrotoxicity in Spanish and Italian NICUs.Methods. A prospective cross-sectional study was conducted in Italian and Spanish NICUs using a webbased survey with 43 questions. A modi ed Delphi method involved experts re ning the survey through online consensus. Ethical approval was obtained, and responses were collected from January to July 2023. The survey covered various aspects, including drug-related ototoxic and nephrotoxic management, hearing screening, and therapeutic drug monitoring.Results. Responses from 131 participants (35.9% from Spain and 64.1% from Italy) revealed awareness of drug toxicity risks. Varied practices were observed in hearing screening protocols, and a high prevalence of ototoxic and nephrotoxic drug use, including aminoglycosides (100%), vancomycin (70.2%), loop diuretics (63.4%), and ibuprofen (62.6%). Discrepancies existed in guideline availability and adherence, with differences between Italy and Spain in therapeutic drug monitoring practices.Conclusions. The study underscores the need for clinical guidelines and uniform practices in managing ototoxic and nephrotoxic drugs in NICUs. Awareness is high, but inconsistencies in practices indicate a necessity for standardization, including the implementation of therapeutic drug monitoring and the involvement of clinical pharmacologists. Addressing these issues is crucial for optimizing neonatal care in Southern Europe.The Joint Committee on Infant Hearing (JCIH) identi es ototoxic drugs like aminoglycosides and loop diuretics as risk indicators for hearing loss, so hearing screening is recommended [18; 19]. Recently, vancomycin was linked to hearing loss in very low birth weight infants [20].Apart from previously mentioned drugs, potential ototoxic and nephrotoxic agents encompass antibiotics (e.g., piperacillin/tazobactam), nonsteroidal anti-in ammatory drugs (indomethacin, ibuprofen), antivirals (acyclovir), antifungals (amphotericin B), angiotensin-converting enzyme inhibitors (captopril, enalapril), and spironolactone [21][22][23][24][25][26][27][28][29][30].Newborns on these drugs require close kidney function monitoring for acute kidney injury (AKI) and chronic kidney disease (CKD). A single-center study revealed that 70% of children had lasting kidney damage after nephrotoxic medication-induced AKI [31]. However, diagnosing drug-induced AKI (D-AKI) is complex due to varying criteria, hindering accurate identi cation [32][33][34].Considering that the above-mentioned drugs are among the most commonly used in neonatology, we conducted a survey in Spanish and Italian neonatal units on the use and management of drugs with a higher...

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The Use of Antifungal Therapy in Neonatal Intensive Care

Cited by 21 publications

References 115 publications

Invasive fungal infection in neonatal intensive care units: a multicenter survey

Invasive fungal infection in neonatal intensive care units: a multicenter survey

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey

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