OBJECTIVE: The purpose of this study was to compare the incidence of 
nephrotoxicity, defined as doubling of baseline serum creatinine concentration, 
in newborn infants with peak vancomycin serum concentrations </=40 microg/mL at 
steady state to infants with peak vancomycin serum concentrations >40 microg/mL. 
A secondary objective was to correlate concomitant disease states and 
potentially nephrotoxic drug therapy with rises in serum creatinine in 
vancomycin recipients.
METHODS: Newborn infants with culture-proven Staphylococcus aureus or 
coagulase-negative staphylococcal septicemia who received vancomycin therapy for 
>3 days between 1985 and 1995 were identified from an existing database and a 
review of medical record. All 69 patients included in the study had serial serum 
creatinine determinations, including a baseline value within 48 hours of 
starting treatment with vancomycin, and serum vancomycin concentrations 
determined after at least three doses, with peak and trough concentrations 
determined 1 hour after a 60-minute infusion and 15 to 30 minutes before a dose, 
respectively. Infants with congenital renal or cardiac anomalies were excluded. 
Demographic characteristics, vancomycin dosing regimen, serum vancomycin 
concentrations and sample times, concomitant drug therapy, and disease states 
were recorded. Patients were divided into group A (peak vancomycin concentration 
</=40 microg/mL) and group B (peak vancomycin concentration >40 microg/mL). The 
change in serum creatinine concentration between the start and end of vancomycin 
therapy was determined. Nephrotoxicity was identified if serum creatinine 
doubled at any time from the start to the end of vancomycin therapy. Alternative 
definitions of nephrotoxicity (any rise in serum creatinine to >0.6 mg/dL or new 
abnormalities of urine sediment) were used in additional analyses.
RESULTS: A total of 69 evaluable patients (gestational age, 28.9 +/- 3.0 weeks; 
birth weight, 1219 +/- 516 g) were identified, 61 in group A and 8 in group B. 
Six patients in group A underwent doubling of serum creatinine concentration 
during vancomycin therapy, whereas none in group B did so. Serum creatinine 
doubled to >0.6 mg/dL in only 3 infants (all in group A). Any increase in serum 
creatinine to >0.6 mg/dL was seen in 10 infants, 9 of whom were in group A. No 
confounding variable, including previous or concomitant underlying disease 
states associated with renal dysfunction or treatment with other potentially 
nephrotoxic agents, were associated with a significant rise in serum creatinine.
CONCLUSION: Vancomycin-associated nephrotoxicity is rare in neonates, even with 
serum peak concentrations >40 microg/mL.