Risk Factors for Nephrotoxicity Among Neonates Receiving Vancomycin: A Systematic Review and Meta-analysis.

IF 3.3 3区医学 Q1 PEDIATRICS

Pediatric Drugs Pub Date : 2025-07-01 Epub Date: 2025-04-10 DOI:10.1007/s40272-025-00690-w

Yuan Gao, Tong Wu, Libin Pu, Mengjie Wang, Chang Wang, Yinyin Guo, Wen Qiu

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引用次数: 0

Abstract

Background: Nephrotoxicity may increase the risk of neonatal mortality. Early identification of risk factors for nephrotoxicity is essential to improve clinical outcomes. This study aimed to determine the risk factors for nephrotoxicity in neonates receiving vancomycin to promote the safe use of vancomycin.

Methods: We searched international and Chinese databases from 1990 to 24 March 2024 for studies involving neonates receiving vancomycin and reporting their nephrotoxic outcomes. Effects were estimated with 95% confidence intervals (CIs), odds ratios (ORs), and standardized mean differences. We evaluated the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results: In total, the study included 12 retrospective cohort studies involving 2079 neonates. In neonates receiving vancomycin, the incidence of nephrotoxicity varied from 2.7 to 20.0%. Moderate-quality evidence indicated that furosemide (OR 5.80; 95% CI 2.98-11.28), amphotericin B (OR 2.75; 95% CI 1.23-6.12), patent ductus arteriosus (OR 5.93; 95% CI 2.80-12.55), and necrotizing enterocolitis (OR 4.49; 95% CI 2.12-9.49) were risk factors for nephrotoxicity in neonates receiving vancomycin. Low-quality evidence suggested that vasoactive agents (OR 9.23; 95% CI 1.06-80.62) were risk factors. Subgroup analysis with moderate-quality evidence identified a steady-state vancomycin trough concentration > 20 mg·L^-1 (OR 6.87; 95% CI 3.81-12.39) as a risk factor. Very low-quality evidence indicated that aminoglycosides (OR 0.29; 95% CI 0.13-0.62) were not risk factors.

Conclusions: This study reveals the nephrotoxic risk factors for neonates receiving vancomycin, which could help in the implementation of measures to prevent further renal impairment.

Prospero registration number: CRD42024564584.

查看原文本刊更多论文

接受万古霉素治疗的新生儿肾毒性的危险因素：一项系统综述和荟萃分析。

背景：肾毒性可增加新生儿死亡的风险。早期识别肾毒性的危险因素对改善临床结果至关重要。本研究旨在确定万古霉素对新生儿肾毒性的危险因素，以促进万古霉素的安全使用。方法：我们检索了1990年至2024年3月24日的国际和中国数据库，检索了涉及接受万古霉素治疗的新生儿并报告其肾毒性结局的研究。用95%置信区间（ci）、优势比（ORs）和标准化平均差异估计效果。我们使用分级推荐评估、发展和评估（GRADE）工具评估证据的确定性。结果：本研究共纳入12项回顾性队列研究，涉及2079名新生儿。在接受万古霉素治疗的新生儿中，肾毒性的发生率从2.7%到20.0%不等。中等质量证据表明，呋塞米(OR 5.80；95% CI 2.98-11.28)，两性霉素B (OR 2.75；95% CI 1.23-6.12)，动脉导管未闭(OR 5.93；95% CI 2.80-12.55)和坏死性小肠结肠炎(OR 4.49；95% CI 2.12-9.49)是接受万古霉素治疗的新生儿肾毒性的危险因素。低质量证据提示血管活性药物(OR 9.23；95% CI 1.06-80.62)为危险因素。中等质量证据亚组分析确定万古霉素稳定谷浓度> 20 mg·L-1 (OR 6.87；95% CI 3.81-12.39)作为危险因素。极低质量的证据表明氨基糖苷类(OR 0.29；95% CI 0.13-0.62)不是危险因素。结论：本研究揭示了接受万古霉素治疗的新生儿肾毒性危险因素，有助于实施预防进一步肾功能损害的措施。普洛斯彼罗注册号：CRD42024564584。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Drugs PEDIATRICS-PHARMACOLOGY & PHARMACY

CiteScore

7.20

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Pediatric Drugs promotes the optimization and advancement of all aspects of pharmacotherapy for healthcare professionals interested in pediatric drug therapy (including vaccines). The program of review and original research articles provides healthcare decision makers with clinically applicable knowledge on issues relevant to drug therapy in all areas of neonatology and the care of children and adolescents. The Journal includes: -overviews of contentious or emerging issues. -comprehensive narrative reviews of topics relating to the effective and safe management of drug therapy through all stages of pediatric development. -practical reviews covering optimum drug management of specific clinical situations. -systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. -Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in the pediatric population. -original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Pediatric Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.