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研究生： 黃郁淳
Huang, Yu-Chun
論文名稱： 靜脈輸注方式對新生兒血中Amikacin濃度之影響
Influence of Intravenous Infusion Procedure on the Amikacin Serum Levels in Neonates.
指導教授： 高雅慧
Yang, Yea-Huei Kao
林其和
Lin, Chyi-Her
林毓志
Lin, Yuh-Jyh
學位類別： 碩士
Master
系所名稱： 醫學院 - 臨床藥學研究所
Institute of Clinical Pharmacy
論文出版年： 2004
畢業學年度： 92
語文別： 中文
論文頁數： 151
中文關鍵詞： Amikacin 、藥物治療濃度監測 、靜脈輸注方式 、新生兒加護病房
外文關鍵詞： amikacin, TDM, NICU, intravenous infusion method
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    • 研究背景
    　　在成大醫院之新生兒加護病房（NICU），當懷疑新生兒受到院內感染時，amikacin併用ampicillin/sulbactam為經驗性治療之首選藥物。在文獻上關於amikacin之藥動學研究，發現藥物在新生兒之分布體積及排除半衰期，隨著小兒成長過程之生理變化，有明顯之個體間差異，尤其是低出生體重之早產兒，因此建議新生兒使用amikacin時，應進行治療濃度監測，以確保療效及避免毒性，而過去在院內尚未有執行經驗。在臨床上執行藥物治療濃度監測時，amikacin建議在藥品輸注完後30分鐘抽血，而目前新生兒加護病房之靜脈輸注方式，若無法在特定時間內將藥品輸注完，將可能影響amikacin治療濃度監測之結果及判讀，因此為本研究希望探討之議題。

    研究目的
    本研究之目的主要包括：
    (1) 利用體外試驗，評估新生兒加護病房現行之靜脈輸注方式，對藥品輸注時間之影響。
    (2) 收集新生兒amikacin治療濃度監測之執行經驗，並且探討可能影響血中濃度之因素。

    體外試驗之研究方法
    　　利用新生兒加護病房使用之靜脈輸注管及輸注幫浦（IMED），將amikacin分別由輸注管上三個不同注射Y-site投予，並設定輸注流速為5、10、30 ml/hr。在藥品輸注期間，藉由輸注管末端收集之amikacin藥物量，評估不同條件下，輸注完至少95%藥量之時間。

    研究結果
    　　Amikacin之輸注時間會隨著流速及注射部位而改變，當流速為5 ml/hr，由輸注管之遠端Y-site給藥後，輸注完95%藥量至少需要三小時。若要確保amikacin在30分鐘輸注完，則流速5 ml/hr時，應由近端Y-site給藥，流速10及30 ml/hr時，應由中間Y-site給藥。對照臨床上治療濃度監測之結果，延長藥品輸注時間，會顯著影響到amikacin之最高血中濃度值。

    結論
    　　目前新生兒加護病房使用之靜脈輸注方式，在不同流速及注射部位下，會影響藥品輸注時間，根據體外試驗之研究結果，建議amikacin可統一改由輸注管之中間Y-site給藥，則在流速5~30 ml/hr時，藥品輸注時間為30~60分鐘。
    在新生兒amikacin之治療濃度監測方面，由於本研究期間，實際執行抽血監測之人數偏低，因此無法探討其它可能影響血中濃度之因素，未來在新生兒執行amikacin治療濃度監測，仍需要加以推廣，才能進一步評估。

    Background: In the NICU of National Cheng Kung University Hospital (NCKUH), amikacin combined with ampicillin/sulbactam is the drug of choice in newborns of suspected nosocomial infection. The pharmacokinetic studies of amikacin in neonates had demonstrated significant inter-individual variability in drug distribution and elimination, especially in the low birth weight premature infants. The therapeutic drug monitoring (TDM) of amikacin in neonates has been recommended to ensure effectiveness and avoid toxic side effect, but a standard procedure has never been established in our hospital. We observed that the administering procedure of amikacin infusion may result in erroneous dosing, which can further lead to therapeutic failure.

