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356 SERUM NETILMICIN LEVELS IN PREMATURE INFANTS

Aminoglycosides can be safely used by close monitoring of serum concentrations. Limited information and the unique physiology of prematures during the first week of life makes interpretation of peak and trough levels more difficult. This study was designed to measure serum netilmicin levels following a 2.5 mg/kg push IV infusion. Blood samples were taken on the fifth day of therapy (age) one hour before and one, six and eleven hours following a dose. Fifteen prematures weighing 1000-1500 gms at birth and 20 others whose weight ranged from 1501-2750 gms comprised the study population. All prematures were AGA and of them, only 2 were severely asphyxiated. At the time of the study, 10 neonates were still on respirators. Serum and urine sodium and creatinines, BUN and urinalysis were obtained in 28 of these infants. No evidence of renal dysfunction was found. All infants received 100 mg/kg IV ampicillin every 12 hours but none were being treated with diuretics. Serum netilmicin levels were measured by an enzymatic immunoassay (SYVA), peak and trough were calculated by extrapolating the first order decay curve. Peak levels ranged from 3.4 to 14.4 mcg/ml (x 6.6 ± 2.5mcg/mlSD) and 80% of them were above 4 mcg/ml. Half of the small prematures (1000-1500 gm Bwgt) presented trough values above 3mcg/ml. Pharmacokinetic analysis of our data predicts that a 2.5 mg/kg loading dose followed by 2 mg/kg given every 12 hours will decrease by one-half the number of small prematures exceeding the considered “safe” trough level (>3 mcg/ml).