Enhanced Vancomycin Elimination in an Infant Following an Unsuccessful Gastroschisis Repair Surgery

To report the case of an infant who required high-dose vancomycin therapy after an unsuccessful gastroschisis repair surgery.

An infant born at 35 weeks and 5 days of gestation underwent a gastroschisis repair on day of life 47. The repair was unsuccessful causing fluid backup and accumulation into the stomach. A replogle was placed to allow for suctioning of this fluid. During this admission, the patient received 3 courses of vancomycin. During the first course, the patient had minimal output via the replogle tube. On the infant's second and third courses of vancomycin, the infant necessitated vancomycin dosing above that of the neonatal protocol, and subsequent levels were still found to be below goal. Vancomycin was increased to a maximum of 15 mg/kg every 4 hours (90 mg/kg/d) in order to achieve serum trough levels greater than 10 mg/L. Residuals were drawn from the replogle ranging from 0.76 to 4.33 mL/kg/h during the second and third course of vancomycin.

A premature male infant required up to 90 mg/kg/d of vancomycin to achieve trough levels above 10 mg/L after an unsuccessful gastroschisis repair surgery and gastric suctioning.

Clinicians should be aware of the possibility for decreased vancomycin levels and the potential need for increased monitoring in postsurgical infants receiving gastric suctioning.