Abstract
Extracorporeal membrane oxygenation (ECMO) has been used in more than 1,000 infants in 50 centers in the United States. The extracorporeal circuit contains approximately 400 ml of blood, an amount exceeding the blood volume of most full-term neonates. The effect of this additional blood volume on drug disposition is unknown. In this study, we determined the pharmacokinetic parameters of gentamicin in 10 infants on ECMO. Gentamicin concentrations were determined by a fluorescence polarization immunoassay. Pharmacokinetic parameters were determined from these concentrations by using a two-compartment model. Our study demonstrated a mean steady-state volume of distribution of 0.51 +/- 0.11 liters/kg, a figure similar to that in previous studies of full-term infants. The elimination half-life was found to be prolonged (mean, 573 +/- 263 min). The creatinine level in the plasma of the infants was found to be a statistically significant predictor of elimination half-life. Recommendations regarding initial dosing levels of gentamicin in infants on ECMO are made.
Full text
PDF


Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arant B. S., Jr Developmental patterns of renal functional maturation compared in the human neonate. J Pediatr. 1978 May;92(5):705–712. doi: 10.1016/s0022-3476(78)80133-4. [DOI] [PubMed] [Google Scholar]
- Husson C., Chevalier J. Y., Jezequel M., Mathe J. C., Costil J., Aymard P. Pharmacokinetic study of gentamicin in preterm and term neonates. Dev Pharmacol Ther. 1984;7 (Suppl 1):125–129. doi: 10.1159/000457241. [DOI] [PubMed] [Google Scholar]
- Kasik J. W., Jenkins S., Leuschen M. P., Nelson R. M., Jr Postconceptional age and gentamicin elimination half-life. J Pediatr. 1985 Mar;106(3):502–505. doi: 10.1016/s0022-3476(85)80691-0. [DOI] [PubMed] [Google Scholar]
- Many M., Soroff H. S., Birtwell W. C., Wise H. M., Deterling R. A., Jr The physiologic role fo pulsatile and nonpulsatile blood flow. 3. Effects of unilateral renal artery depulsation. Arch Surg. 1968 Dec;97(6):917–923. doi: 10.1001/archsurg.1968.01340060095010. [DOI] [PubMed] [Google Scholar]
- McCracken G. H., Jr, Jones L. G. Gentamicin in the neonatal period. Am J Dis Child. 1970 Dec;120(6):524–533. doi: 10.1001/archpedi.1970.02100110072007. [DOI] [PubMed] [Google Scholar]
- Miranda J. C., Schimmel M. M., James L. S., Spinelli W., Rosen T. S. Gentamicin kinetics in the neonate. Pediatr Pharmacol (New York) 1985;5(1):57–61. [PubMed] [Google Scholar]
- SISSON T. R., LUND C. J., WHALEN L. E., TELEK A. The blood volume of infants. I. The full-term infant in the first year of life. J Pediatr. 1959 Aug;55(2):163–179. doi: 10.1016/s0022-3476(59)80084-6. [DOI] [PubMed] [Google Scholar]
- Thomson A. H., Way S., Bryson S. M., McGovern E. M., Kelman A. W., Whiting B. Population pharmacokinetics of gentamicin in neonates. Dev Pharmacol Ther. 1988;11(3):173–179. doi: 10.1159/000457685. [DOI] [PubMed] [Google Scholar]
- Zenk K. E., Miwa L., Cohen J. L., Waffarn F., Huxtable R. F. Effect of body weight on gentamicin pharmacokinetics in neonates. Clin Pharm. 1984 Mar-Apr;3(2):170–173. [PubMed] [Google Scholar]