Monitoring Of Vancomycin Concentration In Neonates And Infants And Analysis Of Its Effectiveness And Safety

Objective: There are great metabolic differences between adults and neonates or infants.In order to better understand the efficacy and safety of vancomycin in different blood concentrations in neonates and infants this study looked at the clinical efficacy and adverse reactions observed in babies with Gram-positive(G+)cocci sepsis treated with intravenous vancomycin.Blood concentrations of vancomycin were monitored during treatment.Relative studies were conducted to explore the effectiveness and safety of vancomycin blood concentrations in neonates and infants.Methods: A retrospective study was conducted to collect and record data on the gender,age,gestational age,weight,birth history,clinical symptoms and blood of neonates and infants with G+ cocci septicemia who were admitted to the Neonatal and intensive care unit(NICU)of Shanghai Jiaotong University Children's Hospital from June 2014 to June 2018.Routine liver and kidney function,procalcitonin,trough concentration of vancomycin,peak concentration of vancomycin,microbiology,combined medication,hospitalization time and other data was also collected,the original data was processed by statistical processing software SPSS 22.0.The clinical effects of different trough concentration groups and side effects of different peak concentrations were analyzed.Results: There were a total of 55 eligible patients,their blood was collected and monitored 71 times.The children were divided into three groups according to the value of trough concentration monitoring: A(<5?g/m L),B(5-10?g/m L)and C(10-20 ?g/m L)).The trough concentration of group A was 41.8%(23 cases);the trough concentration of group B was 25.5%(14 cases);the trough concentration of group C was 32.7%(18 cases).According to the value of peak concentration monitoring,the children were divided into three groups: D(<20 ?g/m L),E(20-40 ?g/m L)and F(> 40 ?g/m L).The peak concentration of group D was 60%(33cases),the peak concentration of group E was 29.1%(16 cases),and the peak concentration of group F was 10.9%(6 cases).The results of groups A?B & C showed that there was nosignificant difference in the changes of white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT)between the groups before and after treatment.P values of greater than 0.05 indicate there was no statistical significance.Whilst the time of use(P = 0.87)and the clinical efficacy(P=0.36)were no significant difference between the groups,there was no statistically significant difference.The results of groups D?E & F showed that the changes of creatinine(Cr),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and platelet(PLT)were not significantly different before and after treatment(P > 0.05).The absolute value of neutrophils before and after treatment showed a statistically significant difference between groups F = 8.60,P < 0.05 and groups D & E.The results of a further two comparisons showed that the absolute value of neutrophils in group F was significantly higher than that in groups E,and the difference was statistically significant.Among the influencing factors of trough concentration,there were significant differences in trough concentration among different weight groups,Z=-4.32,P<0.01,with statistical significance.Conclusions:(1)In newborns and infants with G+ cocci sepsis and intravenous vancomycin use,the blood trough concentrations of vancomycin < 5?g/m L,5-10?g/m L and 10-20?g/m L were monitored.Comparison of the three groups indicated the lowering of inflammatory indexes(WBC,CRP,PCT),hospitalization time and clinical efficacy were no significant difference.(2)In newborns and infants with G+ cocci sepsis and intravenous use of vancomycin,the groups with peak concentrations of vancomycin in the blood of < 20?g/m L,20-40?g/m L and > 40?g/m L showed not significantly different of renal function,liver function and thrombocytopenia.(3)In newborns and infants with G+ cocci sepsis and intravenous use of vancomycin,the incidence of neutropenia observed whilst monitoring the peak concentrations(< 20?g/m L,20-40?g/m L and > 40?g/m L)of vancomycin in blood was significantly higher in those with a peak concentration of > 40?g/m L than in those with <40?g/m L.(4)The blood trough concentration of vancomycin were related to the weight of the patients.The larger the body weight,the smaller the trough concentration monitored.