Oral Nystatin: An Effective Prophylaxis for Fungal Infection in Preterm Babies in a Tertiary Level Hospital

Abstract

Introduction: Candida is a common cause of oral mucous membrane and skin infections in newborn infants and an important cause of neonatal morbidity and mortality. Methods: This Quasi experimental study was carried out in NCU, Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, over a period of 16months, to find out the efficacy of oral Nystatin in reducing colonization of fungus and fungaemia in preterm babies admitted in NCU. One hundred sixty consecutive preterm babies admitted in NCU within 72 hours of birth fulfilling the inclusion criteria were enrolled. Every alternate baby was taken as case and another was taken as control and the first one selected by lottery. Case group received oral Nystatin prophylaxis 1lacs unit 6 hourly for five days and control group given usual NCU care without antifungal prophylaxis. Babies were examined daily. Swab from oral mucous membrane was collected for gram staining, wet film preparation for direct microscopy and culture for fungus and blood culture for fungus and bacteria. Results: The mean age of enrolled babies was 23.9±19.3 hours in case and 19.3±17.8 hours in control groups. Both the groups were similar regarding GA, sex, mode of delivery, anthropometry, duration of antibiotics uses, and mean hospital stay. Gram staining, wet film preparation with 20% KOH for direct microscopic examination and culture of oral swab and blood culture of cases & controls at baseline and follow up revealed no Candida or any other fungus. However, Gram staining of oral swab revealed Gram positive cocci both in case and control groups at base line and at follow up which was not significant. Both oral swab culture and Blood culture developed growth of various organisms without any fungus both in case and in controls at base line and at follow up, which was also not significant. Conclusion & Recommendations: The present study revealed that Gram staining of oral swab, wet film preparation and culture of oral swab and blood at baseline and at follow up, 5 days after enrollment did not grow any fungus in both cases and controls. So Nystatin prophylaxis in the case was of no use in preventing oral colonization of fungus and fungaemia. For generalization of this hypothesis further multicenter study with a large sample size and longer duration of follow up is required. Methods: This Quasi experimental study was carried out in NCU, Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, over a period of 16months, to find out the efficacy of oral Nystatin in reducing colonization of fungus and fungaemia in preterm babies admitted in NCU. One hundred sixty consecutive preterm babies admitted in NCU within 72 hours of birth fulfilling the inclusion criteria were enrolled. Every alternate baby was taken as case and another was taken as control and the first one selected by lottery. Case group received oral Nystatin prophylaxis 1lacs unit 6 hourly for five days and control group given usual NCU care without antifungal prophylaxis. Babies were examined daily. Swab from oral mucous membrane was collected for gram staining, wet film preparation for direct microscopy and culture for fungus and blood culture for fungus and bacteria.Introduction: Candida is a common cause of oral mucous membrane and skin infections in newborn infants and an important cause of neonatal morbidity and mortality. Methods: This Quasi experimental study was carried out in NCU, Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital, Dhaka, over a period of 16months, to find out the efficacy of oral Nystatin in reducing colonization of fungus and fungaemia in preterm babies admitted in NCU. One hundred sixty consecutive preterm babies admitted in NCU within 72 hours of birth fulfilling the inclusion criteria were enrolled. Every alternate baby was taken as case and another was taken as control and the first one selected by lottery. Case group received oral Nystatin prophylaxis 1lacs unit 6 hourly for five days and control group given usual NCU care without antifungal prophylaxis. Babies were examined daily. Swab from oral mucous membrane was collected for gram staining, wet film preparation for direct microscopy and culture for fungus and blood culture for fungus and bacteria.