Serum calcium values in term and late-preterm neonates receiving gentamicin

Abstract

Since noting an apparent increase in hypocalcemia in neonates receiving gentamicin every 24 h (q 24 h) for > or = 4 days, we have prospectively monitored serum calcium (Ca) values in these patients receiving prolonged gentamicin therapy. This study is a retrospective analysis of those values measured during gentamicin treatment. The study included neonates with gestational age > or = 35 weeks who received > or = 4 days of gentamicin therapy and in whom at least one serum Ca value was measured > or = 47 h after initiation of therapy. Hypocalcemia was defined as a serum Ca level < 8 mg/dl (2 mmol/l). Data were analyzed by Student t-test, chi-square test, and Pearson product moment correlation. There were 1,624 neonates that met the study criteria. Ca was < 8 mg/dl in 241 (15%). Ca < 8 mg/dl was more likely in boys than in girls (16.4% vs 11.8%, P = 0.01) and in neonates < 37 weeks gestational age (GA) than in those > or = 37 weeks GA (23.9% vs 14.1%, P = 0.01). A second Ca value was obtained in 883 neonates (54%); 23.2% of neonates with initial Ca < 8 mg/dl remained hypocalcemic, and 30% of these were receiving oral Ca supplementation. The second Ca value was < 8 mg/dl in eight neonates in whom initial Ca was > or = 8 mg/dl. Hypocalcemia is not uncommon in neonates receiving gentamicin therapy, and it may occur more frequently in boys and late-preterm infants. These data suggest that the monitoring of serum Ca levels should be considered when gentamicin is given > or = 4 days.

Effect of intravenous gentamicin on urinary calcium excretion in newborns

“…Indeed, a cumulative effect of gentamicin was observed. [10][11][12] We found an increase in urinary calcium excretion after the first dose of gentamicin, and an even higher increase after the second dose of gentamicin. A previous study showed that serum calcium levels were lowest on third day of gentamicin.…”

“…1,2 Some studies in newborns and animals have shown that gentamicin increases urinary calcium excretion. [11][12][13][14][15] Injection every 36-48 hours is a new recommendation for intravenous gentamicin treatment in newborns. 3 Following this new recommendation, there have been no further studies on the effects of extended gentamicin dosage on urinary calcium excretion in newborns.…”

Serum vitamin D deficiency in NICU hospitalized neonates and its association with neonatal outcomes

“…Vitamin D de ciency was de ned as serum 25(OH) vitamin D < 10 ng/ml, insu ciency 10-30 ng/ml and su ciency > 30 ng/ml, respectively (17,18). Serum Calcium < 8 mg/dL was also considered as hypocalcemia (19)…”

Calcemia and Inflammatory Markers in Early-Onset Neonatal Infection

“…Administration of aminoglycosides, in particular gentamicin, to neonates, is also associated with a drop in calcemia (12)(13). This could be explained by the fact that aminoglycoside antibiotics are CaSR agonists (14)(15).…”