Related Experiment Videos
Renal function in premature infants during aminoglycoside therapy
V I Giapros1, S Andronikou, V I Cholevas
1Department of Paediatrics, University of Ioannina Medical School, Greece.
Insights
Aminoglycoside antibiotics like gentamicin and netilmicin can cause temporary kidney function changes in premature infants, affecting electrolyte balance. These effects normalize after treatment cessation.
Area of Science:
- Neonatalogy
- Pharmacology
- Nephrology
Background:
- Premature infants often require antibiotic treatment for infections.
- Aminoglycosides are commonly used antibiotics in neonates.
- Potential renal toxicity of aminoglycosides necessitates careful monitoring in vulnerable populations.
Purpose of the Study:
- To evaluate the impact of amikacin, gentamicin, and netilmicin on renal function in premature infants.
- To assess specific markers of renal tubular function during and after aminoglycoside therapy.
- To compare the renal effects of three different aminoglycosides in a neonatal cohort.
Main Methods:
- A comparative study involving 30 premature infants treated with amikacin, gentamicin, or netilmicin for 7 days.
- Inclusion of a control group of 10 infection-free premature infants.
- Serial assessment of plasma creatinine, fractional excretion of electrolytes (sodium, potassium, magnesium, phosphate, uric acid), and urinary calcium/creatinine ratio.
Main Results:
- Gentamicin and netilmicin groups showed significant increases in fractional excretion of sodium and magnesium, and urinary calcium/creatinine ratio compared to controls.
- Renal function disturbances were observed at trough and peak aminoglycoside concentrations.
- Elevated plasma creatinine levels persisted in 27% of treated infants for up to 10 days post-therapy.
Conclusions:
- Transient renal functional disturbances, including electrolyte and mineral imbalances, can occur with aminoglycoside use in premature infants.
- The observed changes highlight the need for vigilant renal function monitoring during aminoglycoside therapy in neonates.
- These transient effects may lead to significant electrolyte disturbances in sick premature infants.
Abstract:
The effect of three different aminoglycosides on renal function was evaluated in 30 premature infants of similar gestational age who were treated within 24 h of birth with either amikacin (10 infants, group A), gentamicin (10 infants, group B) or netilmicin (10 infants, group C), for a period of 7 days. Ten infection-free premature infants of similar post-conceptional age were used as controls. Serial determinations of plasma creatinine concentration (PCr), as well as the fractional excretion of sodium (FENa), potassium, magnesium (FEMg), phosphate (FEP) and uric acid (FEUA), and the urinary excretion of calcium (UCa/UCr ratio) were assessed before, during and after treatment. During the treatment period a significant increase in FENa, FEMg and UCa/UCr was observed in group B (P < 0.05 and P < 0.01, respectively) and an increase in FENa and UCa/UCr in group C (P < 0.01) compared with controls. These disturbances were observed with trough concentrations of aminoglycosides but were accentuated at peak serum concentrations and were restored to normal 2 days after stopping therapy. In addition, a significant correlation was demonstrated between FENa, FEMg and UCa/UCr ratio in treated patients. PCr levels decreased similarly in all patient groups, but in 8 of 30 infants (27%) they remained elevated and returned to control values only 10 days after stopping therapy. Such renal functional disturbances, although transient, may result in significant electrolyte and mineral imbalance in the sick premature infant.