Reviews

Does fluconazole prophylaxis reduce the incidence of death or invasive candida infection in extremely preterm infants?

CANDIDA Invasive candidiasis remains relatively common and is frequently deadly among extremely low birthweight infants. Thus, strategies to prevent invasive disease are needed. For this purpose, the effectiveness of prophylactic fluconazole to prevent invasive candidiasis in infants born at <750 g was evaluated. The combined outcome of death or invasive candidiasis was not different between treatment and control groups. These data provide no compelling argument that prophylactic fluconazole should be used routinely to prevent invasive candidiasis in infants weighing <750 g at birth.

A randomized blinded trial to assess whether near infrared spectroscopy measures of cerebral saturation in infants

NIRS Cerebral oxygenation after extremely preterm birth may be unstable. Extremely preterm infants (<28 wks) were randomized to NIRS for 3-72 hours after birth and an algorithm to stabilize it, or not (NIRS-data blinded). NIRS-monitoring resulted in longer periods of cerebral oxygen saturation on target (55-85%), but did not significantly reduce IVH or mortality. This report found no significant difference in clinical outcomes. Further validation and clinical demonstration must be provided before NIRS-monitors become standard of care.

Humidification and heating of inspired gas during delivery room stabilization improves admission temperature in preterm infants

NORMOTHERMIA Maintaining normothermia in preterm infants after birth remains a challenge. Meyer and colleagues have demonstrated that the use of heated humidified gas during preterm infants stabilization improves temperature on admission to NICU. However, firm recommendations for clinical practice cannot be given at this time based on the limited evidence currently available.