The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

Leslie, Garth I.; Philips, Joseph B.; Work, Jack; Ram, Sunanda J.; Cassady, George

doi:10.1203/00006450-198605000-00014

Cited by 33 publications

(10 citation statements)

References 17 publications

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“…Again no significant differences were found. This contrasts with the data of Leslie et al [21], who found a negative effect of artificial ventilation on glomerular filtration using creatinine clearance. In their study the reported values for creatinine clearance are surprisingly low for infants needing artificial ventilation as well as for those breathing spontaneously.…”

Section: Discussionmentioning

confidence: 56%

Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age

et al. 1988

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In 41 preterm neonates with a gestational age (GA) varying from 27 to 36 weeks, glomerular filtration rate (GFR) was measured by means of the continuous inulin infusion technique. The reliability of the technique was confirmed. During postnatal development GFR was found to increase in two ways: firstly, an increase with advancing gestational age, associated with the increase in body weight (BW) [GFR (ml/min) = 0.15 X GA-3.20, r = 0.48, P = 0.0048]; secondly, a postnatal increase, being independent from increment in BW. An increase in GFR (ml/min.kg) from 0.88 +/- 0.23 to 1.18 +/- 0.28 was observed between day 4 and day 11 postnatally (P less than 0.008). This latter increase is probably associated with changes in renal haemodynamics. No significant influence of artificial ventilation on GFR could be demonstrated in preterm neonates.

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Section: Discussionmentioning

confidence: 56%

Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age

et al. 1988

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“…Although mechanical ventilation with positive pressure in VLBW infants is associated with a lower creatinine clearance and higher values of urinary arginine vasopressin and osmolality [29], we did not exclude infants receiving this therapy from our analysis. All 23-to 28-week GA infants received courses of ampicillin/gen- Sense 5′-CAACAGCCCTTTCTTCCACATG-3′ 303 Antisense 5′-TGTCATAGCCTCTCTTCATCCTGG-3′ GAPDH Sense 5′-GCTGAACGGGGAAACTCACTG-3′ 307 Antisense 5′-TCCACCACCCTGTTGCTGTA-3′ tamicin or vancomycin/cefotaxime, as clinically indicated.…”

Section: Generalmentioning

confidence: 98%

Sodium and potassium clearances by the maturing kidney: clinical-molecular correlates

Delgado

Rohatgi

Khan

et al. 2003

Pediatric Nephrology

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A temporal dissociation exists between the early appearance of sodium absorptive and later detection of potassium secretory processes in the maturing rabbit collecting duct. To extend the latter findings to the human, we sought to correlate developmental changes in renal sodium and potassium clearances with the molecular expression of corresponding ion channels in kidneys of premature infants. In a longitudinal prospective study of 23- to 31-week gestational age (GA) infants, sodium, potassium, and creatinine clearances were measured weekly for 5 weeks and the absolute and fractional excretions of sodium (FE(Na)) and potassium (FE(K)) calculated. Gene-specific probes were used to assess steady-state abundance of mRNA encoding the sodium channel ENaC and potassium channel ROMK in homogenates of human kidneys (obtained from the Anatomic Gift Foundation). Although urinary losses of sodium in infants /=28 weeks and all infants >approximately 32 weeks GA achieved a state of positive balance, a maturational process associated with a decrease in FE(Na )and increase in ENaC. Infants >approximately 30 weeks GA maintained a state of positive potassium balance. We noted a twofold reduction in FE(K )after approximately 26 weeks GA and no change in ROMK abundance during the developmental window studied. We speculate that the developmental regulation of renal ENaC expression contributes, at least in part, to the decrease in FE(Na )observed with advancing GA, and that in the human, as in the rabbit, there is a delay between the maturation of sodium absorptive and potassium secretory pathways.

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“…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

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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.

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The Effect of Assisted Ventilation on Creatinine Clearance and Hormonal Control of Electrolyte Balance in Very Low Birth Weight Infants

Cited by 33 publications

References 17 publications

Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age

Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age

Sodium and potassium clearances by the maturing kidney: clinical-molecular correlates

Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance

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