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Assessing long-term, vestibulotoxic side effects after gentamicin therapy in neonatal sepsis or infection using video
Lena Zaubitzer1, Anja Kotzur1, Stefan Hegemann2
1Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Insights
Nearly half of children treated with gentamicin for newborn sepsis showed abnormal results on the video head impulse test (VHIT), indicating potential vestibular issues. Early VHIT screening can detect gentamicin
Area of Science:
- Pediatric Otolaryngology
- Neonatal Medicine
- Neuroscience
Background:
- Newborn sepsis requires guideline-compliant treatment, often including intravenous gentamicin.
- Gentamicin is known to cause vestibulotoxicity, a potential side effect impacting balance.
- Previous studies used older methods to assess gentamicin's vestibulotoxicity in newborns; current data on video head impulse testing (VHIT) in this population is lacking.
Purpose of the Study:
- To investigate the incidence of vestibular abnormalities in children treated with neonatal gentamicin therapy using VHIT.
- To assess the utility of VHIT as a sensitive screening tool for detecting subclinical vestibulotoxicity in this cohort.
Main Methods:
- A prospective, single-center, cross-sectional study involving 23 children aged 3-7 years who received at least five days of intravenous gentamicin for newborn sepsis.
- Video head impulse test (VHIT) was performed to measure median gain and identify refixational saccades.
- Parental questionnaires were used to gather information on potential risk factors and vestibular/cochlear abnormalities.
Main Results:
- Abnormal VHIT results were observed in 11 out of 23 children (47.8%).
- Unilateral abnormalities were found in 6 children (26.1%), and bilateral abnormalities in 5 children (21.7%).
- Five children with abnormal VHIT also reported vestibular or cochlear abnormalities via questionnaires.
Conclusions:
- Almost half of children treated with neonatal gentamicin therapy exhibited VHIT abnormalities, despite lacking overt clinical signs of vestibular dysfunction.
- VHIT is a sensitive method for early detection of vestibulotoxic side effects following gentamicin treatment in children.
- Early identification via VHIT may facilitate timely intervention for affected children.
Study Background:
Newborn infection and sepsis remain serious problems. Guideline-compliant therapy includes, among other therapeutics, calculated intravenous antibiosis with gentamicin. One of the known side effects of gentamicin is severe vestibulotoxicity, which can be detected using the video head impulse test (VHIT), which is a sensitive examination method for the detection of vestibular hypofunction in children and adults. Previous studies on the vestibulotoxicity of gentamicin in newborns were carried out using caloric testing, rotary testing, and electronystagmography. Nevertheless, there are currently no data available on VHIT examinations in children who have been treated with neonatal gentamicin therapy.
Methods:
A single-center, prospective cross-sectional study, was conducted at a tertial referral center. VHIT was performed on 23 children aged 3-7 years who had received intravenous gentamicin therapy for at least five days as part of the treatment of newborn sepsis between 2012 and 2016. Main outcome was median gain and occurrence of refixational saccades as measured with VHIT. In addition, the children's parents received questionnaires to detect possible risk factors and vestibular and cochlear abnormalities.
Results:
Out of 23 children with a mean age of four years and seven months (ranging from 3 to 7 years), 11 (47.8%) indicated abnormal results in VHIT. The VHIT results were unilaterally abnormal in six children (26.1%) and bilaterally abnormal in five others (21.7%). Additionally, five of the children with an abnormal HIT had abnormalities, as found in the questionnaire results.
Conclusion:
and Relevance: Almost half of the children observed after having undergone gentamicin therapy as newborns showed abnormalities in VHIT, although they did not show any clinical signs of disbalance or vestibular hypofunction. VHIT can serve as a sensitive investigation method for the early screening of post-therapeutic vestibulotoxic side effects after gentamicin therapy in children. Additionally, VHIT can enable early intervention in these children.
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