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In particular, when we analyzed the decade from 1996 to 2005 and compared the period 2001–2005 with the 5-year period before the introduction of fluconazole prophylaxis (388 versus 345 patients, respectively), we found significant reductions in fungal colonization (any site: from 45.2% to 23.9%, 95% confidence interval 0.265–0.608; P < 0.0001), fungal systemic infection (from 16.1% to 4.6%, 95% confidence interval 0.135–0.498; P < 0.0001) and rates of progression from colonization to infection (from 0.36 to 0.18, 95% confidence interval 0.148–0.802; P = 0.01), with no increase in the number of infants colonized (10/345 versus 11/388; P = 0.45) or infected (5/345 versus 4/388; P = 0.35) by fluconazole-resistant fungi. Similarly to the findings reported by Ho and coworkers, overall hospital mortality was not significantly reduced with fluconazole (from 11.8% to 10.4%; P = 0.29); however, colonized infants treated with prophylactic fluconazole were significantly more likely to survive than were those who were not treated (mortality rate 4.1% versus 17.7%, 95% confidence interval 0.039–0.778; P = 0.008). Our data confirm the effectiveness of the strategy of administering prophylactic fluconazole in a population of highrisk patients other than those most frequently described (i.e. high-risk surgical patients), and suggest that extension of this policy to high-risk patients in neonatal intensive care settings is warranted.

Use of prophylactic fluconazole in a neonatal intensive care unit: efficacy is similar to that described in adult high-risk surgical patients.