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Objective <p>Gentamicin (GM), a renally eliminated drug, is widely used to treat infections in neonates. Neonatal dosing is typically based on body weight and postmenstrual age (PMA). Although serum creatinine (Cr) is the gold standard for evaluating renal function, Cr at birth may reflect both neonatal and maternal levels. This study aimed to identify determinants of trough GM concentrations, focusing on renal function parameters.</p> Methods <p>This retrospective, single-center, observational study included 78 neonates who started intravenous GM on postnatal days 0–1. Dosing regimen was stratified by birth weight: &lt; 1200&#xa0;g (<i>n</i> = 22), 5&#xa0;mg/kg every 48&#xa0;h; 1200–1999&#xa0;g (<i>n</i> = 10), 4&#xa0;mg/kg every 36&#xa0;h; ≥ 2000&#xa0;g (<i>n</i> = 46), 4&#xa0;mg/kg every 24&#xa0;h. Dose-normalized trough concentration (C/D) was calculated by dividing trough GM concentration by 24-h equivalent GM dose. Cr level measured at birth (Cr<sub>birth</sub>) and the first Cr level measured after GM initiation (Cr<sub>GM</sub>) were analyzed.</p> Results <p>In neonates &lt; 1200&#xa0;g and 1200–1999&#xa0;g, Cr<sub>GM</sub> was significantly higher than Cr<sub>birth</sub>. C/D correlated significantly with PMA, Cr<sub>GM</sub>, and urine output, but not with Cr<sub>birth</sub>. Multiple regression analysis incorporating variables measured at birth (Cr<sub>birth</sub> and PMA) as covariates identified PMA as the only significant predictor of C/D. When variables available following GM initiation (Cr<sub>birth</sub>, PMA, Cr<sub>GM</sub>, urine output, and ibuprofen co-administration) were included as covariates, Cr<sub>birth</sub> emerged as the sole independent factor predicting C/D.</p> Conclusion <p>PMA-based dosing appears to be preferable for determining initial GM dosing on postnatal day 0, whereas Cr-based renal function parameters may be more effective for guiding maintenance dosing.</p>

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Impact of Postnatal Changes in Creatinine Levels on Plasma Gentamicin Concentrations in Neonates

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月16日

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  • Haruka Tsushita,
  • Ryota Tanaka,
  • Masanori Inoue,
  • Ryosuke Tatsuta,
  • Shintaro Kishimoto,
  • Tomoki Maeda,
  • Naoki Yoshikawa,
  • Kenji Ihara,
  • Hiroki Itoh

摘要

Objective

Gentamicin (GM), a renally eliminated drug, is widely used to treat infections in neonates. Neonatal dosing is typically based on body weight and postmenstrual age (PMA). Although serum creatinine (Cr) is the gold standard for evaluating renal function, Cr at birth may reflect both neonatal and maternal levels. This study aimed to identify determinants of trough GM concentrations, focusing on renal function parameters.

Methods

This retrospective, single-center, observational study included 78 neonates who started intravenous GM on postnatal days 0–1. Dosing regimen was stratified by birth weight: < 1200 g (n = 22), 5 mg/kg every 48 h; 1200–1999 g (n = 10), 4 mg/kg every 36 h; ≥ 2000 g (n = 46), 4 mg/kg every 24 h. Dose-normalized trough concentration (C/D) was calculated by dividing trough GM concentration by 24-h equivalent GM dose. Cr level measured at birth (Crbirth) and the first Cr level measured after GM initiation (CrGM) were analyzed.

Results

In neonates < 1200 g and 1200–1999 g, CrGM was significantly higher than Crbirth. C/D correlated significantly with PMA, CrGM, and urine output, but not with Crbirth. Multiple regression analysis incorporating variables measured at birth (Crbirth and PMA) as covariates identified PMA as the only significant predictor of C/D. When variables available following GM initiation (Crbirth, PMA, CrGM, urine output, and ibuprofen co-administration) were included as covariates, Crbirth emerged as the sole independent factor predicting C/D.

Conclusion

PMA-based dosing appears to be preferable for determining initial GM dosing on postnatal day 0, whereas Cr-based renal function parameters may be more effective for guiding maintenance dosing.