Duration of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the Neonatal Intensive Care Unit (NICU) and Future Adolescent Kidney Health

Authors

Andrew F. Schiff, Department of Pediatrics, Section of Neonatology, Wake Forest University School of Medicine, Winston Salem, NC
Danielle Deines, University of Otago School of Medicine, Dunedin, New Zealand
Elizabeth T. Jensen, Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC
Nathaniel O'Connell, Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC
Courtney J. Perry, Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston Salem, NC
Hossam A. Shaltout, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston Salem, NC; Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Alexandria, Egypt
Lisa K. Washburn, Department of Pediatrics, Section of Neonatology, Wake Forest University School of Medicine, Winston Salem, NC
Andrew M. South, Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC; Department of Pediatrics, Section of Nephrology, Wake Forest University School of Medicine, Winston Salem, NC

Document Type

Article

Publication Date

9-16-2023

Abstract

OBJECTIVE: To determine whether greater duration of simultaneous exposure to antimicrobials with high nephrotoxicity risk combined with lower-risk antimicrobials (simultaneous exposure) in the neonatal intensive care unit (NICU) is associated with worse later kidney health in adolescents born preterm with very low birth weight (VLBW).

STUDY DESIGN: Prospective cohort study of participants born preterm with VLBW (<1500 >g) as singletons between January 1, 1992, and June 30, 1996. We defined simultaneous exposure as a high-risk antimicrobial, such as vancomycin, administered with a lower-risk antimicrobial on the same date in the NICU. Outcomes were serum creatinine, estimated glomerular filtration rate (eGFR), and first-morning urine albumin-creatinine ratio (ACR) at age 14 years. We fit multivariable linear regression models with days of simultaneous exposure and days of nonsimultaneous exposure as main effects, adjusting for gestational age, birth weight, and birth weight z-score.

RESULTS: Of the 147 out of 177 participants who had exposure data, 97% received simultaneous antimicrobials for mean duration 7.2 days (SD 5.6). No participant had eGFR/min/1.73 m

CONCLUSIONS: Despite frequent simultaneous exposure to high-risk combined with lower-risk nephrotoxic antimicrobials in the NICU, there were no clinically relevant associations with worse kidney health identified in adolescence. Although future studies are needed, these findings may provide reassurance in a population thought to be at increased risk of chronic kidney disease.

Publisher

Mosby

Publication Title

The Journal of pediatrics

ISSN

1097-6833

Volume

264

First Page

113730

Last Page

113730

Recommended Citation

Schiff AF, Deines D, Jensen ET, O'Connell N, Perry CJ, Shaltout HA, Washburn LK, South AM. Duration of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the Neonatal Intensive Care Unit (NICU) and Future Adolescent Kidney Health. J Pediatr. 2023 Sep 16;264:113730. doi: 10.1016/j.jpeds.2023.113730. Epub ahead of print. PMID: 37722552.