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Trough value prediction using umbilical blood cystatin C value during tobramycin administration

Kentaro Hirayama1, Arisa Fukui1, Tomoya Tsuchihashi1

  • 1NICU Division, Department of Perinatal Medicine, Wakayama Medical University, Wakayama City, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|May 14, 2025
PubMed

Insights

Umbilical cord blood cystatin C (CysC) levels, adjusted for gestational week and body surface area, can predict tobramycin trough values in neonates. This non-invasive method helps optimize aminoglycoside dosing to prevent infant nephrotoxicity.

Area of Science:

  • Neonatal pharmacokinetics
  • Pediatric pharmacology
  • Clinical chemistry

Background:

  • Aminoglycoside therapy, including tobramycin, is crucial in neonatal care but requires therapeutic drug monitoring.
  • Estimating drug trough values non-invasively is essential to minimize risks associated with repeated blood draws in infants.

Purpose of the Study:

  • To investigate the utility of umbilical cord blood serum creatinine (Cr) and cystatin C (CysC) for estimating neonatal tobramycin (TOB) trough values.
  • To determine if cord blood biomarkers can predict TOB levels without increasing invasive testing risks.

Main Methods:

  • A cohort of 16 infants treated with tobramycin from birth was studied.
  • Cord blood Cr and CysC were measured, alongside tobramycin trough levels at 3 days of age.
  • Correlations between cord blood biomarkers (adjusted for gestational week, birth weight, and body surface area) and TOB trough values were analyzed.

Main Results:

  • Cord blood CysC adjusted for gestational week and body surface area (CysC/GW/BSA) demonstrated a strong correlation with tobramycin trough values (r=0.77).
  • A cut-off value of 0.29 for CysC/GW/BSA effectively predicted TOB trough values ≥1 mg/mL (AUC: 0.927, sensitivity: 1.00, specificity: 0.75).

Conclusions:

  • Umbilical cord blood CysC/GW/BSA is a reliable and non-invasive predictor of tobramycin trough levels in neonates.
  • This method allows for early estimation of drug levels, facilitating dosage adjustments to prevent nephrotoxicity and reduce infant risks.
Abstract

Keywords:
creatininecystatin Ctherapeutic drug monitoringtobramycinumbilical cord blood

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