Alfentanil pharmacokinetics in preterm infants

Article Abstract:

Preterm infants have problems associated with the incomplete development of many organ systems, such as the kidneys, heart, liver and lungs. Often, these infants need mechanical ventilation (use of a respirator) in order to breathe. Experts do not agree about whether these infants should be medicated with sedatives to better coordinate their efforts to breathe with the ventilator, and perhaps to reduce their discomfort (it is not known whether the ventilation produces discomfort). Information on the absorption, metabolism and action (pharmacokinetics) of a synthetic opioid, alfentanil, was collected to evaluate the usefulness and safety of this sedative for ventilated premature infants. The subjects were seven girls and 15 boys with an average gestational age of 30 weeks (range of 25 to 36 weeks) and average birth weight of 1,343 grams (range 690 to 4,084 g). The serum concentration, clearance and elimination rates were variable, as each infant responded differently to the drug. However, a transient decrease in heart rate and blood pressure was expected and was observed in all cases. No relationships between birth weight, gestational age, or gender and drug clearance or elimination rates could be established. This study shows that alfentanil can be safely given to preterm infants without harmful cardiovascular effects and without accumulation of the drug in the bloodstream. But the study does not indicate whether the drug relieves the stress of treatment with a ventilator, or whether this effect is even desirable; ongoing studies are addressing these issues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diseases, Artificial respiration, Mechanical ventilation, Alfentanil

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Treatment of sepsis with IgG in very low birthweight infants

Article Abstract:

Preterm infants who have a very low birth weight, especially those born before 32 weeks gestation, have little ability to resist infection because their immune systems are very immature. Thus in premature infants, sepsis, a bacterial infection in the bloodstream, is most likely caused by poorly developed defense mechanisms (immunodeficiency) and is still a major problem even with new antibacterial drug therapy. An alternative treatment involves boosting the infant's immune system with highly purified human immunoglobulin G (IgG), which is an immune protein that these infants have in only low quantities. The results from four randomized trials suggest that IgG therapy significantly reduced the incidence of sepsis in two trials. Further, the survival rate improved when IgG was used in infants who were suspected of having sepsis. Published results demonstrate that IgG therapy may decrease the incidence of sepsis, but the author cautions that IgG is incapable of fighting all infections. Additional tests are needed to determine the lowest effective dose and a suitable time-table for administering IgG to prevent sepsis in preterm infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Physiological aspects, Birth weight, Low, Low birth weight, Immunoglobulin G

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Ciprofloxacin in neonatal Enterobacter cloacae septicaemia

Article Abstract:

Antibiotics are effective in eliminating a wide variety of bacterial infections. However, treatment of infection by Enterobacter cloacae bacteria has become difficult because of demonstrated resistance to penicillins and cephalosporins. Ciprofloxacin, a synthetic fluoroquinolone antibiotic, is a new drug that has broad antibacterial activity. The successful ciprofloxacin treatment of six premature infants who developed multiresistant E. cloacae infections is reported. The organism was eliminated in all cases in an average of four days and no side effects such as liver, kidney or joint damage were observed. The authors agree that ciprofloxacin represents an acceptable alternative treatment for multiresistant organisms like E. cloacae, but should be used only after resistance to other antibiotics is established. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Drug resistance in microorganisms, Microbial drug resistance, Enterobacteriaceae, Ciprofloxacin

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