Renal function and effect of aminoglycoside therapy during the first ten days of life

Abstract

The effect of aminoglycoside administration on kidney functional maturation was evaluated in groups of 30 preterm and 30 fullterm infants who were treated for 7 days because of suspected infection. One of three different aminoglycosides was administered to each subgroup of ten preterm and ten fullterm infants. Changes in tubular function in groups of ten preterm and ten fullterm infants who were not given antibiotics were also compared. The mean gestational age for preterm infants from 32.5 to 33.6 weeks and for fullterm infants between 39.2 and 39.5 weeks. The renal tubular function was assessed by examining the fractional excretion of sodium (FENa), potassium (FEK), phosphorus (FEP), magnesium (FEMg) and uric acid (FEUA) as well as by the urinary excretion of calcium as the calcium/creatinine (UCa/UCr) ratio. Gentamicin affected the normal plasma creatinine (PCr) decline in both treated groups (fullterm and preterm). Disturbances in FENa and UCa/UCr were more pronounced in treated preterm than in fullterm infants especially after netilmicin and gentamicin administration. FEMg was significantly affected in preterm infants treated with gentamicin. The findings of this study indicate that the effect of aminoglycosides on tubular function is dependent upon kidney maturity and the type of the aminoglycoside used for therapy.

Extended-Interval Aminoglycoside Administration for Children: A Meta-analysis

“…[9][10][11][12][13][14][15][16]48 Those meta-analyses showed no difference in clinical efficacy between ODD and MDD 9,13,14,16 or even better efficacy with ODD. [10][11][12]15 With the exception of severely ill children, clinical failures were uncommon in the trials we analyzed, regardless of the regimen used.…”

“…Also, we observed a trend toward fewer bacteriologic failures, which again was consistent with the results of adult meta-analyses that evaluated this outcome. 10,11,14,15,48 One meta-analysis 9 of adult data suggested that ODD might reduce nephrotoxicity, whereas other meta-analyses [10][11][12][13][14][15]48 showed nonsignificant trends or no difference in nephrotoxicity outcomes. In our meta-analysis, we were not able to show any reduction in the risk of primary nephrotoxicity outcomes with ODD.…”

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

“…Importantly, in this regard, antibiotics such as the aminoglycosides can readily cross the placenta [98] and there have been a number of experimental studies linking antibiotics with impairment of nephrogenesis [99][100][101][102]. For instance, it has been shown that incubation of metanephroi in culture with gentamicin leads to decreased branching morphogenesis of the ureteric tree and thus reduced nephron formation [99].…”

“…It is known that antibiotics, such as the aminoglycosides, can be nephrotoxic in the newborn (with the preterm infant most vulnerable) [101] and they are also linked with impairment of nephrogenesis [103,173]. Administration of gentamicin in neonates has been shown to primarily result in renal tubular necrosis [100], which consequently leads to increased sodium excretion, proteinuria, and a significant reduction in GFR [101,181,182].…”

“…Administration of gentamicin in neonates has been shown to primarily result in renal tubular necrosis [100], which consequently leads to increased sodium excretion, proteinuria, and a significant reduction in GFR [101,181,182].…”