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Ponthier L, Ensuque P, Destere A, Marquet P, Labriffe M, Jacqz-Aigrain E, Woillard JB. Optimization of Vancomycin Initial Dose in Term and Preterm Neonates by Machine Learning. Pharm Res 2022; 39:2497-2506. [PMID: 35918452 DOI: 10.1007/s11095-022-03351-6] [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] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Vancomycin is one of the antibiotics most used in neonates. Continuous infusion has many advantages over intermittent infusions, but no consensus has been achieved regarding the optimal initial dose. The objectives of this study were: to develop a Machine learning (ML) algorithm based on pharmacokinetic profiles obtained by Monte Carlo simulations using a population pharmacokinetic model (POPPK) from the literature, in order to derive the best vancomycin initial dose in preterm and term neonates, and to compare ML performances with those of an literature equation (LE) derived from a POPPK previously published. MATERIALS AND METHODS The parameters of a previously published POPPK model of vancomycin in children and neonates were used in the mrgsolve R package to simulate 1900 PK profiles. ML algorithms were developed from these simulations using Xgboost, GLMNET and MARS in parallel, benchmarked and used to calculate the ML first dose. Performances were evaluated in a second simulation set and in an external set of 82 real patients and compared to those of a LE. RESULTS The Xgboost algorithm yielded numerically best performances and target attainment rates: 46.9% in the second simulation set of 400-600 AUC/MIC ratio vs. 41.4% for the LE model (p = 0.0018); and 35.3% vs. 28% in real patients (p = 0.401), respectively). The Xgboost model resulted in less AUC/MIC > 600, thus decreasing the risk of nephrotoxicity. CONCLUSION The Xgboost algorithm developed to estimate the initial dose of vancomycin in term or preterm infants has better performances than a previous validated LE and should be evaluated prospectively.
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Affiliation(s)
- Laure Ponthier
- Pharmacology & Transplantation, University Limoges, INSERM U1248 P&T, 2 rue du Pr Descottes, F-87000, Limoges, France.,Department of Pediatrics, University Hospital of Limoges, Limoges, France
| | - Pauline Ensuque
- Department of Pediatrics, University Hospital of Limoges, Limoges, France
| | - Alexandre Destere
- Pharmacology & Transplantation, University Limoges, INSERM U1248 P&T, 2 rue du Pr Descottes, F-87000, Limoges, France.,Department of Pharmacology and Toxicology, University Hospital of Nice, Nice, France
| | - Pierre Marquet
- Pharmacology & Transplantation, University Limoges, INSERM U1248 P&T, 2 rue du Pr Descottes, F-87000, Limoges, France.,Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Marc Labriffe
- Pharmacology & Transplantation, University Limoges, INSERM U1248 P&T, 2 rue du Pr Descottes, F-87000, Limoges, France.,Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Evelyne Jacqz-Aigrain
- Pediatric Pharmacology, Department of Biological Pharmacology, Saint-Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Saint-Louis, France
| | - Jean-Baptiste Woillard
- Pharmacology & Transplantation, University Limoges, INSERM U1248 P&T, 2 rue du Pr Descottes, F-87000, Limoges, France. .,Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France.
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Ponthier L, Ensuque P, Guigonis V, Bedu A, Bahans C, Teynie F, Medrel-Lacorre S. Parental presence during painful or invasive procedures in neonatology: A survey of healthcare professionals. Arch Pediatr 2020; 27:362-367. [PMID: 32891481 DOI: 10.1016/j.arcped.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Newborns in neonatology are exposed to invasive and painful procedures. The absence of parents during procedures revealed significantly high pain scores. OBJECTIVE The aim of this study was to assess practices regarding the role of parents during painful and invasive procedures. METHODS This was a prospective, observational, multicenter study in France in which 471 caregivers participated. Professional practices regarding the role of parents during painful procedures on their child were assessed. Univariate and multivariate analyses were performed to identify factors associated with parental presence during painful procedures. RESULTS Parental presence was most often allowed during capillary blood sampling, nasogastric tube insertions, and vein punctures, whereas it was mostly restricted during central line insertions, extubations, lumbar punctures, and intubations. However, we found discrepancies depending on the type of facility and caregiver seniority. CONCLUSION An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported.
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Affiliation(s)
- L Ponthier
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France.
| | - P Ensuque
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - V Guigonis
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - A Bedu
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - C Bahans
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - F Teynie
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - S Medrel-Lacorre
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
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