title: Renal tolerance with the use of intralipid-amphotericin B in low-birth-weight neonates.
abstract: Amphotericin B is still the first-line therapy for neonatal fungal infections. With several comparative trials of intralipid-based amphotericin B (IL-AmB) demonstrating its clinical effectiveness and reduced renal toxicity in adults, we examined the renal tolerance and infection outcome in low-birth-weight infants in our 48-bed NICU treated with IL-AmB. Over 2 years, 52 patients (58 courses) received > or = 10 days of IL-AmB. Nineteen charts (23 episodes) were randomly accessed and reviewed. Mean birthweight = 747 grams, gestational age = 25.6 weeks, total IL-AmB dosage = 19.8 +/- 3.3 mg/kg (n = 23); 20 of these episodes were fungal culture positive (9 fungemias). Only one patient (who died during therapy) had a rise in creatinine of > 0.3 mg/dL. Overall, serum creatinine decreased significantly after Day 10 of IL-AmB therapy, from 0.93 +/- 0.42 mg/dL at baseline, to 0.54 +/- 0.24 after 19 days of therapy (p < 0.0001). Serial urine output, serum potassium and potassium supplementation data showed no significant differences from baseline. No interruption of therapy nor infusion reactions occurred. Only one death occurred attributable to fungal infection. Intralipid-amphotericin B may provide an effective alternative in the antifungal therapy of low birthweight neonates, without nephrotoxicity. Further prospective, comparative trials are warranted.
authors.affiliation: Department of Pediatrics, Women's and Children's Hospital, LAC+USC Medical Center 90033, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Friedlich
authors.forename: I
authors.initials: I
authors.lastname: Steinberg
authors.forename: A
authors.initials: A
authors.lastname: Fujitani
authors.forename: R A
authors.initials: RA
authors.lastname: deLemos
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000704:Analysis of Variance; D000935:Antifungal Agents / Q000627:therapeutic use*; D001806:Blood Urea Nitrogen; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000401:mortality; D007363:Intensive Care Units, Neonatal; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D007677:Kidney Function Tests; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D003404:Creatinine