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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Myra L. Barnes, MPH, Clinical Outcomes, Research, and Epidemiology, Children's Hospital of the Kings Daughters , Norfolk,VA, 601 Children's Lane, Norfolk, VA 23507, 757-668-8251, barnesml@chkd.com, Louise Lawson, PhD, Children's Hospital of The King's Daughters, Center for Pediatric Research, 855 West Brambleton Ave, Norfolk, VA 23510, Bonnie L. Burke, MS, Clinical Outcomes, Research and Epidemiology, Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA 23507, Neonatal Candidiasis Study Group, Neonatal Candidiasis Study Group, Various institutions, None, VA 99999, and M. Gary Karlowicz, MD, Neonatology, Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA 23507.
Background: One study showed fluconazole prophylaxis during the first six weeks of life reduced the incidence of systemic candidiasis from 18% to 0% in infants weighing <1000g. However, treating all infants <1000g exposes a large number of lower risk infants to fluconazole. Objective: To determine candidemia incidence among extremely low birth weight (ELBW=401-1000g) infants >23 weeks gestational age (GA) to identify a target population for study of fluconazole prophylaxis so >90% of candidemia cases are captured, yet the number of infants exposed to prophylaxis is reduced by >25%. Methods: A retrospective cohort study on all >23 weeks GA infants admitted to the NICU surviving >5 days in five U.S. children渥s hospitals between 1994-1998 was conducted. Positive predictive value (PPV), negative predictive value (NPV) and number needed to treat (NNT) were calculated to test efficacy. T-tests evaluated differences in test efficacy measures for groups defined by birthweight markers. Results: Candidemia was diagnosed in 136/1372 (10%). ELBW infants serving as the prophylaxis group yielded a PPV=0.10, NPV=0.995 and NNT=20. Infants 移950g accounted for 131 (96.3%) cases and 86.8% of ELBW infants. Those 移900g accounted for 127 (93.4%) cases and 73.4% of ELBW infants. Those 移850g accounted for 117 (86.0%) cases and 62.9% of ELBW infants. Those 移900g serving as the prophylaxis group increased PPV to 0.13 (p=0.038), decreased NNT by 25% to 15, while maintaining NPV=0.99 (p=0.50). Conclusions: Targeting infants 移900g for fluconazole prophylaxis improves the clinical efficacy to detect candidemia compared to infants 移1000g while exposing 26.6% fewer infants to prophylaxis.
Learning Objectives:
Keywords: Neonatal Screening, Intervention
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.