[Comparison of two gentamicin dosing schedules in the newborn]. / Comparación de dos pautas de dosificación de gentamicina en el recién nacido.

INTRODUCTION: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. OBJECTIVE: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. MATERIAL AND METHODS: The study included 200 newborns who were started on gentamicin therapy. Group A (N=100) was prescribed a multiple-daily dosing regimen and Group B (N=100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. RESULTS: Peak serum gentamicin levels were significantly higher (8.2+/-0.22 microg/ml vs. 5.9+/-0.13 microg/ml; p

Comparación de dos pautas de dosificación de gentamicina en el recién nacido / Comparison of two gentamicin dosing schedules in the newborn

Introducción: La gentamicina es uno de los antibióticos más utilizado en el tratamiento de las infecciones bacterianas graves del recién nacido y diferentes pautas de dosificación de gentamicina han sido recomendadas en este grupo poblacional. Objetivo: Comparar las concentraciones séricas, la eficacia y la toxicidad de dos pautas de dosificación de gentamicina en recién nacidos a término y pretérmino. Material y métodos: Se evaluó prospectivamente a 200 recién nacidos que recibieron tratamiento con gentamicina. En el grupo A (n = 100) se administró según una pauta de múltiples dosis diarias (2,5-3,5 mg/kg/dosis cada 12-18 h), dependiendo de la edad posnatal y las concentraciones séricas de creatinina. En el grupo B (n = 100) se administró en pauta de única dosis diaria (4-5 mg/kg/dosis cada 24-48 h), según la edad posnatal y posconcepcional. Entre ambos grupos se compararon las concentraciones pico y valle séricas de gentamicina, los datos generales y la prevalencia de nefrotoxicidad y ototoxicidad. Resultados: Las concentraciones pico de gentamicina fueron significativamente superiores (8,2 ± 0,22 μg/ml frente a 5,9 ± 0,13 μg/ml; p £ 0,001) y las concentraciones valle fueron significativamente inferiores (0,9 ± 0,06 μg/ml frente a 1,7 ± 0,08 μg/ml; p £ 0,001) en el grupo B. No hubo diferencias significativas entre ambos grupos respecto a la eficacia clínica, o a la prevalencia de nefrotoxicidad u ototoxicidad. Conclusiones: La pauta de gentamicina en única dosis diaria es efectiva, segura y disminuye el riesgo de concentraciones séricas fuera de rango terapéutico en recién nacidos pretérmino y a término (AU)

Introduction: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. Objective: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. Material and methods: The study included 200 newborns who were started on gentamicin therapy. Group A (N = 100) was prescribed a multiple-daily dosing regimen and Group B (N = 100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. Results: Peak serum gentamicin levels were significantly higher (8.2 ± 0.22 μg/ml vs. 5.9 ± 0.13 μg/ml; p £ 0.001) and trough levels were significantly lower (0.9 ± 0.06 μg/ml vs. 1.7 ± 0.08 μg/ml; p £ 0.001) in Group B than in Group A. There was no significant difference between the groups either in the clinical failure rate or in the nephrotoxicity or ototoxicity outcomes. Conclusions: Once-daily dosing regimen of gentamicin in preterm and term newborns is safe and effective, with a reduced risk of serum drug concentrations falling outside the therapeutic range (AU)

[Use of somatostatin in five neonates with chylothorax]. / Tratamiento con somatostatina en cinco recién nacidos con quilotórax de diferentes etiologías.

BACKGROUND: The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. OBJECTIVE: To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. PATIENTS: Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 microg/kg/12 h to continuous perfusion at 10 microg/kg/h. RESULTS: In all patients the chylous drainage was stopped. No adverse effects were observed. CONCLUSIONS: Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment.

[Epidemiology of respiratory syncytial virus infections in the Canary Islands]. / Epidemiología de la infección por virus respiratorio sincitial en las islas Canarias.

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in young children. Outbreaks of RSV infection occur yearly during the winter or spring in temperate climates. Our study of 634 hospitalized children under 3 years of age with bronchiolitis and pneumonia (November 1988 to January 1990) revealed that 227 (35.8%) had VRS infections. These cases showed a yearly epidemic pattern with 86.8% of the cases occurring during the winter. Furthermore, 67.4% of the cases occurred in children between 1-6 months of age and the boy/girl ration was 1.2/1. In 26.9% of the infections there was an antibody response. These results for RSV infection on this island show the same epidemiological pattern as that in the temperate climates.