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Prophylactic efficacy of enteral antifungal administration of miconazole for intestinal perforation, especially for necrotizing enterocolitis: a historical cohort study at a single institution

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Abstract

Purpose

Despite improvements in neonatal intensive care, the outcomes of extremely-low-birth-weight infants (ELBWIs) with surgical diseases remain to be improved. We started administering enteral miconazole (MCZ) to ELBWIs from 2002 to prevent fungal infection. Since then, the incidence of intestinal perforation has significantly decreased. We investigated this prophylactic effect of MCZ against necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) and explored a new prophylactic concept against intestinal perforation.

Methods

We designed a historical cohort study to evaluate the effect of MCZ for intestinal perforation in ELBWIs who underwent treatment in our neonatal intensive-care unit between January 1998 and December 2005. We divided these cases into two groups: the Pre-MCZ group and the Post-MCZ group. We compared the morbidity, clinical outcomes and pathological features of NEC and FIP.

Results

The rate of intestinal perforation with NEC was significantly reduced after the introduction of MCZ (p = 0.007, odds ratio; 3.782, 95% confidence interval; 1.368–12.08). The pathological findings of NEC specimens showed that the accumulation of inflammatory cells was significantly reduced in the Post-MCZ group when compared with the Pre-MCZ group (p < 0.05).

Conclusions

The efficacy of the enteral administration of MCZ on intestinal perforation with NEC highlights a new prophylactic concept in the clinical management of ELBWIs.

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Acknowledgements

We thank Mr. Brian Quinn for his comments and help with the manuscript. This study was supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS: 20K08934, 20K17558, 20K10403, 20K08933, 19K10485, 19K09150, 19K09078, 19K03084, 19K18061, 19K17304, 19K18032, 18K08578, 18K16262 17K10555, 17K11514, 17K10183, 17K11515, 16K10466, 16K10094, 16K10095, 16K10434, 16H07090), research grant from The Mother and Child Health Foundation and research grant from the Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics.

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Author notes

  1. Motofumi Torikai and Koshiro Sugita contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan

    Motofumi Torikai, Koshiro Sugita, Kenichi Murakami, Shin Shinyama, Motoi Mukai, Takamasa Ikee & Satoshi Ieiri

  2. Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan

    Motofumi Torikai, Koshiro Sugita, Satoshi Ibara, Chie Ishihara, Masaya Kibe, Kenichi Murakami, Shin Shinyama, Motoi Mukai & Takamasa Ikee

  3. Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan

    Hiroyuki Noguchi

  4. Department of Clinical Pathology, Kagoshima City Hospital, Kagoshima, Japan

    Kazunobu Sueyoshi

Authors
  1. Motofumi Torikai
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  2. Koshiro Sugita
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Correspondence to Satoshi Ieiri.

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Torikai, M., Sugita, K., Ibara, S. et al. Prophylactic efficacy of enteral antifungal administration of miconazole for intestinal perforation, especially for necrotizing enterocolitis: a historical cohort study at a single institution. Surg Today 51, 568–574 (2021). https://doi.org/10.1007/s00595-020-02125-0

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  • DOI: https://doi.org/10.1007/s00595-020-02125-0

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