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Exposure to an Extended-Interval, High-Dose Gentamicin Regimen in the Neonatal Period Is Not Associated With
Veronika Rypdal1,2, Sondre Jørandli3, Dagny Hemmingsen2,4
1Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
Frontiers in Pediatrics
|December 17, 2021
Summary
Neonatal gentamicin exposure, even at high doses, did not show signs of kidney damage in schoolchildren. This study suggests the gentamicin regimen is safe for long-term kidney health in children.
Area of Science:
- Pediatric Nephrology
- Neonatal Pharmacology
- Clinical Toxicology
Background:
- Gentamicin is a critical antibiotic for neonatal infections.
- High-dose gentamicin regimens are sometimes necessary but raise concerns about potential long-term kidney toxicity.
- Assessing subclinical nephrotoxicity in school-aged children post-neonatal exposure is crucial for evaluating treatment safety.
Purpose of the Study:
- To evaluate the association between neonatal high-dose gentamicin exposure and subclinical nephrotoxicity in school-aged children.
- To identify potential long-term kidney injury using validated urine biomarkers and blood pressure measurements.
Main Methods:
- A cohort of 222 children exposed to three or more doses of gentamicin (6 mg/kg) as neonates was followed up in school age.
- Urine biomarkers including protein-creatinine ratio (PCR), albumin-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and N-acetyl-beta-D-glucosaminidase (NAG-Cr) were assessed.
- Logistic, linear, and non-parametric kernel regression analyses were used to correlate gentamicin exposure (cumulative dose and trough plasma concentration) with biomarker levels.
Main Results:
- Only 6.8% of children (15 out of 222) exhibited one or two marginally abnormal urine biomarker values.
- No significant differences in gentamicin exposure, gestational age, or birth weight were found between children with abnormal versus normal biomarker results.
- Regression analyses revealed no association between gentamicin exposure metrics (cumulative dose or TPC) and urine biomarker values.
Conclusions:
- Extended-interval, high-dose gentamicin regimens in neonates were not associated with subclinical nephrotoxicity in school-aged children.
- The studied gentamicin treatment regimen appears safe concerning long-term kidney health.
- Further research may explore other potential long-term effects or specific subgroups if any.
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