Am J Perinatol 1997; 14(7): 377-383
DOI: 10.1055/s-2007-994164
ORIGINAL ARTICLE

© 1997 by Thieme Medical Publishers, Inc.

Renal Tolerance with the Use of Intralipid-Amphotericin B in Low-Birth-Weight Neonates

Philippe S. Friedlich1 , 2 , Irving Steinberg2 , 3 , 4 , Adrian Fujitani2 , 4 , Robert A. de Lemos1 , 2
  • 1Divisions of Newborn Medicine, Los Angeles, California
  • 2Divisions of Pediatric Pharmacotherapy, Los Angeles, California
  • 3Department of Pediatrics, Women's and Children's Hospital, LAC+USC Medical Center, University of Southern California, Schools of Medicine Los Angeles, California
  • 4Department of Pharmacy, Los Angeles, California
Further Information

Publication History

Publication Date:
04 March 2008 (online)

ABSTRACT

Amphotericin B is still the first-line therapy for neonatal fungal infections. With several comparative trials of Intralipid-based amphotericin B (IL-AmB) demonstrating its clinical effectiveness and reduced renal toxicity in adults, we examined the renal tolerance and infection outcome in low-birth-weight infants in our 48-bed NICU treated with IL-AmB. Over 2 years, 52 patients (58 courses) received ≥ 10 days of IL-AmB. Nineteen charts (23 episodes) were randomly accessed and reviewed. Mean birthweight = 747 grams, gestational age = 25.6 weeks, total IL-AmB dosage = 19.8 ± 3.3 mg/kg (n = 23); 20 of these episodes were fungal culture positive (9 fungemias). Only one patient (who died during therapy) had a rise in creatinine of > 0.3 mg/dL. Overall, serum creatinine decreased significantly after Day 10 of IL-AmB therapy, from 0.93 ± 0.42 mg/dL at baseline, to 0.54 ± 0.24 after 19 days of therapy (p < 0.0001). Serial urine output, serum potassium and potassium supplementation data showed no significant differences from baseline. No interruption of therapy nor infusion reactions occurred. Only one death occurred attributable to fungal infection. Intralipid-amphotericin B may provide an effective alternative in the antifungal therapy of low birthweight neonates, without nephrotoxicity. Further prospective, comparative trials are warranted.