    Objectives: An in vitro study was designed to investigate whether the intravenous infusion method influence the time of complete delivery of amikacin. And, an exact procedure for drug administration can then be formulated.

    Methods of the in vitro study: We used the infusion set and infusion pump in the NICU. Amikacin was injected into the infusion set at three injection Y-sites set at 5, 10, 30 ml/hr flow rate. The amount of amikacin collected at varied infusion intervals was determined and the time required for complete drug delivery was calculated.

    Results: The delivery time of amikacin varied with infusion rate and injection site. The longest drug delivery time was 3 hours at a flow rate of 5 ml/hr when drug was injected into the distal Y-site. Only when amikacin was injected into the proximal Y-site at a flow rate of 5 ml/hr and the middle Y-site at the flow rate of 10 and 30 ml/hr can the drug be delivered completely within 30 minutes. Comparing with the results of TDM, the delay of drug delivery will obviously influence the peak level of amikacin.

    Conclusions: The infusion procedure in the NICU influenced drug delivery time at various infusion rates and injection sites. We recommend that amikacin should be injected into the middle Y-site to ensure drug delivery time within 30~60 minutes at flow rate of 5~30 ml/hr.

    中文摘要………………………………………………………I 英文摘要……………………………………………………III 誌謝……………………………………………………………V 縮寫表 ……………………………………………‥……‥VI 目錄……………………………………………………‥‥VII 表目錄 ………………………………………………‥……XI 圖目錄 …………………………………………………‥XIII 第一篇 靜脈輸注方式對新生兒血中amikacin濃度之影響 ‥‥‥‥…………………‥‥‥‥‥‥‥‥‥‥‥‥‥‥1 第壹章 研究背景‥……………………‥‥‥‥‥‥‥‥1 第貳章 文獻回顧……………………………………‥‥‥5 第一節 新生兒加護病房之院內感 ‥…………………‥ 5 1.1 危險因子 ……………………………………‥‥‥‥5 1.2 常見致病菌 ‥‥…………………………………‥‥7 1.3 臨床表現及經驗性抗生素治療 ‥‥……………‥‥9 第二節 Amikacin之藥效學特性 ‥…………………‥‥11 2.1 藥物特性及藥理作用‥‥‥……………‥‥‥‥‥11 2.2 抗菌範圍及臨床應用‥‥………………………‥‥12 2.3 抗藥性‥‥…………………………………‥‥‥‥13 第三節 Amikacin之藥物動力學 ‥……‥‥……………15 3.1 吸收…………………………………………‥‥‥‥15 3.2 分布‥‥……………………‥………………………16 3.3 排除‥‥…………………………………………‥‥17 第四節 Amikacin之建議劑量及治療血中濃度 ‥‥‥‥20 第五節 Amikacin之藥物不良反應 ‥‥…………‥‥‥24 5.1 腎毒性‥‥‥………………………………………‥24 