Renal Functions of Low Birth Weight Infants during the First Two Months of Life

Ross, Barbara S.; Cowett, Richard M.; Oh, William

doi:10.1203/00006450-197711000-00010

Cited by 92 publications

(35 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Positive pressure ventilation had a small effect on CL which was model dependent. Although Van der Heijden [23] has documented an absence of any effect of ventilation on renal clearance in premature neonates at PNA 3 days, others [22,29,30] have demonstrated a reduction of renal clearance in premature neonates in their first 2 weeks of life. This reduction may be mediated through lowered renal function due to decreased atrial natriuretic peptide and increased antidiuretic hormone production attributable to right atrial pressure receptors which are influenced by altered thoracic pressures during positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Anderson

Allegaert

Anker

et al. 2006

Brit J Clinical Pharma

151

View full text Add to dashboard Cite

What is already known about this subject• Effects of size, renal function, age (postnatal age, gestational age and postmenstrual age) as predictors of vancomycin clearance in premature neonates are established, but the relative contribution of each component remains poorly quantified, largely because these variables are closely correlated.• We have quantified the covariates contributing to vancomycin clearance population parameter variability in order to establish the major covariates required for dosing predictions. Size, standardized using allometric models, was the primary covariate used in our analysis. What this study adds• Size explained 49.8%, postmenstrual age 18.2% and renal function 14.1% of clearance variability.• Descriptors of the relationship between age and clearance in premature neonates vary.• The use of a variable slope sigmoidal model to describe the relationship between clearance and postmenstrual age predicted an adult clearance of 3.79 l h − 1 70 kg − 1 (95% confidence interval 2.76, 4.98) from premature neonatal data. AimTo identify and quantify factors describing the variability of vancomycin clearance in premature neonates. MethodsPopulation pharmacokinetics were estimated (NONMEM) in 214 neonates [postmenstrual age (PMA) 30.4 weeks, range 24-34 weeks; postnatal age 11.9 days, range 1-27 days; weight 1.30 kg, range 0.42-2.6 kg] using therapeutic drug monitoring data. Covariate analysis included weight, PMA, serum creatinine, use of inotropes or ibuprofen, positive blood culture and respiratory support. A one-compartment linear disposition model with zero order input and first-order elimination was used to describe the data (604 observations). ResultsThe population estimate for volume of distribution ( V ) was 39 l 70 kg − 1 (coefficient of variation 19.4%). Clearance (CL) increased from 0.897 l h − 1 70 kg − 1 at 24 weeks PMA to 2.02 l h − 1 70 kg − 1 by 34 weeks PMA. The between-subject variability for CL was 18.6% and the between-occasion variability was 12.2%. The use of ibuprofen reduced clearance, but this effect was attributable to reduced renal function. Overall, 82% of the variability of CL was predictable. Size explained 49.8%, P MA 18.2% and renal function 14.1%. The use of a variable slope sigmoidal model to describe the relationship between clearance and PMA predicted an adult clearance of 3.79 l h − 1 70 kg − 1 (95% confidence interval 2.76, 4.98). ConclusionsSize, renal function and PMA are the major contributors to clearance variability in premature neonates. The small (18%) unexplained variability in clearance suggests target concentration intervention is unnecessary if size, age and renal function are used to predict the dose. Extrapolation to an adult clearance from neonatal data is possible using allometric size models and a function describing clearance maturation.B. J. Anderson et al.

show abstract

Section: Discussionmentioning

confidence: 99%

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Anderson

Allegaert

Anker

et al. 2006

Brit J Clinical Pharma

151

View full text Add to dashboard Cite

show abstract

“…Compared to term neonates, the rate of increase in GFR after birth is slower in neonates born preterm (Gordjani et al, 1998). Up until two months of age there are similar findings, with a number of studies observing an increase in GFR concurrent to increasing gestational and postnatal ages (Ross et al, 1977;Fawer et al, 1979;Sulyok et al, 1979;Aperia et al, 1981;Wilkins, 1992;Bueva and Guignard, 1994;Gallini et al, 2000;Cuzzolin et al, 2006;Thayyil et al, 2008). Although a number of studies have now been performed in this area, there is still a lack of clear definition regarding expected GFR values in the preterm neonate.…”

Section: Glomerular Filtration Ratementioning

confidence: 57%

“…Therefore, high urine sodium levels may be indicative of structural immaturity of the renal tubule (short length of the tubules, and changes in the density and structure of transporter proteins) (Jones and Chesney, 1992), or due to renal injury (Ueda and Shah, 2000;Bonventre, 2007). Studies that have assessed FENa during the neonatal period have determined that sodium excretion is significantly higher in preterm neonates compared to term controls (Siegel and Oh, 1976;Aperia et al, 1981), and significantly decreases with increasing gestational (Gallini et al, 2000) and postnatal age (Ross et al, 1977;Sulyok et al, 1979;Aperia et al, 1981;Gallini et al, 2000;Giapros et al, 2007). Therefore, with increasing renal maturity a positive sodium balance (low FENa) is achieved, which is essential for the growth and development of the neonate and the maintenance of fluid homeostasis (Engle, 1986).…”

