Abstract:
Background:
Vancomycin, is a first-line therapy for late-onset neonatal sepsis. Limited information on renal elimination and the immediate and long-term adverse effects of vancomycin in premature neonate is available.
Objectives:
To evaluate the renal elimination of vancomycin and the immediate and long-term vancomycin-associated adverse effect in infants receiving vancomycin for neonatal sepsis during a 4-year follow-up period in UMMC.
Methods:
This study comprises of retrospective and prospective data collection. In the retrospective study, all neonatal patients with a gestational age of 34 weeks or below, receiving intravenous vancomycin were reviewed between November 2012 to December 2014. The risk and incidence of nephrotoxicity, ototoxicity, and the growth development of the study subjects were recorded and analysed. As for the prospective study, urine samples from premature neonates receiving vancomycin therapy were collected and serum creatinine and vancomycin concentration were measured and analysed.
Results:
Only 14.3% out of 42 study subjects were found to have vancomycin trough level of more than 20 mg/L. Nephrotoxicity was defined using KDIGO and 33% of study subjects met the criteria. Ototoxicity was not discovered in patient’s receiving vancomycin. As for the growth development, most patients were documented to be underweight. In regards with the renal elimination of vancomycin and creatinine, the
average amount of vancomycin per hour and concentration of creatinine excreted was 4.09 ± 10.295 mg and 241.056 ± 166.336 μmol/L respectively.
Conclusion:
The use of vancomycin in premature neonates correlates with nephrotoxicity. Ototoxicity was not observed in the patients. However, monitoring of serum vancomycin levels are routinely done to ensure safe dosing. Premature neonates in this study turn out to be underweight in their infant years, thus their growth development and quality of life may be negatively impacted during adolescence and adulthood.
Keywords:
Vancomycin; renal elimination; nephrotoxicity; premature neonates
