Serum creatinine concentration, urinary creatinine excretion and creatinine clearance during the first 9 weeks in preterm infants with a birth weight below 1500 g

Sonntag, Josef; Prankel, Bernhard H.; Waltz, Stephan

doi:10.1007/bf02002914

Cited by 104 publications

(35 citation statements)

References 13 publications

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“…Vancomycin is almost exclusively cleared by renal elimination and PMA is a predictor of vancomycin clearance, presumably because it predicts the time course of development of the glomerular filtration rate (GFR). Our current estimates for vancomycin clearance mirror GFR estimates in premature neonates [22,23]. GFR matures during infancy and approaches an adult rate (6 l h −1 70 kg −1 ) by 6 months post natal age [24,25].…”

Section: Discussionmentioning

confidence: 57%

“…Positive pressure ventilation had a small effect on CL which was model dependent. Although Van der Heijden [23] has documented an absence of any effect of ventilation on renal clearance in premature neonates at PNA 3 days, others [22,29,30] have demonstrated a reduction of renal clearance in premature neonates in their first 2 weeks of life. This reduction may be mediated through lowered renal function due to decreased atrial natriuretic peptide and increased antidiuretic hormone production attributable to right atrial pressure receptors which are influenced by altered thoracic pressures during positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 99%

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Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Anderson

Allegaert

Anker

et al. 2006

Brit J Clinical Pharma

153

151

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What is already known about this subject• Effects of size, renal function, age (postnatal age, gestational age and postmenstrual age) as predictors of vancomycin clearance in premature neonates are established, but the relative contribution of each component remains poorly quantified, largely because these variables are closely correlated.• We have quantified the covariates contributing to vancomycin clearance population parameter variability in order to establish the major covariates required for dosing predictions. Size, standardized using allometric models, was the primary covariate used in our analysis. What this study adds• Size explained 49.8%, postmenstrual age 18.2% and renal function 14.1% of clearance variability.• Descriptors of the relationship between age and clearance in premature neonates vary.• The use of a variable slope sigmoidal model to describe the relationship between clearance and postmenstrual age predicted an adult clearance of 3.79 l h − 1 70 kg − 1 (95% confidence interval 2.76, 4.98) from premature neonatal data. AimTo identify and quantify factors describing the variability of vancomycin clearance in premature neonates. MethodsPopulation pharmacokinetics were estimated (NONMEM) in 214 neonates [postmenstrual age (PMA) 30.4 weeks, range 24-34 weeks; postnatal age 11.9 days, range 1-27 days; weight 1.30 kg, range 0.42-2.6 kg] using therapeutic drug monitoring data. Covariate analysis included weight, PMA, serum creatinine, use of inotropes or ibuprofen, positive blood culture and respiratory support. A one-compartment linear disposition model with zero order input and first-order elimination was used to describe the data (604 observations). ResultsThe population estimate for volume of distribution ( V ) was 39 l 70 kg − 1 (coefficient of variation 19.4%). Clearance (CL) increased from 0.897 l h − 1 70 kg − 1 at 24 weeks PMA to 2.02 l h − 1 70 kg − 1 by 34 weeks PMA. The between-subject variability for CL was 18.6% and the between-occasion variability was 12.2%. The use of ibuprofen reduced clearance, but this effect was attributable to reduced renal function. Overall, 82% of the variability of CL was predictable. Size explained 49.8%, P MA 18.2% and renal function 14.1%. The use of a variable slope sigmoidal model to describe the relationship between clearance and PMA predicted an adult clearance of 3.79 l h − 1 70 kg − 1 (95% confidence interval 2.76, 4.98). ConclusionsSize, renal function and PMA are the major contributors to clearance variability in premature neonates. The small (18%) unexplained variability in clearance suggests target concentration intervention is unnecessary if size, age and renal function are used to predict the dose. Extrapolation to an adult clearance from neonatal data is possible using allometric size models and a function describing clearance maturation.B. J. Anderson et al.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Anderson

Allegaert

Anker

et al. 2006

Brit J Clinical Pharma

153

151

View full text Add to dashboard Cite

show abstract

“…GFR has been reported to be affected by prenatal treatment with steroids or indomethacin (23,24) and by respiratory failure in the neonate in some (25,26) but not all studies (27). Data were therefore collected on prenatal drug use (antenatal betamethasone was scored when given within 8 d before birth), respiratory support during the first 24 h of life, and the use of surfactant.…”

