Effect of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the NICU and Future Adolescent Kidney Health

The present investigated whether extended exposure to both high-nephrotoxicity antimicrobials and lower-risk antimicrobials simultaneously during the neonatal intensive care unit (NICU) stay is linked to adverse kidney health outcomes in later adolescence for individuals born prematurely with very low birth weight (VLBW).

It included participants born preterm with VLBW (<1500 grams) as singleton and defined simultaneous exposure as a high-risk antimicrobial, like vancomycin, administered with a lower-risk antimicrobial on the same date in the NICU. It looked for serum creatinine, estimated glomerular filtration rate (eGFR), and first-morning urine albumin-creatinine ratio (ACR) at age 14 years. 

The study observed-

• Of the 147 out of 177 participants with exposure data, 97% received simultaneous antimicrobials for a mean duration of 7.2 days (SD 5.6). 
• None had eGFR <90 ml/min/1.73 m2.
• The mean ACR was 15.2 mg/g (SD 38.7).
•  7% had albuminuria (ACR >30 mg/g). 
• Each day of simultaneous exposure was linked to a 1.04-mg/g higher ACR.

In conclusion, this study found that despite the frequent concurrent use of high-risk and lower-risk nephrotoxic antimicrobials in the NICU, there aren't any clinically significant associations with adverse kidney health outcomes during adolescence. While further research is warranted, these results offer reassurance for a population previously considered at heightened risk of developing chronic kidney disease.

Schiff AF, et al. Duration of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the NICU and Future Adolescent Kidney Health. The Journal of Pediatrics. 2023. DOI:https://doi.org/10.1016/j.jpeds.2023.113730