Gentamicin Use in Neonates Mary Catherine Pilkington, BSN-SN NUR 401

1. Gentamicin Use in Neonates Mary Catherine Pilkington, BSN-SN NUR 401 Action Plan Planning: all team members talk about how they could best implement a guideline such as the one from National Guideline Clearinghouse, to give the patient the best outcomes Action: Implement the plan created and have inservices to make sure all staff members are on the same page and know what to do Charge nurse duty: provide and teach the inservices, available for questions, research, determine if guideline is working for their patients Nurses: Keep track of each patient and how well the treatments are working for them Introduction Detailed research has been conducted to make sure that providers for neonates know the correct dosing regimen and amount of medication to give to a baby with a potential or actual infection within the first few weeks of life. Overall, it is found best to give gentamicin if the patient is presenting with certain pathology that could indicate a possible infection, but more research should still be done to monitor peak and trough levels in order to keep the antibiotic in the patient’s body at a therapeutic range. Literature Reviews: Ali, A., Farouq, M., & Al-Faify, K. (2012). “Pharmacokinetic approach for optimizing gentamicin use in neonates during the first week of life”. - Level 3, Quality B Fullas, F., Padomek, M., Thieman, C., & Van Gorp, A. (2011). “Comparative evaluation of six extended-interval gentamicin dosing regimens in premature and full-term neonates”. - Level 2, Quality B Alshaikh, B., Dersch-Mills, D, Taylor, R., Akierman, A., & Yusuf, K. (2012). “Extended interval dosing of gentamicin in premature neonates ≤ 28-week gestation”. - Level 1, Quality B Contopoulos-Ioannidis, D., Giotis, N., Baliatsa, D., & Ioannidis, J. (2004). “Extended-interval aminoglycoside administration for children: A meta-analysis”. – Level 1, Quality A Kaguelidou, F., Turner, M., Choonara, I., Anker, J., Manzoni, P., Alberti, C., & Jacqz-Aigrain, E. (2013). “Randomized controlled trials of antibiotics for neonatal infections: A systematic review”. – Level 1, Quality B • Definition of Terms • Neonate- any newborn child, especially in the first week of life and up to four weeks old • Peak level- the amount of medication in the blood that represents the highest level during a drug administration cycle • Trough level- the point of minimum concentration of a drug or therapeutic agent, usually immediately before administering a drug’s next dose • Preterm- infant is one born before 37 weeks of gestation • Evaluation • PICO question was somewhat answered • More research is required to see if antibiotics given prophylactically really do help patient stay clear of infection • Research does support the guideline in that, given certain indications, gentamicin should be given prophylactically to keep the neonate from having an infection • More research and studies required to conclude if a one-time dose or multiple doses are more effective PICO Question: Does the use of gentamicin in neonates reduce the risk of actual infections as compared to those who do not receive any antibiotics? Revised Question: Does the use of gentamicin given to neonates as a one time dose or multiple doses reduce the risk of actual infections as compared to those who do not receive any antibiotics? National Guideline Clearinghouse. (2012). Antibiotics for early-onset neonatal infection.