Does protocol miconazole administration improve mortality and morbidity on surgical necrotizing enterocolitis?

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Pharmacology

Background:

• Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in extremely low-birth-weight infants (ELBWIs).
• Previous pilot studies suggested miconazole (MCZ) may prevent NEC morbidity.
• A long-term investigation was needed to re-evaluate MCZ's efficacy over two decades.

Purpose of the Study:

• To investigate the long-term effects of prophylactic miconazole (MCZ) administration on surgical necrotizing enterocolitis (NEC) in extremely low-birth-weight infants (ELBWIs).
• To compare clinical outcomes between ELBWIs who received MCZ and those who did not.

Main Methods:

• A retrospective cohort study analyzed 1169 ELBWIs admitted between April 1998 and March 2020.
• The study compared outcomes for infants with and without MCZ administration, with MCZ protocol initiated in 2002 for high-risk neonates.
• Propensity score-matched analysis was used to control for confounding factors.

Main Results:

• The MCZ protocol was associated with decreased NEC morbidity but did not improve mortality rates.
• MCZ-treated infants experienced a 12-day delay in the onset of surgical NEC and showed increased body weight at surgery.
• Neurological development in language-social and postural-motor domains was not improved, but cognitive-adaptive skills improved by age three.

Conclusions:

• Extending the miconazole (MCZ) dosing period may offer further improvements in outcomes for surgical necrotizing enterocolitis (NEC).
• Prophylactic MCZ demonstrates potential in managing NEC morbidity in ELBWIs, warranting further protocol optimization.