Vancomycin pharmacokinetics in critically ill neonates receiving extracorporeal membrane oxygenation

Abstract

Objective This study aimed to characterise vancomycin pharmacokinetics in critically ill neonates undergoing extracorporeal membrane oxygenation. Methods In a retrospective analysis, the pharmacokinetics of vancomycin were determined in 25 full-term neonates receiving extracorporeal membrane oxygenation and compared with those of matched controls (n = 25) not receiving extracorporeal membrane oxygenation. Results The half-life of vancomycin in the neonates undergoing extracorporeal membrane oxygenation was significantly prolonged compared with that in the controls (17.45 +/- 11.01hour vs 5.92 +/- 2.70 hour, P<0.001). Clearance decreased significantly in the extracorporeal membrane oxygenation group relative to the control group (0.03 +/- 0.02L/kg/hr vs 0.08 +/- 0.05 L/kg/hr, P<0.001). No significant difference was found in the volume of distribution between the two groups (0.63 +/- 0.30L/kg in the extracorporeal membrane oxygenation group vs 0.57 +/- 0.14L/kg/hr in control, P=0.596). Clearance values were significantly correlated with serum creatinine (r = - 0.528, P<0.001). In the subgroup analysis using patients with serum creatinine < 0.5mg/dL, similar results were obtained including significantly prolonged half-life (11.52 +/- 6.31hour vs 5.44 +/- 2.36hour, P<0.001) and decreased clearance (0.05 +/- 0.02L/kg/hr vs 0.09 +/- 0.05L/kg/hr, P<0.001) in the extracorporeal membrane oxygenation group relative to the control group. Conclusions Vancomycin clearance decreased significantly in the neonates undergoing extracorporeal membrane oxygenation compared with the controls. Dosing adjustments of vancomycin and close therapeutic drug monitoring are required for the safe and effective management of neonates during extracorporeal membrane oxygenation.