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Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?

IMPORTANCE: Body fluid dynamics and renal maturation status vary during the neonatal period. We hypothesized that differences in peak and trough gentamicin concentrations could be expected. OBJECTIVE: To predict the peak and trough gentamicin concentrations in critically ill neonates and to predict...

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Autores principales: Sridharan, Kannan, Al Jufairi, Muna, Al Ansari, Eman, Alsadah, Lulwa, Wasel, Howra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10262884/
https://www.ncbi.nlm.nih.gov/pubmed/37324598
http://dx.doi.org/10.1002/ped4.12386
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author Sridharan, Kannan
Al Jufairi, Muna
Al Ansari, Eman
Alsadah, Lulwa
Wasel, Howra
author_facet Sridharan, Kannan
Al Jufairi, Muna
Al Ansari, Eman
Alsadah, Lulwa
Wasel, Howra
author_sort Sridharan, Kannan
collection PubMed
description IMPORTANCE: Body fluid dynamics and renal maturation status vary during the neonatal period. We hypothesized that differences in peak and trough gentamicin concentrations could be expected. OBJECTIVE: To predict the peak and trough gentamicin concentrations in critically ill neonates and to predict the changes in the predicted peak plasma concentrations of gentamicin following fat‐free mass dosing. METHODS: Critically ill neonates that received gentamicin and have gentamicin concentration measured were recruited. Fat mass was estimated using skinfold thicknesses. Changes in the peak plasma concentrations (C(max)) using whole‐body weight (estimated using the current dosing regimen) and predicted concentrations following the fat‐free mass‐based dosing were the outcome measures. RESULTS: Eighty‐nine critically ill neonates were recruited. Sub‐therapeutic C(max) was estimated using the current dosing regimen in 32.6%, and 22.5% neonates following the first and second doses of gentamicin. Preterm neonates had significantly higher fat mass compared to term neonates. All except one had C(max) above 12 μg/ml after the first dose and all had after the second gentamicin dose following the predicted fat‐free mass‐based gentamicin dosing. The recommended doses are as follows: extreme preterm: 7.95 mg/kg every 48 h; very preterm: 7.30 mg/kg every 36–48 h; late preterm: 5.90 mg/kg every 36–48 h; and term neonates at 5.10 mg/kg every 24 h. INTERPRETATION: Fat‐free mass dosing may be considered for obtaining optimal therapeutic effects in the neonatal population.
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spelling pubmed-102628842023-06-15 Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates? Sridharan, Kannan Al Jufairi, Muna Al Ansari, Eman Alsadah, Lulwa Wasel, Howra Pediatr Investig Original Article IMPORTANCE: Body fluid dynamics and renal maturation status vary during the neonatal period. We hypothesized that differences in peak and trough gentamicin concentrations could be expected. OBJECTIVE: To predict the peak and trough gentamicin concentrations in critically ill neonates and to predict the changes in the predicted peak plasma concentrations of gentamicin following fat‐free mass dosing. METHODS: Critically ill neonates that received gentamicin and have gentamicin concentration measured were recruited. Fat mass was estimated using skinfold thicknesses. Changes in the peak plasma concentrations (C(max)) using whole‐body weight (estimated using the current dosing regimen) and predicted concentrations following the fat‐free mass‐based dosing were the outcome measures. RESULTS: Eighty‐nine critically ill neonates were recruited. Sub‐therapeutic C(max) was estimated using the current dosing regimen in 32.6%, and 22.5% neonates following the first and second doses of gentamicin. Preterm neonates had significantly higher fat mass compared to term neonates. All except one had C(max) above 12 μg/ml after the first dose and all had after the second gentamicin dose following the predicted fat‐free mass‐based gentamicin dosing. The recommended doses are as follows: extreme preterm: 7.95 mg/kg every 48 h; very preterm: 7.30 mg/kg every 36–48 h; late preterm: 5.90 mg/kg every 36–48 h; and term neonates at 5.10 mg/kg every 24 h. INTERPRETATION: Fat‐free mass dosing may be considered for obtaining optimal therapeutic effects in the neonatal population. John Wiley and Sons Inc. 2023-06-08 /pmc/articles/PMC10262884/ /pubmed/37324598 http://dx.doi.org/10.1002/ped4.12386 Text en © 2023 Chinese Medical Association. Pediatric Investigation published by John Wiley & Sons Australia, Ltd on behalf of Futang Research Center of Pediatric Development. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Article
Sridharan, Kannan
Al Jufairi, Muna
Al Ansari, Eman
Alsadah, Lulwa
Wasel, Howra
Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title_full Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title_fullStr Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title_full_unstemmed Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title_short Is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
title_sort is fat‐free mass‐based gentamicin dosing regimen preferable than whole‐body weight in neonates?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10262884/
https://www.ncbi.nlm.nih.gov/pubmed/37324598
http://dx.doi.org/10.1002/ped4.12386
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