Urine output predicts serum gentamicin concentration in preterm infants

K. M. Oski, Mitchell Kresch, C. Kimble, D. Buchanan, N. Hussain

Research output: Contribution to journalArticle

Abstract

There are no reliable predictors of gentamicin (G) levels in premature infants. As G is excreted by the kidneys, we hypothesized G levels can be predicted by urine output. We conducted a retrospective study of neonates (GA 30-36wks, n= 20) who received G therapy (3 mg/kg/day). Infants with a Dx of acute tubular necrosis, asphyxia, hypotension or received vasopressor support or indomethacin were excluded. We collected data on gestational age (GA), body weight, urine output (UOP, cc/m2/hr and cc/k/hr), fluid intake and output (I/O), G intervals/route, body surface area, G levels and day of life G levels drawn. Volume of distribution (VD, liters) was calculated as dose given/[peak-trough] levels. Data were analyzed by student's test, chi square test, correlation coefficient as appropriate. Results showed urine output ≥2 and ≤ 4.0 cc/k/hr predicted therapeutic G levels (peak= 5-10 μg/mL) in premature infants (sensitivity 0.78, specificity 1 and positive predictive value 1). Urine output >4 cc/k/hr resulted in peak levels < 5 μg/mL. There were significant inverse correlations comparing peak G levels to UOP and VD (Table). We conclude that urine output, 24hrs prior to G level measurement, is a non-invasive, highly predictive measure of adequacy of dose. We also conclude that the inverse correlation of peak G levels with urine output reflects the change in volume of distribution. Table: Correlations of Peak Gentamicin (G) Concentrations UOP (cc/kg/hr) UOP (cc/m2/hr) VD r -0.572 -0.648 -0.49 r2 0.328 0.42 0.24 p value 0.008 0.002 0.03.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume47
Issue number2
Publication statusPublished - 1999

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All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

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