Vol. 3 No. 02 (2019)
Original Article

Effect of Prophylactic Oral Nystatin on Fungaemia Prevention among VLBW Neonates in NICU

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  • Mohammad Enamul Karim,
  • Ishrat Jahan,
  • Md. Kamrul Ahsan Khan,
  • Md. Abdul Mannan,
  • Habiba Anjuman,
  • Ferdous ara
Mohammad Enamul Karim
Registrar, National Heart Foundation Hospital and Research Institute
Ishrat Jahan
Asst. Registrar, Uttara Adhunik Medical College and Hospital
Md. Kamrul Ahsan Khan
Assistant Professor Neonatology. Sheikh Sayera Khatun Medical College. Gopalgonj
Md. Abdul Mannan
Chairman, Department of Neonatology. Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka
Habiba Anjuman
Asst. Registrar, Uttara Adhunik Medical College and Hospital, Dhaka
Ferdous ara
Registrar, Uttara Adhunik Medical College and Hospital, Dhaka

Published 21-09-2021

Keywords

  • Oral Nystatin,
  • Fungaemia,
  • VLBW,
  • NICU,
  • Prophylactic

Copyright (c) 2019 The Planet

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This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

1.
Effect of Prophylactic Oral Nystatin on Fungaemia Prevention among VLBW Neonates in NICU. Planet (Barisal) [Internet]. 2021 Sep. 21 [cited 2024 Nov. 21];3(02):13. Available from: https://bdjournals.org/index.php/planet/article/view/32

Abstract

Introduction: Recent global estimates suggest that > 1 in 10 or an estimated 15 million babies born in 2010 were preterm, of which >1 million died as a result of prematurity and its complications. Bangladesh ranked the 7th on the top-10 country list for high preterm births in 2010. The risk of invasive fungal infections is high in very low birth weight (VLBW) infants (<1500 g) and highest for infants born at the youngest gestational ages who survive past theimmediate postnatal period. Overall mortality attributable to invasive candidiasis was 19.3%. Starting empiric antifungal therapy may decrease the high mortality rate of invasive fungaemia in VLBW infants, especially those born at <28 weeks' gestation. Objectives- To evaluate the efficacy of prophylactic oral Nystatin on fungaemia among VLBW neonates. Methodology- It was a RCT; conducted in NICU of the Department of Neonatology, BSMMU, Dhaka; from Dec.15 to Sept. 16. A total of 25 cases (Group-A) and 25 controls (Group-B) were included in this study purposively and grouped by lottery. Group-A got prophylactic Nystatin orally [1 ml (100000units/ml) every 6 hour started, 24 hours after initiation of feeding until discharged] and group B did not get any prophylactic anti-fungal medication. All the babies received supportive treatment as required. Results- Both groups showed similar pattern of distribution; regarding sex, gestational age, anthropometric measurements and vital parameters. For both groups, Jaundice was present in most neonates (>90.0%). Chest indrawing, Apnoea, Hyperglycaemia, Hypoglycaemia, Grunting and Cyanosis were mostnotable presentations. All the presentations showed higher ‘positive’ counts in ‘Group-B’ and there was some positive association for most of the factors (except Hypoglycaemia, Grunting, Cyanosis and Shock). Majority in Group-B needed Phototherapy, Ionotrop and respiratory support (either CPAP or ventilator) than Group-A. Feeding intolerance developed more in Group–B, though not significant (p-0.5558). None in Group–A but 24.0% neonates in Group–B had invasive fungaemia (p-0.009). Neonates of Group-A (16.96 ± 6.931days) had to stay at hospital for shorter duration than Group-B (26.84± 16.062days) for treatment (p-0.009). Death rate (due to any cause) was lower in Group-A group (12.0%) than Group-B group (28.0%). (p0.3057). Conclusion-. The study concludes, prophylactic oral nystatin in neonates reduces the frequency of developing fungaemia and also reduces duration of hospital stay.

