Renal function in premature infants during aminoglycoside therapy

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.