Nephrotoxic medication exposure in very low birth weight infants

J Matern Fetal Neonatal Med. 2014 Sep;27(14):1485-90. doi: 10.3109/14767058.2013.860522. Epub 2013 Nov 29.


Objective: To quantify exposure to potentially nephrotoxic medications among very low birth weight (VLBW) infants and determine the relationship of nephrotoxic medication exposure to acute kidney injury (AKI) in this vulnerable population.

Methods: We reviewed 107 VLBW infants who survived to discharge from April 2011 to March 2012 and measured exposure to the following nephrotoxic medications: acyclovir, amikacin, amphotericin B, gentamicin, ibuprofen, indomethacin, iohexol, tobramycin and vancomycin. Acute kidney injury was determined by the KDIGO guidelines.

Results: Exposure to ≥ 1 nephrotoxic medication occurred in 87% of infants. The most common exposures were gentamicin (86%), indomethacin (43%) and vancomycin (25%). There was an inverse linear relationship between birth weight and nephrotoxic medications received per day (R(2) = 0.169, p < 0.001). Infants with AKI received more nephrotoxic medications per day than those who did not (0.24 versus 0.15; p = 0.003).

Conclusions: VLBW infants are frequently exposed to nephrotoxic medications, receiving approximately two weeks of nephrotoxic medications before discharge or 1 for every 6 d of hospitalization. The greatest exposure occurred among the smallest, most immature infants and those who experienced AKI.

Keywords: Acute kidney injury; aminoglycosides; neonatal intensive care; non-steroidal anti-inflammatory agents; premature infant.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / congenital
  • Acute Kidney Injury / epidemiology*
  • Drug Prescriptions / statistics & numerical data
  • Drug-Related Side Effects and Adverse Reactions / complications
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / chemically induced*
  • Infant, Premature, Diseases / epidemiology*
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Retrospective Studies