Aminoglycoside-related nephrotoxicity in the premature newborn

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Abstract
The nephrotoxicity of gentamicin and amikacin was compared during presumed sepsis in 107 premature neonates. To examine the possibility that nephrotoxicity was directly associated with the clinical conditions of sepsis, a control group of 26 chloramphenicol-treated newborns was also studied. Two markers of proximal renal tubular injury, N-acetyl-.beta.-glucosaminidase (NAG) and .beta.2-microgloblin, were measured in 6 h aliquots of urine. Because urine creatinine excretion increased with postconception age, markers were expressed in terms of excretion rate rather than per mg of creatinine. The NAG excretion rate was significantly higher in gentamicin-treated patients (138 .+-. 10 U/min, mean .+-. SE) than in amikacin-treated patients (85 .+-. 7 U/min) but did not differ between patients treated with amikacin and those treated with chloramphenicol (81 .+-. 11 U/min). Excretion of .beta.2-microglobulin did not differ among the 3 patient groups. Amikacin may be less nephrotoxic than gentamicin in the premature newborn.