Gentamicin extended interval regimen and ototoxicity in neonates

El-Barbary, Mohamed; Ismail, R I H; Ibrahim, Adel A.A.

doi:10.1016/j.ijporl.2015.05.036

Cited by 19 publications

(8 citation statements)

References 39 publications

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“…This might be because of drug serum levels and the short courses of these antibiotics. Our results match those of many authors who have investigated ototoxicity, especially aminoglycosides and loop diuretics, in NICU populations: even with extended regimens and the simultaneous administration of more than one ototoxic drug, there seems to have been no increase in the incidence of hearing loss [28][29][30]. Nevertheless, the regular assessment of drug serum levels and short administrations are strongly recommended.…”

Section: Discussionsupporting

confidence: 88%

Risk Factors Affecting Hearing in Neonatal Intensive Care Unit Neonates

et al. 2016

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Background: Neonatal intensive care unit graduates are considered to be of higher risk for hearing impairment, either auditory neuropathy or hearing loss. In this study we examine the presence of risk factors and try to identify their effect on the hearing of high-risk neonates. Material and methods:In this prospective cohort study we used automated auditory brainstem responses (a-ABRs) and otoacoustic emissions (OAEs) to screen 453 neonatal intensive care unit neonates who had at least one risk factor for hearing impairment.Results: In the initial examination, 382 (84.3%) infants passed and 71 (15.7%) failed a-ABRs. Out of those who failed, 39 newborns (55%) passed the transiently evoked otoacoustic emission (TEOAE) test, while 32 (45%) failed that test too. Re-examination was performed before their first month of age, eventually resulting in 8 newborns being diagnosed with possible hearing loss and 8 with possible auditory neuropathy. The overall dropout rate was 4.9%. Low birth-weight (p=0.016), as well as craniofacial abnormalities (p=0.03) and TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections proved to have a statistically significant correlation (p=0.05) with hearing impairment. Conclusion:Because a significant number of children may have auditory neuropathy, ABRs and OAEs (both transiently evoked and distortion product OAEs) remain the cornerstones of any universal hearing screening program in neonatal intensive care units. An efficient tracking system is needed to reduce the number of neonates lost to follow-up. Low birth-weight, craniofacial deformities, and congenital infections appear to be the most significant factors predisposing an infant to hearing impairment.

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Section: Discussionsupporting

confidence: 88%

Risk Factors Affecting Hearing in Neonatal Intensive Care Unit Neonates

et al. 2016

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“…On the other hand, this low number combined with a high variance in exposure to gentamicin lead to 95% CIs around the observed difference in gentamicin exposure that are consistent with as much as 25% higher exposure to gentamicin in infants who developed SNHL. Previous studies reporting on the absence of ototoxicity of gentamicin in newborns also suffer from methodological limitations including a small size, incomplete information on gentamicin exposure and absence of long term audiologic assessment [ 21 , 33 – 36 , 46 , 47 ]. Hearing impairment may have resulted from the combined effect of prematurity, low birthweight, gentamicin treatment and other ototoxic medications such as furosemide and vancomycin, and genetic factors.…”

Section: Discussionmentioning

confidence: 99%

Gentamicin Exposure and Sensorineural Hearing Loss in Preterm Infants

et al. 2016

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ObjectiveTo evaluate the impact of gentamicin exposure on sensorineural hearing loss (SNHL) in very low birth weight (VLBW) infants.MethodsExposure to gentamicin was determined in infants born between 1993 and 2010 at a gestational age < 32 weeks and/or with a birthweight < 1500 g, who presented with SNHL during the first 5 years of life. For each case, we selected two controls matched for gender, gestational age, birthweight, and year of birth.ResultsWe identified 25 infants affected by SNHL, leading to an incidence of SNHL of 1.58% in our population of VLBW infants. The proportion of infants treated with gentamicin was 76% in the study group and 70% in controls (p = 0.78). The total cumulated dose of gentamicin administered did not differ between the study group (median 10.2 mg/kg, Q1-Q3 1.6–13.2) and the control group (median 7.9 mg/kg, Q1-Q3 0–12.8, p = 0.47). The median duration of gentamicin treatment was 3 days both in the study group and the control group (p = 0.58). Maximum predicted trough serum levels of gentamicin, cumulative area under the curve and gentamicin clearance were not different between cases and controls.ConclusionThe impact of gentamicin on SNHL can be minimized with treatments of short duration, monitoring of blood levels and dose adjustment.

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“…10–12 The ototoxicity may be exacerbated when gentamicin is used for prolonged duration, 13,14 multiple courses, 15 concomitantly with other ototoxic drugs such as diuretics, 16 in a noisy NICU environment, 7 during hypoxia, 17 or in some individuals with a genetic predisposition for developing hearing loss. 18 Adult, child, and infant data that show an association between gentamicin use and ototoxicity 16,19–24 come from small observational or retrospective studies, so larger, more robust analyses are needed during the neonatal period. In this study, we investigated the effect of gentamicin dose and duration of therapy on hearing screen results at the time of initial discharge in a large multicenter cohort of hospitalized infants.…”

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confidence: 99%

Evaluation of Gentamicin Exposure in the Neonatal Intensive Care Unit and Hearing Function at Discharge

Puia‐Dumitrescu

Bretzius

Brown

et al. 2018

The Journal of Pediatrics

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Objective To characterize the association between gentamicin dosing, duration of treatment, and ototoxicity in hospitalized infants. Study design This retrospective cohort study conducted at 330 neonatal intensive care units (2002–2014) included inborn infants exposed to gentamicin with available hearing screen results, and excluded infants with incomplete dosing data and major congenital anomalies. Our primary outcome was the final hearing screen result performed during hospitalization: abnormal (failed or referred for further testing in one or both ears) or normal (bilateral passed). The 4 measures of gentamicin exposure were highest daily dose, average daily dose, cumulative dose, and cumulative duration of exposure. We fitted separate multivariable logistic regression models adjusted for demographics, comorbidities, and other clinical events. Results A total of 84 808 infants met inclusion/exclusion criteria; median (25th, 75th percentile) gestational age and birth weight were 35 weeks (33, 38) and 2480 g (1890, 3184), respectively. Failed hearing screens occurred in 3238 (3.8%) infants; failed screens were more likely in infants of lower gestational age and birth weight, who had longer hospital lengths of stay, higher rates of morbidities, and were small for gestational age. Median highest daily dose, average daily dose, and cumulative dose were 4.0 mg/kg/day (3.0, 4.0), 3.8 mg/kg/day (3.0, 4.0), and 12.1 mg/kg (9.1, 20.5), respectively. Median cumulative duration of exposure was 3 days (3, 6). In adjusted analysis, gentamicin dose and duration of therapy were not associated with hearing screen failure. Conclusions Gentamicin dosing and duration of treatment were not associated with increased odds of failed hearing screen at the time of discharge from initial neonatal intensive care unit stay.

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Gentamicin extended interval regimen and ototoxicity in neonates

Cited by 19 publications

References 39 publications

Risk Factors Affecting Hearing in Neonatal Intensive Care Unit Neonates

Risk Factors Affecting Hearing in Neonatal Intensive Care Unit Neonates

Gentamicin Exposure and Sensorineural Hearing Loss in Preterm Infants

Evaluation of Gentamicin Exposure in the Neonatal Intensive Care Unit and Hearing Function at Discharge

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