Extended Interval Aminoglycoside Treatment for Klebsiella Pneumoniae Endocarditis in an Extremely Low Birth Weight Neonate

Infective endocarditis (IE) in neonates is associated with high mortality and incidence has been increasing over the past two decades. The majority of very low birth weight infants will be treated with at least one nephrotoxic medication during their hospital course. Over one-quarter of very low birth weight neonates exposed to gentamicin may develop acute kidney injury (AKI); this is particularly worrisome as AKI is an independent factor associated with increased neonatal mortality and increased length of stay. AKI during periods of neonatal nephrogenesis, which continues until 34–36 weeks postmenstrual age, may also have serious effects on the long-term nephron development which subsequently puts infants at risk of chronic kidney disease. Extended interval (EI) aminoglycoside (AMG) dosing has been used for decades in adult populations and has proven to reduce AKI while being at least as effective as traditional dosing, although there is limited published research for using an EI AMG in endocarditis in adults or pediatric patients. We describe an extremely low birth weight neonate, born preterm at 24 weeks gestation treated for Klebsiella pneumoniae IE that required AMG therapy who also had concurrent AKI. We utilized EI AMG combination therapy for treatment of Klebsiella pneumoniae endocarditis with good outcome and encourage others to report their experiences to improve our knowledge of EI AMG in this population.

Download Full-text

Peritoneal dialysis in extremely and very low-birth-weight infants

Peritoneal Dialysis International ◽

10.1177/0896860819887292 ◽

2020 ◽

Vol 40 (2) ◽

pp. 233-236 ◽

Cited By ~ 1

Author(s):

Kathrin Burgmaier ◽

Agnes Hackl ◽

Rasmus Ehren ◽

Angela Kribs ◽

Mathias Burgmaier ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Kidney Injury ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Daily Cycles ◽

Good Clinical Condition ◽

Increasing Demand

The outcome of extremely low-birth-weight (ELBW) and very low-birth-weight (VLBW) infants has substantially improved in recent years. As acute kidney injury is frequent in these infants due to various risk factors, there is an increasing demand for renal replacement therapy in these patients. Data on that topic, however, are scarce. We review the available literature on that topic and report our experience on temporary dialysis in three extremely immature infants (two ELBW and one VLBW) with acute kidney failure. Peritoneal dialysis (PD) was performed for 19, 23, and 44 days until recovery of native renal function. At recent follow-up of 18 and 24 months, two patients are in good clinical condition with chronic kidney disease stages 1 and 4, respectively. One patient deceased at the age of 12 months due to secondary liver failure. The dialysis regimen applied in our study differed significantly from older infants with extremely short dwell times and accordingly high numbers of daily cycles. The use of rigid acute PD catheters was associated with less catheter-related complications (leakage, dislocation, and obstruction) as compared to ascites drainage catheters. In summary, PD was technically feasible and effective also in extremely immature infants, but frequent adjustments of dialysis regimens and high numbers of daily cycles posed immense efforts on both, parents and medical staff.

Download Full-text

Acute kidney injury in an extremely low birth weight infant with nephrolithiasis: a case report

Acta medica Lituanica ◽

10.6001/actamedica.v25i3.3864 ◽

2019 ◽

Vol 25 (3) ◽

pp. 166-172

Author(s):

Rasa Garunkštienė ◽

Rimutė Vaitkevičienė ◽

Ieva Paulavičienė ◽

Nijolė Drazdienė ◽

Rimantė Čerkauskienė

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Kidney Injury ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Low Birth Weight Infant ◽

The Right

Acute kidney injury is associated with mortality of very low birth weight infants and reduces their survival regardless of other factors. The kidneys in the extremely preterm infants are very immature and susceptible to environmental factors. Clinical conditions and medications are risk factors for acute kidney injury in these patients. Nephrolithiasis in preterm infants is an extremely rare phenomenon that usually manifests as a complication of nephrocalcinosis. This is a case report that describes several episodes of acute kidney injury in the first two months of age in an extremely low birth weight infant with kidney stones in the background. The main causes that led to acute kidney injury in this patient were persistent ductus arteriosus, sepsis and captopril. At one month of age, ultrasound detected calcinates in the right kidney. Within two weeks a large number of linear stones formed across the collecting duct system. Small calcinates still remained in the right kidney when the girl was half a year of the corrected age. The evaluation of a neonate who develops acute kidney injury requires a systematic approach. Early identification of the emerging risk factors and prevention of nephrolithiasis along with effective treatment can reduce the risk of developing acute kidney injury in very low birth weight infants.

