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Related Experiment Video

Updated: Jan 11, 2026

Broth Microdilution In Vitro Screening: An Easy and Fast Method to Detect New Antifungal Compounds
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Antifungal prophylaxis-Where are we today?

David A Kaufman1

  • 1University of Virginia Children's Hospital, Charlottesville, VA, 22908, USA.

Seminars in Fetal & Neonatal Medicine
|November 9, 2025
PubMed
Summary

Invasive Candida infection (ICI) affects premature infants due to immature immunity. Targeted fluconazole prophylaxis effectively prevents ICI in high-risk extremely low birth weight infants.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pediatric Critical Care

Background:

  • Invasive Candida infection (ICI) is a growing concern in premature infants, particularly those of lower gestational ages (GAs).
  • Immature immune systems and underdeveloped barriers increase susceptibility to ICI in neonates.
  • High mortality and neurodevelopmental impairment (NDI) persist in extremely low birth weight (ELBW) infants with ICI.

Purpose of the Study:

  • To review the incidence, risk factors, and prevention strategies for invasive Candida infection (ICI) in premature infants.
  • To evaluate the efficacy and safety of fluconazole prophylaxis in high-risk ELBW infants.
  • To highlight the need for standardized definitions and reporting of ICI across different gestational ages.

Main Methods:

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  • Review of existing literature on invasive Candida infection (ICI) in premature infants.
  • Analysis of data regarding fluconazole prophylaxis efficacy and safety in extremely low birth weight (ELBW) infants.
  • Identification of key risk factors associated with ICI development and outcomes.

    • Main Results:

    • Targeted fluconazole prophylaxis (3 or 6 mg/kg) twice weekly is effective and safe for preventing ICI in high-risk ELBW infants.
    • Fluconazole prophylaxis is more effective than nystatin and can be administered intravenously, independent of feeding status.
    • Identified risk factors include antibiotic use, parenteral nutrition, central venous catheters, vaginal delivery, specific cephalosporins/carbapenems, and gastrointestinal conditions.

    Conclusions:

    • Fluconazole prophylaxis is a recommended strategy for preventing ICI in high-risk ELBW infants.
    • Standardization of ICI definitions and reporting is crucial for accurate assessment of rates and outcomes.
    • Early identification of high-risk infants and timely antifungal prophylaxis can improve outcomes.