5.2 耳毒性‥‥………………………………………‥‥25 第六節 新生兒靜脈給藥 ‥………………………………27 6.1 靜脈輸注幫浦‥‥………………………………‥‥27 6.2 靜脈輸注方式之種類‥‥‥……………………‥‥30 6.2.1 順行輸注系統‥‥‥…………………………‥‥30 6.2.2 逆行輸注系統‥‥‥…………………………‥‥30 6.2.3 注射針幫浦輸注系統…‥‥‥……………‥‥‥32 6.3 新生兒靜脈給藥需考慮之因素……‥‥………‥‥34 第七節 影響藥品輸注時間之因素 ……………‥‥‥‥36 7.1 流速及藥品注射部位………………………‥‥‥‥36 7.2 藥品之比重‥‥………………………………………40 7.3 藥品注射體積……………………………‥‥‥‥‥41 第八節 靜脈輸注方式對血中濃度監測之影響 ‥………42 8.1 最高血中濃度‥……………………‥‥‥‥………42 8.2 分布體積及排除半衰期……………………‥‥‥‥44 第九節 Amikacin血中濃度監測之參考準則 ‥………‥46 第參章 研究目的 ……………………………‥‥‥……48 第肆章 靜脈輸注體外試驗之研究方法 …………‥‥‥49 第一節 研究材料 ‥………………………………‥‥‥49 1.1 藥品及靜脈輸注裝置………………………‥‥……49 1.2 實驗器材…………………………………‥‥………49 1.3 測量儀器及分析試劑…………………………‥‥‥49 第二節 標準溶液之配製 …………………………‥‥‥50 第三節 標準校正曲線及再現性評估 …………‥‥‥…52 3.1 標準校正曲線…………………………………‥‥…52 3.2 再現性評估………………………‥‥………………52 第四節 靜脈輸注管輸注體積之測量方式 ‥……………53 第五節 流速設定方式 …………………………‥‥‥…54 第六節 研究流速 ……………………‥……………‥‥55 第七節 檢品藥量之計算方式 ……‥‥‥………………57 第八節 統計分析 …………………………………………58 8.1 資料分析‥……………………………………………58 8.2 統計軟體………………………………‥‥‥………58 第伍章 靜脈輸注體外試驗之研究結果 ‥‥……………59 第一節 標準校正曲線及再現性評估 ………………‥‥59 1.1 標準校正曲線………………………………………‥59 1.2 再現性評估………………………………………‥‥61 第二節 靜脈輸注管距末端之體積 …………………‥‥63 第三節 檢品藥量之計算結果 ………………………‥‥64 第四節 藥品輸注時間 ……………………………‥‥‥71 第陸章 Amikacin血中濃度監測執行結果 ………‥‥…75 第一節 執行方法 ……………………………………‥‥75 第二節 研究對象基本資料 …………………………‥‥76 第三節 血中濃度監測結果 …………………………‥‥79 第柒章 討論 …………………………………………‥‥85 第一節 Amikacin靜脈給藥之體外試驗 …………‥‥…85 1.1 藥品濃度之測定方法……………………………‥‥85 1.2 藥品輸注時間……………………………………‥‥87 第二節 Amikacin之血中濃度監測 ………………‥‥…91 2.1 不同研究執行結果之比較…………………………‥91 2.2 影響amikacin血中濃度之因素…………………‥‥93 2.3 藥品稀釋方式對血中濃度之影響………………‥‥95 2.4 監測頻次及抽血時間之建議………………………‥96 第三節 研究限制 ……………………………………‥‥97 第四節 未來研究方向 ………………………………‥‥98 第捌章 結論 …………………………………………‥‥99 參考文獻………………………………………………‥‥100 第二篇 新生兒加護病房臨床藥事服務 ‥……………110 第一節 靜脈給藥方式建議‥…………‥………………111 1.1 藥品稀釋方式可能產生之問題 ‥‥…………‥…111 1.2 稀釋方式之建議 ‥‥…………………………‥…115 第二節 藥物諮詢服務‥………………………‥………118 2.1 新生兒藥物治療之臨床問題 ‥‥…………‥‥…119 2.2 孕婦及哺乳婦女用藥 ‥‥…………………‥‥…129 2.3 注射劑混合後之安定性及相容性 ‥‥‥……‥…136 第三節 Aminophylline血中濃度監測 ……‥…………139 第四節 藥物使用之臨床觀察……………………‥‥…143 4.1 Erythromycin用於早產兒餵食不佳 ……‥‥…‥143 （附錄一） 使用Amikacin之病患資料紀錄表 …‥‥‥148 （附錄二） 成大醫院臨床藥事服務簡易個案記錄表 ‥149 （附錄三） Aminophylline治療藥物濃度監測記錄表‥150 （附錄四） Erythromycin在早產兒餵食不佳之治療記錄表 ‥151

