Ototoxic drugs and sensorineural hearing loss following severe neonatal respiratory failure.
OBJECTIVE
To determine relationships between ototoxic drugs and 4-y sensorineural hearing loss (SNHL) in near-term and term survivors of severe neonatal respiratory failure.


METHODS
All 81 survivors of the Canadian arm of the Neonatal Inhaled Nitric Oxide Study (mortality 32, loss to follow-up 9) received loop diuretics, aminoglycosides, and neuromuscular blockers (NMB), and 50 received vancomycin as neonates. Prospective, longitudinal secondary outcome using audiological tests diagnosed late-onset, progressive SNHL in 43 (53%); not flat (sloping) in 29, flat (severe to profound) in 14. Risk for SNHL was determined.


RESULTS
A combination of duration of diuretic use of >14 d and average NMB dose of >0.96 mg/kg/d contributed to SNHL among survivors (odds ratio 5.2; 95% CI 1.6, 16.7). Markers of illness severity did not contribute. Dosage or duration of aminoglycosides use did not relate to SNHL. Cumulative dosages and duration of use of diuretics; NMB; use of vancomycin; and overlap of diuretics with NMB, aminoglycosides, and vancomycin individually linked to SNHL (p<0.001).


CONCLUSIONS
Overuse of loop diuretics and/or NMB contributes to SNHL after neonatal respiratory failure; markers of illness severity or the appropriate administration of aminoglycosides do not.
Robertson
Charlene M T
CM
Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Capital Health, Edmonton, Alberta T5G 0B7, Canada. croberts@cha.ab.ca
Tyebkhan
Juzer M
JM
Peliowski
Abraham
A
Etches
Philip C
PC
Cheung
Po-Yin
PY
D000583:Amikacin / Q000009:adverse effects / Q000627:therapeutic use; D000617:Aminoglycosides / Q000009:adverse effects* / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001301:Audiometry, Pure-Tone / Q000379:methods; D001309:Auditory Threshold / Q000502:physiology; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D004976:Ethacrynic Acid / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010197:Pancuronium / Q000009:adverse effects / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D012720:Severity of Illness Index; D014031:Tobramycin / Q000009:adverse effects / Q000627:therapeutic use; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use; D014673:Vecuronium Bromide / Q000009:adverse effects / Q000627:therapeutic use
D000617:Aminoglycosides; D000890:Anti-Infective Agents; D004232:Diuretics; D005839:Gentamicins; D014640:Vancomycin; D014673:Vecuronium Bromide; D005665:Furosemide; D000583:Amikacin; D010197:Pancuronium; D004976:Ethacrynic Acid; D014031:Tobramycin