Download Full-text

ON THE SUBJECT OF MEDICAL/SOCIAL ASPECTS OF REHABILITATION FOR VERY-LOW-BIRTH WEIGHT INFANTS IN EARLY CHILDHOOD

Российский педиатрический журнал ◽

10.18821/1560-9561-2017-20-1-30-35 ◽

2019 ◽

Vol 20 (1) ◽

pp. 30-35

Author(s):

A. V. Migali ◽

K. A. Kazakova ◽

Yu. S. Akoyev ◽

V. M. Studenikin ◽

M. A. Varichkina ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Premature Infants ◽

Very Low Birth Weight ◽

Intensive Therapy ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Team Care ◽

Care Approach ◽

Paroxysmal Disorders

Innovative technologies in the reanimation and intensive therapy permitted to improve the survival of premature infants, including those with extremely low birth weight infants. There are considered various issues of practical medical care for very-low-birth weight infants in the first three years of life. The special attention is given to patients with bronchopulmonary dysplasia (BPD). There is briefly presented the own authors’ experience of the observation for premature infants in conditions of a multidisciplinary team care approach. There were described such important aspects of the mentioned category of patients as neurodietology/nutritional rehabilitation, compliance with aseptic environmental conditions, the correction of visual and hearing impairment, treatment of neurological deficit, especially neuropharmacology, treatment of paroxysmal disorders and epilepsy.

Download Full-text

The clinical value of ultrasonic cardiac output monitor in very-low birth-weight and extremely-low-birth-weight infants undergoing PDA ligation

Early Human Development ◽

10.1016/j.earlhumdev.2021.105522 ◽

2021 ◽

pp. 105522

Author(s):

Yu-Mei Liu ◽

Man-Li Zheng ◽

Xin Sun ◽

Xiao-Bo Chen ◽

Yun-Xia Sun ◽

...

Keyword(s):

Cardiac Output ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Extremely Low Birth Weight ◽

Clinical Value ◽

Low Birth Weight Infants ◽

Pda Ligation ◽

Cardiac Output Monitor

Download Full-text

The concomitant use of vancomycin and piperacillin-tazobactam is associated with acute kidney injury (AKI) in extremely low birth weight infants (ELBW)

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-210866 ◽

2021 ◽

pp. 1-7

Author(s):

Y. Al-Jebawi ◽

K. Karalic ◽

P. Shekhawat ◽

M.J. Mhanna

Keyword(s):

Acute Kidney Injury ◽

Birth Weight ◽

Low Birth Weight ◽

Late Onset ◽

Kidney Injury ◽

Extremely Low Birth Weight ◽

Retrospective Case ◽

Low Birth Weight Infants ◽

Late Onset Sepsis ◽

Increased Risk

BACKGROUND: Late-onset sepsis is common in extremely low birth weight (ELBW) infants, and it leads to the use of antibiotics to cover resistant organisms, which can be nephrotoxic. Here we have investigated the role of vancomycin plus piperacillin-tazobactam on the rate of acute kidney injury (AKI). METHODS: In a retrospective case-control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) with late onset sepsis who were prescribed vancomycin plus piperacillin-tazobactam were reviewed for demographics, clinical characteristics, use of potential nephrotoxic medications and outcomes. RESULTS: During the study period, 264 patients were admitted, of whom 28.4%(75/264) received vancomycin plus piperacillin-tazobactam and were matched with 64 controls. There were no differences in gestational age or birth weight between cases and controls [688±160 vs. 689±162 grams (p = 0.99), and 24.7±1.8 vs. 24.7±1.6 weeks (p = 0.99) respectively]. There was no difference in the rate of sepsis between cases and controls [76%(55/72) vs. 64%(41/64) respectively, p = 0.11]. Infants exposed to vancomycin plus piperacillin-tazobactam had a higher percentage of concomitant use of vasopressors and amphotericin. To adjust for confounders, a logistic regression analysis was conducted with AKI as the dependent variable. Use of vasopressors and vancomycin plus piperacillin-tazobactam were the only risk factors associated with AKI with an adjusted OR (95%CI) of 4.08 (1.90–8.74), p < 0.001; and 2.87 (1.26–6.53), p = 0.01 respectively. CONCLUSION: The use of vancomycin plus piperacillin-tazobactam in ELBW infants is associated with an increased risk for AKI.

Download Full-text