    American Academy of Pediatrics. Antimicrobial agents and related therapy. In: Pickering LK, ed. Red book: 2003 Report of the Committee on Infectious Diseases. 26th ed. American Academy of Pediatrics:Elk Grove Village;2003,p.700.
    Arant BS. Development patterns of renal function maturation compared in the human neonate. J Pediatr 1978;92:705-12.
    Assel BM, Parini R, Rusconi F, Cavanna G. Influence of intrauterine maturation on the pharmacokinetics of amikacin in the neonatal period. Pediatr Res 1982;16:810-5.
    Benzing G, Loggie J. A new retrograde method for administering drugs intravenously. Pediatrics 1973;52:420-5.
    Berger A, Kretzer V, Gludovatz P, Haiden N, Pollak A. Evaluation of an amikacin loading dose for nosocomial infections in very low birthweight infants. Acta Paediatr 2004;356-60.
    Berman W, Whitman V, Marks KH et al. Inadvertent overadministration of digoxin to low-birth weight infants. J Pediatr 1978;92:1024-5.
    Bernard PA, Pechere C, Hebert R. Altered objective audiometry in aminoglycosides-treated human neonates. Arch Otorhinolaryngol 1980;228:205-10.
    Bernard PA. Freedom from ototoxicity in aminoglycoside treated neonates: a mistaken notion. Laryngoscope 1981;12:1985-94.
    Bleyzac N, Varnier V, Labaune JM, et al. Population pharmacokinetics of amikacin at birth and interindividual variability in renal maturation. Eur J Clin Pharmacol 2001;57:499-504.
    Borradori C, Fawer CL, Buclin T, Calame A. Risk Factors of sensorineural hearing loss in preterm infants. Biol Neonate 1997;71:1-10.
    Bromiker R, Adelman C, Shapiro M, Levi H. Safety of Gentamicin Administered by intravenous bolus in the nursery. Clin Pediatr 1999;38:433-5.
    Bromiker R, Arad I, Peleg O, Preminger A, Engelhard D. Neonatal bacteremia: patterns of antibiotic resistance. Infect Control Hosp Epidemiol 2001;22:767-70.
    Cervantes Munguía Ramón, Trujillo López José de J, Vásquez Garibay Edgar M, et al. The amikacin on premature newborn: schema of treatment defined by gestational and postnatal age. Rev Biomed 2000;11:251-6.
    Chadwick EG, Yogev R, Shulman ST. Combination antibiotic therapy in pediatrics. Am J Med 1986;80:166-70.
    Colding H, Vejlsgaard R, Hendel J, et al. Amikacin in newborn infants: summary of pharmacokinetics and recommendation for dosage. J Infect Dis 1976;134:S342.
    Dellagrammaticas HD, Christodoulou C, Megaloyanni E, Papadimitriou M, Kapetanakis J, Kourakis G. Treatment of gram-negative bacterial meningitis in term neonates with third-generation cephalosporins plus amikacin. Biol Neonate 2000;77:139-46.
    El Desoky ES, Sheikh AA, Al Hammadi AY. Aminoglycoside and vancomycin serum concentration monitoring and mortality due to neonatal sepsis in Saudi Arabia. J Clin Pharm Ther 2003;28:479-83.
    Eling RF, Brissie EO. Intravenous infusion of drugs by a retrograde technique. Am J Hosp Pharm 1974;31:740-2.
    Fanos V, Dall’Agnola A. Antibiotics in neonatal infections. Drugs 1999;58:405-27.
    Foca MD. Pseudomonas aeruginosa infections in the neonatal intensive care unit. Semin Perinatol 2002;26:332-9.
    Gal P. Therapeutic drug monitoring in neonates: problems and issues. Drug Intell Clin Pharm 1988;22:317-23.
    Giacoia GP. Intravenous drug administration to low birthweight infants. Clin Pediatr 1987;25-9.
