NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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J Pediatr Jan 2003;142:41-6.
Objective:
To investigate the chance of detecting hearing loss with neonatal hearing
screening in relation to exposure to tobramycin and vancomycin.
Study
design: Automated auditory brainstem response (A-ABR) hearing screening
was performed in all neonates with at least one risk factor. Data on drug
administration were abstracted from patient files. Exposure to these drugs was
related to the result of hearing screening. In patients failing hearing
screening, exposure to ototoxic medication was assessed in the light of other
risk factors for hearing loss.
Results:
Six hundred twenty-five patients were analyzed; 45 neonates failed hearing
screening. Tobramycin, vancomycin, and furosemide were used in 508, 130, and 174
patients, respectively. Exposure to vancomycin, tobramycin, or furosemide or a
combination, defined in terms of treatment duration, total dose, or serum
concentrations of antibiotics, was not related to failure to pass A-ABR
screening. Ototoxic medication was not the most probable risk factor in any of
the patients with serum concentrations outside the therapeutic range.
Conclusions:
Routine therapeutic drug monitoring of vancomycin and tobramycin in neonates for
ototoxicity reasons is not helpful in detecting patients at risk for clinically
important hearing loss in the 2- to 4-kHz range. A longer period of audiometric
follow-up is needed to determine any long-term effects.
Comment:
It was reassuring to see
that there was no association found between these drugs and neonatal hearing
loss. We still need follow up data
to be sure that we’re not missing delayed effects of these drugs.
There are also concerns about potential nephrotoxicity with these
drugs, so monitoring of drug levels with prolonged use (> 3 days) seems
appropriate. ABK
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