Abstract
Auto-regulation of renal blood flow (RBF) and glomerular filtration may be severely compromised in newborns following asphyxia. GFR and urine output may be more dependent on changes in mean arterial pressure (Pa) in the asphyxiated infant. Therefore, the disposition of aminoglycosides, which depend on GFR for clearance, may be altered.
27 preterm infants (<35 weeks gestation) with suspected or proven sepsis were prospectively studied. Gentamicin half-life (T1/2) was compared with the following factors: asphyxia, hypotension, and the use of dopamine (5-15ugms/kg.min) after volume expansion.
T1/2 is prolonged in asphyxiated infants (12.6 hrs vs 7.2 hrs p=0.05). T1/2 is not altered by the use of dopamine. In asphyxiated infants (N=8) the gentamicin T1/2 correlated with urine output (r=0.57) and with Pa (r=0.69). These correlations are not present in non-asphyxiated infants. The gentamicin peak and trough values did not correlate with serial urine flow, blood urea nitrogen or creatinine. There is an inverse relationship to gestational age and post-natal age.
Following perinatal asphyxia, auto-regulation of GFR and RBF may be decreased so that gentamicin T1/2 is more dependent on Pa. Gentamicin kinetics should be carefully monitored in asphyxiated infants.
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Friedman, C., Parks, B. & Rawson, J. 327 GENTAMICIN DISPOSITION IN ASPHYXIATED NEWBORNS: RELATIONSHIP TO MEAN ARTERIAL PRESSURE AND URINE OUTPUT. Pediatr Res 15 (Suppl 4), 494 (1981). https://doi.org/10.1203/00006450-198104001-00338
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DOI: https://doi.org/10.1203/00006450-198104001-00338
