Impact of haemolysis on vancomycin disposition in a full-term neonate treated with extracorporeal membrane oxygenation. (November 2021)

• Record Type: Journal Article
• Authors: Pokorná, Pavla; Šíma, Martin; Tibboel, Dick; Slanař, Ondřej
• Is Part Of: Perfusion. Volume 36:Number 8(2021)
• Page Start: 864
• Page End: 867
• Publication Date: 2021-11
• Subjects: neonate -- vancomycin -- haemolysis -- ECMO -- pharmacokinetics -- acute kidney injury; Perfusion (Physiology) -- Periodicals; Blood -- Circulation, Artificial -- Periodicals; Heart -- Surgery -- Periodicals; Extracorporeal Circulation -- Periodicals; Perfusion -- Periodicals; Circulation extracorporelle -- Périodiques; Perfusion -- Périodiques; 617.41
• DOI: 10.1177/0267659120973595
• Languages: English
• ISSNs: 0267-6591

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is a lifesaving support technology for potentially reversible neonatal cardiac and/or respiratory failure. Pharmacological consequences of ECMO-induced haemolysis in neonates are not well understood. Case report: We report a case report of a full-term neonate treated for congenital diaphragmatic hernia and sepsis with ECMO and with vancomycin. While the population elimination half-life of 7 h was estimated, fitting of the simulated population pharmacokinetic profile to truly observed drug concentration points resulted in the personalized value of 41 h. Discussion: The neonate developed ECMO-induced haemolysis with subsequent acute kidney injury resulting in prolonged drug elimination. Whole blood/serum ratio of 0.79 excluded possibility of direct increase of vancomycin serum concentration during haemolysis. Conclusion: Vancomycin elimination may be severely prolonged due to ECMO-induced haemolysis and acute kidney injury, while hypothesis of direct increase of vancomycin levels by releasing the drug from blood cells during haemolysis has been disproved.