Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

Barrington, Keith J.; Brion, Luc P.

doi:10.1002/14651858.cd003213

Cited by 45 publications

(21 citation statements)

References 27 publications

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“…Fuchs et al (11) incorporated dopamine comedication as a covariate on Cl in their PK model. We did not, however, retrieve data on dopamine use in our cohort of neonates, as there is conflicting literature on the effect of dopamine on the glomerular filtration rate and Cl of aminoglycosides in neonates (13)(14)(15)(16)(17), and at the time of study design, the PK model of Fuchs et al (11) was not yet published. We therefore could not include dopamine use as a covariate when applying the model to our data.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics and Dosing Considerations for Gentamicin in Newborns with Suspected or Proven Sepsis Caused by Gram-Negative Bacteria

Bijleveld

Heuvel

Hodiamont

et al. 2017

Antimicrob Agents Chemother

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The aim of this study was to describe the population pharmacokinetics (PK) of gentamicin in neonates with suspected or proven Gram-negative sepsis and determine the optimal dosage regimen in relation to the bacterial MICs found in this population. Data were prospectively collected between October 2012 and January 2013 in the Neonatal Intensive Care Unit (NICU) at the Academic Medical Center (AMC), Amsterdam, The Netherlands. A single nonlinear mixed-effects regression analysis (NONMEM) was performed to describe the population PK of gentamicin. Dosage regimens based upon gestational age (GA) were generated using Monte Carlo simulations with the final model. Target values were based on the MIC distribution in our patient population. In total, 136 gentamicin concentrations from 65 (pre)term neonates were included. The PK was best described by an allometric 2-compartment model with postmenstrual age (PMA) as a covariate on clearance (Cl). The MIC distribution (median, 0.75 [range, 0.5 to 1.5] mg/liter) justified a gentamicin target peak concentration of 8 to 12 mg/liter. This study describes the PK of gentamicin in (pre)term neonates. Dosage regimens of 5 mg/kg of body weight every 48 h, 5 mg/kg every 36 h, and 5 mg/kg every 24 h for patients with GAs of Ͻ37 weeks, 37 to 40 weeks, and Ն40 weeks, respectively, are recommended.

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics and Dosing Considerations for Gentamicin in Newborns with Suspected or Proven Sepsis Caused by Gram-Negative Bacteria

Bijleveld

Heuvel

Hodiamont

et al. 2017

Antimicrob Agents Chemother

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Section: Discussionmentioning

confidence: 99%

“…For example, compared to participants who reported use of three courses for persistent PDA, participants who use a maximum of two courses consider a higher threshold level of platelet count as a contraindication to indomethacin therapy. The variation found regarding use of interventions such as low-dose dopamine and furosemide to improve renal function and urine output, respectively, may be explained by inconclusive evidence in the literature [5,8].We selected a Web-based survey mode because of the ability for rapid response, much lower cost compared to postal mail, and reduction of data entry errors [7,36]. The cost involved was only $40 to keep the survey active for 2 months.…”

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confidence: 99%

Indomethacin Use for the Management of Patent Ductus Arteriosus in Preterms: A Web-Based Survey of Practice Attitudes Among Neonatal Fellowship Program Directors in the United States