Section: Fluid and Electrolyte Homeostasismentioning

confidence: 99%

Effects of Preterm Birth on the Kidney

Black¹,

Sutherland²,

Gubhaju³

2012

Basic Nephrology and Acute Kidney Injury

View full text Add to dashboard Cite

“…Recent studies have shown that FENa is greater in premature infants than in mature ones and is inversely proportional to the maturity of a neonate (6,15). Premature infants of less than 35 wk of gestation have an obligatory sodium loss, which is believed to be physiologic, resulting from isotonic contraction of body fluid compartments and the disposal of intra-and extracellular fluid solute through the kidney (9). Other studies have indicated that the increased urinary sodium loss in premature infants resulted from deficient proximal and distal tubular reabsorption of sodium (8,16).…”

Section: Discussionmentioning

confidence: 99%

Effects of Aldosterone and Atrial Natriuretic Peptide on Water and Electrolyte Homeostasis of Sick Neonates

et al. 1989

View full text Add to dashboard Cite

ABSTRACT. To clarify fluid homeostasis in neonates, 27 sick neonates (51 had respiratory distress syndrome, 1 2 had hyperbilirubinemia, and nine were low birth wt infants) were studied on 13 to 1 5 days of age. The infants were stabilized and required neither ventilation nor intravenous fluids a t the time of study. All infants were breast fed, and their sodium intake ranged from 1.7 to 2.9 (2.2 f 0.3) mEq/kg/d. Gestational age ranged from 30 to 39 (34 f 3.4) wk and birth wt ranged from 1080 to 3280 (2,070 f 672) g. Creatinine clearance (Ccr), fractional excretion of sodium (FENa), fluid and electrolyte balance, plasma aldosterone and human atrial natriuretic peptide (ANP) concentrations were determined and analyzed according to conceptional age (CA) to clarify their maturational changes. None of the infants had a negative sodium balance or hyponatremia. Ccr remained almost constant until the 36th wk of CA, after which an abrupt increase occurred. FENa and plasma aldosterone level of infants less than the 32nd wk of CA were high (0.75 f 0.33%,2868 f 1153 pg/ mi, respectively) when compared with those in infants of the 3 3 to 34th wk of CA (0.47 f 0.12%, 1,663, f 488 pg/ ml, respectively). There was a negative correlation between FENa and plasma aldosterone level in all cases (p < 0.01).Plasma A N P level of all infants were higher than those of healthy adults (40 f 20 pg/ml). A good correlation was observed between Ccr and plasma A N P level in infants less than 36th wk of CA. These results show that the high plasma aldosterone concentrations possibly act to enhance the reabsorptive capacity of the distal nephron for sodium during development under conditions of low sodium intake and suggest that A N P may be released to control the extracellular space in premature infants with a limited Ccr. (Pediatr Res 25: 591-594,1989) Abbreviations ANP, a-human atrial natriuretic peptide CA, conceptional age Ccr, creatinine clearance ECV, extracellular fluid volume FENa, fractional excretion of sodium GFR, glomerular filtration rate LBW, low birth wt RAAS, renin-angiotensin-aldosterone system RDS, respiratory distress syndrome Plasma aldosterone concentration is relatively high in human newborn infants (1, 2). The cause of increased activity of the RAAS during the neonatal period is not clear. In the newborn the homeostatic function of the kidney may be limited (3). Although full-term infants are able to maintain the volume of body fluids within a narrow range, the physiologic limitations of the renal control of salt and water balance in low birth wt infants are not well established. In addition, recent reports demonstrated that ANP may play an important part in regulating water balance in the newborn period (4, 5). The purpose of this study was to clarify the roles of RAAS and ANP in neonatal fluid homeostasis. MATERIALS AND METHODSStudy protocol. A total of 27 hospitalized sick neonates (15 boys and 12 girls; six had RDS, 12 had hyperbilirubinemia, and nine were LBW infants) were the subjects of this study. Informed co...

show abstract

Renal Functions of Low Birth Weight Infants during the First Two Months of Life

Cited by 92 publications

References 4 publications

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

Effects of Preterm Birth on the Kidney

Effects of Aldosterone and Atrial Natriuretic Peptide on Water and Electrolyte Homeostasis of Sick Neonates

Contact Info

Product

Resources

About