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. 2023 Feb 4;39(1):102.
doi: 10.1007/s00383-023-05390-5.

Does protocol miconazole administration improve mortality and morbidity on surgical necrotizing enterocolitis?

Koshiro Sugita  1 , Mitsuru Muto  1 , Masakazu Murakami  1 , Keisuke Yano  1 , Toshio Harumatsu  1 , Shun Onishi  1 , Koji Yamada  1 , Waka Yamada  1 , Makoto Matsukubo  2 , Takafumi Kawano  1 , Seiro Machigashira  2 , Motofumi Torikai  2 , Chie Ishihara  3 , Takuya Tokuhisa  3 , Satoshi Ibara  3 , Satoshi Ieiri  4
Affiliations

Does protocol miconazole administration improve mortality and morbidity on surgical necrotizing enterocolitis?

Koshiro Sugita et al. Pediatr Surg Int. .

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.

Keywords: Miconazole; Morbidity; Mortality; Necrotizing enterocolitis; Neurological prognosis.

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