Background
Currently, scant data exists regarding ECMO support in neonates with herpes virus infection.
Objectives
We investigated outcomes among neonates with herpes virus infection reported to the Extracorporeal Life Support Organization (ELSO) registry and analyzed factors associated with death prior to hospital discharge with this virus.
Design
Retrospective analysis of ELSO registry dataset from 1985–2005.
Setting
114 ECMO centers contributing data to the ELSO registry.
Patients
Patients 0–31 days of age with herpes simplex virus infection supported with ECMO and reported to the ELSO registry.
Interventions
None
Methods
Clinical characteristics, outcomes, and factors associated with death prior to hospital discharge were investigated for patients in the virus group. Kaplan-Meier estimates of survival to hospital discharge according to virus type were investigated.
Measurements and Main Results
Newborns with HSV infection requiring ECMO support demonstrated much lower hospital survival rates (25%). Clinical presentation with septicemia/ shock was significantly associated with mortality for the HSV group on multivariate analysis. There was no difference in HSV mortality when comparing two era’s (≥ 2000 versus < 2000).
Conclusions
In this cohort of neonatal patients with overwhelming infections due to HSV who were supported with ECMO, survival was dismal. Patients with disseminated HSV infection presenting with septicemia/ shock are unlikely to survive, even with aggressive extracorporeal support.
Aminoglycoside dosing has been studied in the obese population, typically recommending an adjusted weight utilizing a 40% dosing weight correction factor (IBW + 0.4 × (TBW–IBW)). These studies included limited numbers of morbidly obese patients and were not done in the era of extended interval aminoglycoside dosing. Here, we report a retrospective evaluation of morbidly obese patients receiving gentamicin or tobramycin at our hospital. The objective of this study was to evaluate the accuracy of the commonly recommended adjusted weight for weight-based dosing. There were 31 morbidly obese patients who received gentamicin or tobramycin 5–7 mg/kg every 24 hours using a 40% dosing weight correction factor. Our institution utilizes 16-hour postdose concentrations to monitor extended interval aminoglycosides. Twenty-two of the 31 patients (71%) achieved an appropriate serum drug concentration. Four patients (13%) were found to be supratherapeutic and 5 patients (16%) subtherapeutic. The only variable that correlated with supratherapeutic levels was older age (P = 0.0378). Our study helps to validate the current dosing weight correction factor (40%) in the morbidly obese population. We recommend caution when dosing aminoglycosides in morbidly obese patients who are of older age.
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