RENAL TOLERANCE WITH THE USE OF INTRALIPID-AMPHOTERICIN-B IN LOW-BIRTH-WEIGHT NEONATES

Amphotericin B is still the first-line therapy for neonatal fungal inf ections. With several comparative trials of Intralipid-based amphoteri cin B (IL-AmB) demonstrating its clinical effectiveness and reduced re nal 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 greater than or equal to 10 days of IL-AmB. Nineteen charts (23 episodes) were randoml y 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 o f 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 +/- 0.2 4 after 19 days of therapy (p < 0.0001). Serial urine output, serum po tassium and potassium supplementation data showed no significant diffe rences from baseline. No interruption of therapy nor infusion reaction s 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.