Auditive and Renal Long Term Outcomes - Risk After Aminoglycoside Therapy in Neonates (AURORA)

NCT03253614 — Completed, 226 participants, University Hospital of North Norway

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Auditive and Renal Long Term Outcomes - Risk After Aminoglycoside Therapy in Neonates (AURORA-study)

RegistryNCT03253614, acronym AURORA
StatusCompleted
Study typeObservational
Enrollment226 (Actual)
SponsorUniversity Hospital of North Norway (Other)
ConditionsHearing Loss, Gentamicin Adverse Reaction, Renal Tubular Disorder
InterventionsAudiometry, Urine biomarkers for renal tubular function, Blood pressure (Diagnostic test)
Datesstart 2017-09-15, primary completion 2018-09-15, completion 2018-09-15, first posted 2017-08-18, last updated 2019-03-07
Locations1 site in Norway

Related Papers Related Patents Related Grants Related Experts
All trials for Hearing Loss All trials for Gentamicin Adverse Reaction All trials of Audiometry All trials of Urine biomarkers for renal tubular function

-Summary

Gentamicin, in combination with a beta-lactam antibiotic, is commonly used for treatment of neonatal sepsis. Neonates have a high volume of distribution. It is a paradox that most neonatal dosing schedules still recommend lower gentamicin doses (4-5 mg/kg) than in older children (≥ 7 mg/kg). In the neonatal unit in Tromsø a simplified gentamicin high-dose (6 mg/kg) regimen has been in use since 2004.

The investigators have previously shown that this regimen was associated with low number of elevated trough levels, low numbers of prescription errors and no evidence for ototoxicity in the immediate neonatal period. However, the long-term safety of gentamicin therapy in neonates is not well studied when it comes to ototoxicity and possible nephrotoxicity.

The objective of the current study is therefore to perform a detailed hearing evaluation, including an extended high-frequency (EHF; 9-16 kHz) audiometry, in a follow-up study of children (participants) aged 6-15 years who were exposed to a high-dose gentamicin regimen in the neonatal period. Moreover, we will investigate blood pressure and urine biomarkers to assess renal tubular function. The aim is to include 250 children exposed to gentamicin in the neonatal period and a control group of 25 healthy children.

EHF audiometry is a more sensitive method for detecting ototoxic damage and provides evidence of ototoxicity before any hearing loss is detected by conventional systems. This is the background for choice of method.

The primary outcome is the difference in average hearing threshold in the EHF range between the control group and the exposed group.

Secondary outcomes are i) difference in average hearing threshold in the EHF range between the children with gentamicin trough levels > 1.0 mg/L versus those who had lower trough levels, ii) markers of renal tubular function (kidney injury molecule 1) and iii) blood pressure.

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+Arms and interventions

ArmTypeInterventionsDescription
Exposed groupDiagnostic Test: Audiometry; Diagnostic Test: Urine biomarkers for renal tubular function; Diagnostic Test: Blood pressure250 children aged 6-15 years exposed to gentamicin in the neonatal period
Control groupDiagnostic Test: Audiometry25 healthy children aged 6-15 years NOT exposed to gentamicin in the neonatal period
  • Audiometry (Diagnostic test): Extended high-frequency (EHF; 9-16 kHz) audiometry
  • Urine biomarkers for renal tubular function (Diagnostic test): Kidney Injury Molecule-1
  • Blood pressure (Diagnostic test): Blood pressure right arm, measured With standard Methods 3 times

+Outcome measures

Primary outcomes

  • Hearing threshold in the extended high-frequency range [Baseline]: kHz

Secondary outcomes

  • Urine biomarkers [Baseline]: Kidney injury molecule-1
  • Blood pressure right arm [Baseline]: mm Hg
  • Hearing threshold in the normal frequency range [Baseline]: kHz

+Eligibility

Sex: All, ages: 5 Years to 15 Years, accepts healthy volunteers

Inclusion Criteria:

* Exposed to gentamicin therapy in the neonatal period and treated at neonatal unit at the University Hospital of North Norway

Exclusion Criteria:

* Not able to cooperate during an audiometry

+Locations (1)

FacilityCityCountryStatus
University Hospital of North NorwayTromsøNorway

+Publications

  • Fjalstad JW, Laukli E, van den Anker JN, Klingenberg C. High-dose gentamicin in newborn infants: is it safe? Eur J Pediatr. 2013 Nov 14. doi: 10.1007/s00431-013-2194-1. Online ahead of print. PMID 24233331
  • Setiabudy R, Suwento R, Rundjan L, Yasin FH, Louisa M, Dwijayanti A, Simanjuntak E. Lack of a relationship between the serum concentration of aminoglycosides and ototoxicity in neonates. Int J Clin Pharmacol Ther. 2013 May;51(5):401-6. doi: 10.5414/CP201833. PMID 23557866
  • Results publication: Rypdal V, Jorandli S, Hemmingsen D, Solbu MD, Klingenberg C. Exposure to an Extended-Interval, High-Dose Gentamicin Regimen in the Neonatal Period Is Not Associated With Long-Term Nephrotoxicity. Front Pediatr. 2021 Nov 30;9:779827. doi: 10.3389/fped.2021.779827. eCollection 2021. PMID 34917565
  • Results publication: Hemmingsen D, Stenklev NC, Klingenberg C. Extended high frequency audiometry thresholds in healthy school children. Int J Pediatr Otorhinolaryngol. 2021 May;144:110686. doi: 10.1016/j.ijporl.2021.110686. Epub 2021 Mar 23. PMID 33838463
  • Results publication: Hemmingsen D, Mikalsen C, Hansen AR, Fjalstad JW, Stenklev NC, Klingenberg C. Hearing in Schoolchildren After Neonatal Exposure to a High-Dose Gentamicin Regimen. Pediatrics. 2020 Feb;145(2):e20192373. doi: 10.1542/peds.2019-2373. Epub 2020 Jan 8. PMID 31915192

+Investigators