Section: Patientsmentioning

confidence: 99%

Impact of Gestational Age and Birth Weight on Amikacin Clearance on Day 1 of Life

Schreuder

Wilhelm²,

Bökenkamp

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Intrauterine growth restriction (IUGR) and prematurity are associated with a low nephron endowment. It can therefore be expected that neonates who are born premature and/or after IUGR have a lower GFR. Measurement of GFR in neonates is difficult, but the clearance of amikacin has been proven to be a reliable marker. We hypothesized that amikacin clearance is lower after IUGR or premature birth as a marker of low nephron endowment.Design, setting, participants, & measurements: Amikacin clearance was retrospectively analyzed in 161 neonates who received amikacin within the first 24 h of life. Using the MW/Pharm computer program, a population one-compartment model was calculated. The mean population pharmacokinetic parameters were individualized for each patient according to the maximum a posteriori Bayesian fitting method and provided the amikacin clearance.Results: Our results show that birth weight z score and gestational age are correlated with the clearance of amikacin (partial correlation coefficient 0.159, P ‫؍‬ 0.046, and 0.396, P < 0.001, respectively), after correction for other factors.Conclusions: We conclude that renal clearance on the first day of life is lower in neonates with a lower gestational age and/or birth weight z score. This indicates that both prematurity and IUGR impair GFR on the first day of life.

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“…[2][3][4] While in the immediate postnatal period the newborn SCr likely reflect maternal values, 2,4 further increase in the levels of SCr in premature infants have been attributed to increased tubular reabsorption of creatinine due to renal tubular immaturity and also to reduced creatinine clearance. 2,3 It has also been shown by several investigators that creatinine clearance and glomerular filtration rate (GFR) increase with postnatal age in premature infants, [5][6][7][8] and in the absence of urine creatinine measurements, SCr can be used to estimate GFR. [9][10][11][12] However, little is known about the relationship between gestational age/birth weight (GA/BW) and SCr in VLBW infants at birth following stabilization of their SCr.…”

Section: Introductionmentioning

confidence: 99%

Serum creatinine in very low birth weight infants during their first days of life

Auron

Mhanna

2006

J Perinatol

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Objectives: Little is known about the relationship between gestational age (GA) or birth weight (BW) and serum creatinine (SCr) in very low birth weight (VLBW) infants. We sought to study postnatal SCr changes and determine if there is a correlation between GA or BW and SCr in VLBW infants, during their first days of life.Study Design: Medical records of all VLBW infants, who were admitted to our neonatal intensive care unit (NICU) between 1 May 1998 and 1 May 2001, were reviewed. Medical records were reviewed for: BW, GA, gender, race, APGAR scores, mechanical ventilation, use of medications, fluid intake, urinary output, protein intake, blood urea nitrogen (BUN) and SCr during the first days of life. Patients with anuria/oliguria, major congenital anomalies, low APGAR scores at 5 min, on high ventilator settings (on the oscillator), hemodynamically unstable (on pressors, inotropes) and on indomethacin and diuretics were excluded.Results: In total, 138 infants met our inclusion criteria. SCr was found to decrease postnatally, reaching a plateau on day 5 of life in all VLBW infants (repeated measure analysis of variance; P ¼ 0.004); however, there was a delay in the decrease of SCr in the subgroup of infants <29 weeks GA, and <1000 g BW. SCr (on day 5 of life) was also found to decrease with increasing GA and BW (Pearson correlation coefficient: À0.206 (P ¼ 0.05) and À0.236 (P ¼ 0.05) respectively). Conclusion:In VLBW infants SCr decreases significantly during the first days of life; however, in infants younger than 29 weeks GA or smaller than 1000 g BW there is a delay in the decrease of their SCr that extends beyond the first days of life. We also conclude that during the first days of life, and in VLBW infants SCr decreases with advancing GA and BW.

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Serum creatinine concentration, urinary creatinine excretion and creatinine clearance during the first 9 weeks in preterm infants with a birth weight below 1500 g

Abstract: It might be necessary to lower dosage of renal excreted drugs in very immature and mechanically ventilated infants according to the creatinine clearance.

Cited by 104 publications

References 13 publications

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Impact of Gestational Age and Birth Weight on Amikacin Clearance on Day 1 of Life

Serum creatinine in very low birth weight infants during their first days of life

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