1
|
Arribas C, Decembrino N, Raffaeli G, Amodeo I, González-Caballero JL, Riaza M, Ortiz-Movilla R, Massenzi L, Gizzi C, Araimo G, Cattarelli D, Aversa S, Martinelli S, Frezza S, Orfeo L, Mosca F, Cavallaro G, Garrido F. Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey. Eur J Pediatr 2024:10.1007/s00431-024-05467-w. [PMID: 38492032 DOI: 10.1007/s00431-024-05467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Neonates face heightened susceptibility to drug toxicity, often exposed to off-label medications with dosages extrapolated from adult or pediatric studies. Premature infants in Neonatal Intensive Care Units (NICUs) are particularly at risk due to underdeveloped pharmacokinetics and exposure to multiple drugs. The study aimed to survey commonly used medications with a higher risk of ototoxicity and nephrotoxicity in Spanish and Italian neonatal units. A prospective cross-sectional study was conducted in Italian and Spanish neonatal units using a web-based survey with 43 questions. A modified Delphi method involved experts refining the survey through online consensus. Ethical approval was obtained, and responses were collected from January to July 2023. The survey covered various aspects, including drug-related ototoxic and nephrotoxic management, hearing screening, and therapeutic drug monitoring. Responses from 131 participants (35.9% from Spain and 64.1% from Italy) revealed awareness of drug toxicity risks. Varied practices were observed in hearing screening protocols, and a high prevalence of ototoxic and nephrotoxic drug use, including aminoglycosides (100%), vancomycin (70.2%), loop diuretics (63.4%), and ibuprofen (62.6%). Discrepancies existed in guideline availability and adherence, with differences between Italy and Spain in therapeutic drug monitoring practices. CONCLUSIONS The study underscores the need for clinical guidelines and uniform practices in managing ototoxic and nephrotoxic drugs in neonatal units. Awareness is high, but inconsistencies in practices indicate a necessity for standardization, including the implementation of therapeutic drug monitoring and the involvement of clinical pharmacologists. Addressing these issues is crucial for optimizing neonatal care in Southern Europe. WHAT IS KNOWN • Neonates in intensive care face a high risk of nephrotoxicity and ototoxicity from drugs like aminoglycosides, vancomycin, loop diuretics, and ibuprofen. • Therapeutic drug monitoring is key for managing these risks, optimizing dosing for efficacy and minimizing side effects. WHAT IS NEW • NICUs in Spain and Italy show high drug toxicity awareness but differ in ototoxic/nephrotoxic drug management. • Urgent need for standard guidelines and practices to address nephrotoxic risks from aminoglycosides, vancomycin, loop diuretics, and ibuprofen.
Collapse
Affiliation(s)
- Cristina Arribas
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Nunzia Decembrino
- Neonatal Intensive Care Unit, AOU Policlinico G. Rodolico San Marco, 95123, Catania, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | | | - Mónica Riaza
- Department of Pediatrics, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Roberto Ortiz-Movilla
- Neonatal Intensive Care Unit, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - Luca Massenzi
- Neonatal Intensive Care Unit, Ospedale Regionale Di Bolzano, 39100, Bolzano, Italy
| | - Camilla Gizzi
- Division of Pediatrics and Neonatology, Sandro Pertini Hospital, 00157, Rome, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Donatella Cattarelli
- Division of Pediatrics and Neonatology, ASST del Garda, 25015, Desenzano del Garda (BS), Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, 25123, Brescia, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Simonetta Frezza
- Division of Neonatology, Area of Child Health, Department of Woman, Child Health and Public Health, Fondazione IRCCS Policlinico Universitario Agostino Gemelli, 00168, Rome, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, 00186, Rome, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Felipe Garrido
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| |
Collapse
|
2
|
Carrasco I, Muñoz-Chapuli M, Vigil-Vázquez S, Aguilera-Alonso D, Hernández C, Sánchez-Sánchez C, Oliver C, Riaza M, Pareja M, Sanz O, Pérez-Seoane B, López J, Márquez E, Domínguez-Rodríguez S, Hernanz-Lobo A, De León-Luis JA, Sánchez-Luna M, Navarro ML. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth 2021; 21:326. [PMID: 33902483 PMCID: PMC8072086 DOI: 10.1186/s12884-021-03784-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.
Collapse
MESH Headings
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- COVID-19/epidemiology
- COVID-19/physiopathology
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Carrier State/epidemiology
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Comorbidity
- Cough/physiopathology
- Diabetes, Gestational/epidemiology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Gestational Age
- Humans
- Hypertension/epidemiology
- Hypothyroidism/epidemiology
- Immunologic Factors/therapeutic use
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Intensive Care Units/statistics & numerical data
- Lung/diagnostic imaging
- Male
- Obesity, Maternal/epidemiology
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Premature Birth/epidemiology
- Radiography, Thoracic
- Respiration, Artificial
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- COVID-19 Drug Treatment
Collapse
Affiliation(s)
- Itzíar Carrasco
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain.
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Hernández
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Sánchez-Sánchez
- Department of Paediatric Gastroenterology Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Oliver
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mónica Riaza
- Department of Paediatrics, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Marta Pareja
- Department of Paediatrics, Hospital General de Albace, Castilla La Mancha, Spain
| | - Olga Sanz
- Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Juan López
- Department of Paediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Elena Márquez
- Department of Paediatrics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Infectious Diseases Unit, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio De León-Luis
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|