A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges: Part II—The 1990s, the New Millennium, Future Challenges

OBJECTIVES The primary objective was to compare the volume of distribution (Vd), clearance (CL), elimination rate (Ke), and half-life (t½) of amikacin in neonates with cyanotic defects, acyanotic defects, and controls, adjusted for gestational and postnatal age. Secondary objectives were to compare the incidence of acute kidney injury (AKI) between controls and the congenital heart disease (CHD) group and to identify potential risk factors. METHODS This retrospective cohort study included neonates receiving amikacin from January 1, 2013 to August 31, 2016. Patients were excluded if concentrations were not appropriately obtained or if AKI or renal anomalies were identified prior to amikacin initiation. Congenital heart disease was classified as acyanotic or cyanotic. Patients with CHD were matched 1:1 with non-CHD controls according to postmenstrual age. Bivariate analyses were performed using Wilcoxon-Mann-Whitney test, Pearson χ2 tests, or Fisher exact as appropriate with a p value <0.05. Regression analyses included logistic and analysis of covariance. RESULTS Fifty-four patients with CHD were matched with 54 controls. Median (IQR) postnatal age (days) at amikacin initiation significantly differed between CHD and controls, 3.0 (1.0–16.0) versus 1.0 (1.0–3.0), p = 0.016. After adjusting for gestational and postnatal age, there was no difference in the mean (95% CI) Vd (L/kg) and CL (L/kg/hr) between CHD and controls, 0.47 (0.44–0.50) versus 0.46 (0.43–0.49), p = 0.548 and 0.05 (0.05–0.05) versus 0.05 (0.05–0.05), p = 0.481, respectively. There was no difference in Ke or t½ between groups. There was no difference in AKI between the CHD and controls, 18.5% versus 9.3%, p = 0.16. CONCLUSIONS Clinicians should consider using standard amikacin dosing for neonates with CHD and monitor renal function, since they may have greater AKI risk factors.

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A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges: Part II—The 1990s, the New Millennium, Future Challenges

Abstract: This is the second of two articles reviewing the history of newborn medicine. This article will discuss recent accomplishments in the field of newborn medicine, current health outcome data, and future challenges facing the fields of neonatal and perinatal medicine.

Cited by 2 publications

References 78 publications

History of Neonatal Medicine—Limitations in Studies, Guidelines, and Resources Impact Progress

History of Neonatal Medicine—Limitations in Studies, Guidelines, and Resources Impact Progress

Comparison of Amikacin Pharmacokinetics in Neonates With and Without Congenital Heart Disease

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