Dr.Hendrik Weitkamp, Assistant Professor of Neonatology at the ‘Monroe Carell Jr. Children’s Hospital’ at Vanderbilt sheds light on a new protocol which has been successfully used to eliminate the risk of infection from the neonatal intensive care unit. The premature infants, specially born with extremely low weight are at the highest risk to catch fungal infection.‘Neonatal Intensive Care Unit) (NICU)’ is utilizing this new protocol to save the infants from the infections and in an effort to improve quality insurance; it has begun the use of a common antifungal medication for the infants.

Fungal infection among the babies can lead to serious illnesses. They might develop symptoms like radical change in blood pressure and organ failure as happens in case of sepsis. Contrary to the common belief where the symptoms of septic are credited to some bacterial infection, in most of the cases, the children were found infected by some fungal organism, ‘Candida Albicans’ being the most common among them.

It was decided to do assessment of the infection data and decision was made to begin a protocol that a preventive dose of ‘fluconazole’ would be administered to highest-risk babies. Highest risk babies here mean those weighing less than 750 grams at birth or fewer than 26 weeks gestation. This dose would be given twice a week for six weeks as during this period, they have invasive tubes which make them more prone to infections.

This was new as some hospitals which were already using ‘fluconazole’ for prevention had been following the standard of weighing all premature infants weighing less than 1,500 grams at birth as highest risk babies. This was twice the weight limit set by Vanderbilt’s NICU.

This new protocol was initiated by Vanderbilt in 2005. A team would conduct a comparative analysis of the first 42 babies administered prevention according to the new protocol with 44 babies of the same description from the previous year. This would be an attempt to prove that giving fluconazole as a preventive was of clear benefit to such tiny babies.

Weitkamp remarked that they do not have any data of infection for 40 babies who got prophylactic fluconazole for the previous year, however, among the comparison group, nine infants have been included who developed invasive ‘Candida Albicans Infection’.

‘Fluconazole’ might cause occasional mild kidney, blood or liver malfunctions. “We felt the results were a strong reason to continue to use the drug as a preventive in a targeted, highest-risk population,” Weitkamp said.

He further shared with pride that since the protocol has been started; they have been able to wipe out infections from their nursery. As compared to other children’s hospitals in the country, their infection rates have lessened to half, as been reported in one of the academic reports.

However there are still certain issues, which hang back like developing resistance against ‘fluconazole’. Weitkamp agrees to this saying that the question is just as important in the treatment of fungal infections. A careful monitoring of prophylaxis is being done for any signs that it could contribute to make it difficult for ‘Candida’ to flourish or could contribute in making ‘Candida Albicans Infection’ resistant to ‘fluconazole’ itself.