The use of fluconazole in neonatal intensive care units

Preterm neonates in neonatal intensive care units (NICU) are at high risk of invasive fungal infection (IFI), mostly by Candida spp. IFI in such patients is increasingly leading to high morbidity and mortality and frequent neurodevelopmental disabilities in the survivors. Most conditions and risk factors associated with neonatal IFI are unavoidable, being intrinsic to prematurity or related to the aggressive nature of the care these patients require. Neonatal IFI is difficult to diagnose, as candidaemia may be transient and difficult to eradicate due to the high rates of end-organ dissemination. The best option to decrease the burden of disease is thus to prevent it. Fluconazole administration is a suitable strategy and proved effective in many retrospective, single-centre studies and in four randomised, prospective clinical trials. Nevertheless, the use of this azole in high-risk preterm neonates in NICU is not yet a standard of care. This article summarises current evidence on the use of fluconazole in preterm neonates and discusses the concerns surrounding its use in nurseries.