Does protocol miconazole administration improve mortality and morbidity on surgical necrotizing enterocolitis?
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In brief
In brief
This 20-year retrospective study of 1169 extremely low-birth-weight infants found that prophylactic miconazole administration delayed surgical NEC onset by 12 days and increased body weight at surgery, though mortality remained unchanged. The protocol showed partial neurodevelopmental benefits, with cognitive-adaptive domains recovering by age 3.
Written by the GCMD Library team from the article.
Abstract
Purpose
Our previous clinical pilot study reported that miconazole (MCZ) prevented morbidity from surgical necrotizing enterocolitis (NEC). The present study re-investigated this effect in a long-term cohort over 20 years.
Methods
We conducted a retrospective cohort study from April 1998 to March 2020. A total of 1169 extremely low-birth-weight infants (ELBWIs) admitted to our neonatal intensive care unit, including 45 with NEC (3.8%), underwent surgery. Since 2002, protocol MCZ administration for 3 weeks has been applied for neonates born before 26 weeks’ gestation or weighing under 1000 g. We compared the background characteristics and clinical outcomes between patients with and without MCZ administration.
Results
The morbidity rate decreased after applying the MCZ protocol, but no improvement in mortality was seen. A propensity score-matched analysis indicated that treated patients by MCZ showed a delay in developing surgical NEC by 12 days. The MCZ protocol also helped increase body weight at surgery. Prophylactic MCZ administration did not improve the neurological development of the language–social and postural–motor domains in the surgical NEC patients. But cognitive–adaptive domain caught up by a chronological age of 3 years old.
Conclusions
Revising the protocol to extend the dosing period may improve the outcomes of surgical NEC after the onset.