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References

  1. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the
  2. year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162–2172.
  3. Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal Mortality Levels for 193 Countries in 2009 with Trends since
  4. : A Systematic Analysis of Progress, Projections, and Priorities. PLoS Med. 2011; 8(8): e1001080.
  5. World Health Organization, March of Dimes, PMNCH, Save the Children: Born too soon: the global action report on preterm birth. In The global action
  6. report on preterm birth. Edited by Howson C, Kinney M, Lawn J. Geneva: WHO; 2012.
  7. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and
  8. national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379(9832):2151–2161.
  9. Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality
  10. and morbidity. Bull World Health Organ. 2010; 88(1):1–80.
  11. World Health Organization: Coverage of maternity care. A listing of available information. Geneva: World Health Organization; 1997.
  12. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth. 2010; 10(1): S1.
  13. Shah R, Mullany LC, Darmstadt GL, Mannan I, Rahman SM, Talukder RR, et
  14. al. Incidence and risk factors of preterm birth in a rural Bangladeshi cohort. BMC Pediatrics. 2014; 14:112
  15. Stewart C, Katz J, Khatry S, LeClerq S, Shrestha S, West K Jr, et al. Preterm delivery but not intrauterine growth retardation is associated with young
  16. maternal age among primiparae in rural Nepal. Maternal Child Nutrition. 2007; 3(3):174–185.
  17. Baqui A, Rosen H, Lee AC, Applegate J, Arifeen SE, Rahman S, et al. Preterm Birth and Neonatal Mortality in a Rural Bangladeshi Cohort: Implications for
  18. Health Programs. J Perinatol. 2013; 33(12):977–981. doi:10.1038/jp.2013.91. Epub 2013 Aug 15.
  19. Stoll BJ, Gordon I, Korones SB, Shankaran S, Tyson JC, et al. Late onset sepsis in very low birth weight neonates: a report from NICH and Human Dev Neonatal Research Network. Journal of Paediatrics. 1992; 129:63-71.
  20. Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT, et al. National Epidemiology of Mycoses Study Group. Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J. 2001; 20(12):1119-24.
  21. Baley JE, Kliegman RM, Fanaroff AA. Disseminated fungal infections in very low birth weight infants: clinical manifestations and epidemiology.
  22. Paediatrics. 1992; 73:144-52.
  23. Xia H, Wu H, Xia S, Zhu X, Chen C, Qiu G, et al. Invasive Candidiasis in preterm neonates in China: a retrospective study from 11 NICUS during 2009-2011.
  24. Pediatr Infect Dis J. 2014;33(1):106-9.
  25. Kaufman DA, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev. 2004;17(3):638-80.
  26. Kaufman DA. Challenging issues in neonatal candidiasis. Curr Med Res Opin. 2010;26(7):1769-78.
  27. Chitnis AS, Magill SS, Edwards JR, Chiller TM, Fridkin SK, Lessa FC. Trends in Candida central line-associated bloodstream infections among NICUs,
  28. -2009. Pediatrics. 2012;130(1):e46-52.
  29. Kaufman DA. "Getting to Zero": preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. Early Hum Dev. 2012; 88(S2): S45-9.
  30. Rennie J. Neonatal infections. In. Rennie & Robertson’s Textbook of Neonatology, 5th edn. UK. Churchill Living Stone: 2012: 984-5.
  31. Kossoff EH, Buescher ES, Karlowicz MG. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J. 1998;17(6):504-8.
  32. Pfaller MA, Diekema DJ, Jones RN, Messer SA, Hollis RJ. Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with
  33. bloodstream infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000. J Clin Microbiol. 2002;40(3):852-6.
  34. Kaufman DA, Rosenkrantz T. Fungal Infections in Preterm Infants. URL: http://emedicine.medscape.com/article/980487-overview#aw2aab6b2
  35. Berenguer J, Buck M, Witebsky F, Stock F, Pizzo PA, Walsh TJ. Lysis-centrifugation blood cultures in the detection of tissueproven invasive candidiasis.
  36. Disseminated versus single-organ infection. Diagn. Microbiol. Infect. Dis. 1993;17(2), 103–9.
  37. Horvath LL, Hospenthal DR, Murray CK, Dooley DP. Detection of simulated candidemia by the BACTEC 9240 system with plus aerobic/F and anaerobic/F
  38. blood culture bottles. J. Clin. Microbiol. 2003;41(10), 4714–7.
  39. Lai CC, Wang CY, Liu WL, Huang YT, Hsueh PR. Time to blood culture positivity of different Candida species causing fungemia. J. Med. Microbiol.
  40. ; 61, 701–4.
  41. Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C; Third European Conference on Infections in Leukemia Group. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit. Care. 2010;14(6), R222.
  42. Presterl E, Parschalk B, Bauer E, Lassnigg A, Hajdu S, Graninger W. Invasive fungal infections and (1,3)-β-d-glucan serum concentrations in long-term intensive care patients. Int. J. Infect. Dis. 2009;13(6), 707–12.
  43. Avni T, Leibovici L, Paul M. PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. J. Clin. Microbiol. 2011;49(2), 665–70.
  44. Tucker J, McGuire W: Epidemiology of preterm birth. BMJ 2004;329(7467):675–8.
  45. Makhoul IR, Kassis I, Smolkin T. Review of 49 neonates with acquired fungal sepsis: further characterization. Pediatrics. 2001;107(1):61-6.
  46. Benjamin DK, DeLong ER, Steinbach WJ, Cotton CM, Walsh TJ, Clark RH. Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics. 2003;112(3 Pt 1):543-7.
  47. Schelonka RL, Moser SA. Time to positive culture results in neonatal Candida septicemia. J Pediatr. 2003;142(5):564-5.
  48. Ganesan K, Harigopal S, Neal T, Yoxall CW. Prophylactic oral nystatin for preterm babies under 33 weeks’ gestation decreases fungal colonisation
  49. and invasive fungaemia. Arch Dis Child Fetal Neonatal Ed. 2009; 94: F275–F278.
  50. Roberts GD, Washington JA 2nd. Detection of Fungi in blood cultures. J Clin Microbiol. 1975; 3:309-10.
  51. Ozturk MA, Gunes T, Koklu E, Cetin N, Koc N. Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit. Mycoses. 2006; 49(6):484-92.
  52. Sims ME, Yoo Y, You H, Salminen C, Walther FJ. Prophylactic oral nystatin and fungal infections in verylowbirthweight infants. American Journal of Perinatology. 1988; 5:33–36.

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BD Journals.org is a publishing platform founded by Professor (Dr.) HN Sarker in early 2021. The aim of the publication platform is to promote research in Bangladesh and serves as a media for the dissemination of scientific information and recent knowledge among the readers. Two reputed peer reviewed journals “The Planet”- an official journal of Sher-E-Bangla Medical College, Barishal, Bangladesh and “The Insight”- an official journal of Sheikh Sayera Khatun Medical College, Gopalganj, Bangladesh are now being published in this website.





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