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P49 Gentamicin safety in neonatal sepsis following maternal gentamicin given during labour
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  1. James Morris,
  2. Dulip Jayasinghe,
  3. Adriece Al Rifai,
  4. Stella Tse
  1. Nottingham University Hospitals NHS Trust

Abstract

Aim Gentamicin is a recommended antibiotic in neonates with presumed or suspected sepsis.1 NICE guidance was updated in April 2021 to add gentamicin to first-line antibiotics for women with suspected chorioamnionitis in labour.1 Gentamicin is potentially nephrotoxic and ototoxic at high levels2 and is known to cross the placenta - neonatal serum gentamicin levels of up to 50% have been reported.3 4

Our NHS Trust implemented a new protocol for neonatal gentamicin in response to these changes. For neonates whose mother received gentamicin in the 12 hours before delivery, a gentamicin level must be checked before administering gentamicin to the neonate (and only given when level < 2 mg/L) - with adequate safety controls in place to ensure high risk babies were adequately treated.

The aim of this project was to assess compliance with this protocol and evaluate potential risk of gentamicin toxicity to neonates if protocol was not followed.

Method We obtained a list of neonates who had a blood culture taken in August and September 2022 (presumed to be part of a septic screen). We audited whether protocol was followed i.e. gentamicin levels checked prior to administering gentamicin.

Results There were 88 septic screens across the two months audited. There were five cases where maternal gentamicin was given during labour. In all these cases local policy was followed regarding holding gentamicin until level < 2 mg/L. Initial gentamicin levels ranged from 1.26 mg/L to 4.07 mg/L with four of them above 2 mg/L. No neonates demonstrated impaired renal function or ongoing high gentamicin levels.

The previous audit of data from April to June 2022 identified 3 cases where gentamicin was > 2 mg/L at the time that gentamicin would previously have been given, including one level of 5.54 mg/L.

Conclusion Gentamicin levels can be high (> 2 mg/L) in babies born to mothers who had gentamicin in labour. If levels are not checked prior to giving the first dose then there is the potential for high neonatal levels of gentamicin and associated nephrotoxicity and ototoxicity. Identification of such cases is dependent on good communication between obstetric, midwifery and neonatal teams. As the new guidance on obstetric gentamicin use becomes more established we may expect more cases of gentamicin given in labour.

References

  1. NICE, Neonatal infection: antibiotics for prevention and treatment, NICE guideline [NG195].

  2. Kahlmeter G, Dahlager JI. Aminoglycoside toxicity - a review of clinical studies published between 1975 and 1982. J Antimicrob Chemother 1984;13(Suppl A):9–22.

  3. Wilson GA, Nelson A, Bhagat P, et al. Neonatal serum gentamicin concentrations following maternal once-daily gentamicin dosing. Open Forum Infect Dis 2020;7(Suppl 1):S669.

  4. Locksmith GJ, Chin A, Vu T, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstetrics and Gynecology 2005;105:473–479.

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