Newborn hearing screening: Tobramycin and vancomycin are not risk factors for hearing loss
Newborn hearing screening: Tobramycin and vancomycin are not risk factors for hearing loss
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DOI：
10.1067/mpd.2003.mpd037
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发表时间：
2003-01-01
影响因子：
5.1
通讯作者：
van den Anker, JN
中科院分区：
文献类型：
--
作者：
de Hoog, M;van Zanten, BA;van den Anker, JN
目的探讨新生儿听力筛查与妥布霉素和万古霉素暴露的相关性。研究设计对所有至少有一个危险因素的新生儿进行自动听性脑干反应(A-ABR)听力筛查。有关给药的数据是从患者档案中提取的。接触这些药物与听力筛查结果有关。在听力筛查不合格的患者中，根据听力损失的其他危险因素评估耳毒性药物的暴露情况。结果分析了625例患者，其中45例听力筛查未通过。妥布霉素、万古霉素和速尿分别用于508例、130例和174例患者。暴露于万古霉素、妥布霉素或速尿或两者的组合，根据治疗时间、总剂量或血清抗生素浓度定义，与未能通过A-ABR筛查无关。在所有血药浓度超出治疗范围的患者中，耳毒性药物不是最可能的危险因素。结论新生儿因耳毒性原因对万古霉素和妥布霉素进行常规治疗药物监测，不利于发现2-4 kHz范围内临床上有重要听力损失风险的患者。需要更长时间的听力跟踪以确定任何长期影响。
Objective To investigate the chance of detecting hearing loss with neonatal hearing screening in relation to exposure to tobramycin and vancomycin.Study design Automated auditory brainstem response (A-ABR) hearing screening was performed in all neonates with at least one risk factor. Data on drug administration were abstracted from patient files. Exposure to these drugs was related to the result of hearing screening. In patients failing hearing screening, exposure to ototoxic medication was assessed in the light of other risk factors for hearing loss.Results Six hundred twenty-five patients were analyzed; 45 neonates failed hearing screening. Tobramycin, vancomycin, and furosemide were used in 508, 130, and 174 patients, respectively. Exposure to vancomycin, tobramycin, or furosemide or a combination, defined in terms of treatment duration, total dose, or serum concentrations of antibiotics, was not related to failure to pass A-ABR screening. Ototoxic medication was not the most probable risk factor in any of the patients with serum concentrations outside the therapeutic range.Conclusions Routine therapeutic drug monitoring of vancomycin and tobramycin in neonates for ototoxicity reasons is not helpful in detecting patients at risk for clinically important hearing loss in the 2- to 4-kHz range. A longer period of audiometric follow-up is needed to determine any long-term effects.