Efficacy and safety of gentamicin by interval and intravenous dosage adjustment based on the gestational age in Thai neonates.

OBJECTIVE: To determine the pharmacological efficacy and safety of the gentamicin regimen that adjusts intravenous dose and interval based on the gestational age (GA) in Thai neonates. MATERIAL AND METHOD: Neonates aged < or = 7 days, who had received gentamicin for clinically suspected or high risk of sepsis and had no contraindication to gentamicin usage were enrolled. They were stratified into four groups by GA as < or = 29, 30-33, 34-37 and > or = 38 weeks gestation. Gentamicin administration in each group was 5, 4.5, 4 and 4 mg/kg/dose every 48, 36, 36 and 24 hours respectively according to Neofax regimen. Peak serum gentamicin concentration (SGC), trough SGC and serum creatinine (Cr) were obtained. RESULTS: Forty-nine neonates were enrolled. Forty-four (89.7%) had peak SGC within the desirable range (5-12 mg/L). Three neonates had slightly high peak SGC. Their peak SGCs were 13.0, 12.21 and 12.20 mg/L. Two neonates had slightly low peak SGC. Their peak SGCs were 4.91 and 4.4 mg/L. All neonates had trough SGC below 2 mg/L. None had significant rising of serum Cr during the present study period. CONCLUSION: This gentamicin regimen yielded good pharmacological efficacy and safety in Thai neonates, who were in the first week of life and had no renal function impairment.

Severe upper gastrointestinal hemorrhage in the newborn.

Three infants with severe upper gastrointestinal hemorrhage with esophagogastroduodenoscopic (EGD) findings were reported. The underlying conditions of these infants included Down's syndrome, hypoplastic left heart, and diaphragmatic hernia. The precipitating factors were identified in all cases, including prenatal stress, hypoxemia, prolonged ventilatory support, and gastroesophageal reflux. The EGD findings were composed of multiple gastric ulcers and a duodenal ulcer in the first 2 cases, whereas esophagitis and gastritis were noted in the last case. These ulcers were classified as secondary peptic ulcers. All cases responded well to medical treatment, including ranitidine, sucralfate, omeprazole, cisapride, and octreotide.