2007

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The objective of this study was to determine whether neonatal-perinatal fellowship programs (NFTPs) in the United States vary in indomethacin use for the management of patent ductus arteriosus (PDA) in ≤28 week gestational age infants at birth. A 53-item web-based survey was sent to 84 NFTP directors who received prenotification, followed 2 weeks later by a reminder letter. A total of 56 NFTP directors responded (67% maximum response rate). Wide variation exists in the maximum number of indomethacin courses used to close ductus, use of indomethacin for reopened PDA beyond 14 days, ductal closure definition, contraindications before consideration of indo-methacin, interventions for contraindications, and reported ductal closer rate after each indomethacin course. Indomethacin therapy for symptomatic PDA and short course of indomethacin are common practices. Indomethacin use for the management of PDA in premature infants varies among NFTP directors. Practice attitudes may explain variations in ductal closure and ligation rates. Because practice variations may have implications for long-term outcome of vulnerable premature infants, studies relevant to the management of PDA in premature infants are needed. KeywordsIndomethacin; Health care surveys; Premature infants Patent ductus arteriosus (PDA) is extremely common, occurring in 50-75% of infants ≤28 weeks gestational age (GA) [19]. PDA is associated with increased risk of necrotizing © Springer Science+Business Media, LLC 2007 sanjiv_amin@urmc.rochester.edu. NIH Public Access Author ManuscriptPediatr Cardiol. Author manuscript; available in PMC 2015 January 06. Published in final edited form as:Pediatr Cardiol. 2007 ; 28(3): 193-200. doi:10.1007/s00246-006-0093-1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript enterocolitis, chronic lung disease, pulmonary hemorrhage, and intraventricular hemorrhage (IVH) [10,12,24,34]. Indomethacin is often used as a first line of treatment for PDA, with reported response rates greater than 60% in premature infants. However, studies have failed to provide conclusive results regarding the optimum duration, specifically short course (three dose) versus prolonged course (more than three doses) of indomethacin therapy [9,20,21,26,32,33,37]. Evidence is insufficient to support or refute the use of multiple courses (two or more courses) of indomethacin for the management of persistent PDA [23]. In addition, randomized trials conducted to date have varied in their definition of ductal closure based on echocardiographic findings. These variations in echocardiographic definitions of ductal closure have relevance for the interpretation of response rates in the literature and the need for further treatment [10,13,14,20,26,28,32,33,35,37].Although an initial indomethacin course will produce PDA closure in 60-80% of premature infants, the PDA reopens later in 6-53% of infants who initially respond to indomethacin [14,17,22,30]. There also appears to be no consensus regarding the best approach for the managem...

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“…A systematic review 39 concluded that there is no evidence that low-dose dopamine has favorable effects on renal function, including urine flow, and creatinine clearance or on beneficial clinical outcomes. Three studies, investigating the effects of dopamine on renal dysfunction due to indomethacin therapy, were the subject of a Cochrane Systematic Review, 40 which concluded that there was no evidence of renal protection from dopamine during indomethacin therapy.…”

Section: Comparison With No Treatmentmentioning

confidence: 99%

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

2007

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A very large proportion of extremely preterm infants receive treatments for hypotension. There are, however, marked variations in indications for treatment, and in the interventions used, between neonatal intensive care units and between neonatologists.Methods: We performed systematic reviews of the literature in order to determine which preterm infants may benefit from treatment with interventions to elevate blood pressure (BP), and which interventions improve clinically important outcomes.Results: Our review was not able to define a threshold BP that was significantly predictive of a poor outcome, nor whether any interventions for hypotensive infants improved outcomes, nor which interventions were more likely to be beneficial. Conclusions:There is a distinct lack of prospective research of this issue, which prevents good clinical care. It is possible that a simple BP threshold that indicates the need for therapy does not exist, and other factors, such as the clinical status or systemic blood flow measurements, may be much more informative. Such a paradigm shift will also require careful prospective study.

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Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

Cited by 45 publications

References 27 publications

Population Pharmacokinetics and Dosing Considerations for Gentamicin in Newborns with Suspected or Proven Sepsis Caused by Gram-Negative Bacteria

Population Pharmacokinetics and Dosing Considerations for Gentamicin in Newborns with Suspected or Proven Sepsis Caused by Gram-Negative Bacteria

Indomethacin Use for the Management of Patent Ductus Arteriosus in Preterms: A Web-Based Survey of Practice Attitudes Among Neonatal Fellowship Program Directors in the United States

Treating hypotension in the preterm infant: when and with what: a critical and systematic review

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