    Gould T, Roberts RJ. Therapeutic problems arising from the use of the intravenous route for drug administration. J Pediatr 1979;95:465-71.
    Graham III PL. Staphylococcal and enterococcal infections in the neonatal intensive care unit. Semin Perinatol 2002;26:322-31.
    Gupta A. Hospital-acquired infections in the neonatal intensive care unit-Klebsiella pneumoniae. Semin Perinatol 2002;26:340-5.
    Gura KM. Parenteral drug administration guidelines for the pediatric patient: one hospital’s recommendations. Hosp Pharm 1993;28:221-3, 227-8, 231-6, 239-42.
    Hammett-Stabler CA, Johns T. Laboratory guidelines for monitoring of antimicrobial drugs. Clin Chem 1998;44:1129-40.
    Henley CM, Rybak LP. Development ototoxicity. Otolaryngol Clin North Am 1993;26:857-71.
    Howard JB, McCracken GH Jr. Pharmacological evaluation of amikacin in neonates. Antimicrob Agents Chemother 1975;8:86-90.
    Huang YF, Hesieh KS, Liu YC, Feldman RG. The predisposing factors of coagulase negative staphylococcal bacteraemia in neonatal intensive care unit. Acta Pediatr Tw 2001;42:22-6.
    Iwai N, sasaki A, Mizoguchi F, et al. Pharmacokinetics in neonates and infants following administration of amikacin (abstract). Jpn J Antibiot 1987;40:1157-75.
    Jeng PW, Cheng HC, Chen BY. Therapeutic drug monitoring of aminoglycosides in pediatric patients. J Clin Pharm Assoc 1993;2:19-27.
    Johnson CE, Roesner MP, Berman JR, Burch KJ. Administrating incompatible drugs by a retrograde intravenous infusion system. Am J Hosp Pharm 1985;42:109-11.
    Joshi SG, Ghole VS, Niphadkar KB. Neonatal gram-negative bacteremia (abstract). India J Pediatr 2000;67:27-32.
    Kabajak CAM, Leff RD, Robert RJ. Influence of physical characteristics of intravenous systems on drug delivery. Dev Pharmacol Ther 1988;11:189-95.
    Kaiser JR, Cassat JE, Lewno MJ. Should antibiotics be discontinued at 48 hours for negative late-onset sepsis evaluations in the neonatal intensive care unit? J Perinatol 2002;22:445-7.
    Karlowicz MG, Buescher ES, Surka AE. Fluminant late-onset sepsis in a neonatal intensive care unit, 1988-1997, and the impact of avoiding empiric vancomycin therapy. Pediatrics 2000;106:1387-90.
    Kenyon CF, Knoppert DC, Lee SK, et al. Amikacin pharmacokinetics and suggested dosage modifications for the preterm infant. Antimicrob Agents Chemother 1990;34:265-8.
    Koren G, Rajchgot P, Harding E, Perlman M, Macleod SM. Evaluating a filter device used for intermittent intravenous drug delivery to newborn infats. Am J Hosp Pharm 1985;42:106-8.
    Koren G. Therapeutic drug monitoring principles in the neonate. Clin Chem 1997;43:222-7.
    Kwan JW. High-technology i.v. infusion devices. Am J Hosp Pharm 1989;46:320-35.
    Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook. 9th ed. Lexi-comp:Hudson;2001,p.55-7.
    Langhendries JP, Battisti O, Bertrand JM. Adapatation in neonatology of the once-daily concept of aminoglycoside administration: evaluation of a dosing chart for amikacin in an intensive care unit. Biol Neonate 1998;74:351-62.
    Lee NC, Chen SJ, Tang RB, Hwang BT. Neonatal bacteremia in a neonatal intensive care unit: analysis of causative organisms and antimicrobial susceptibility. J Chin Med Assoc 2004;67:15-20.
    Leff RD, Roberts RJ. Methods for intravenous drug administration in the pediatric patient. J Pediatr 1981;98:635-1.
    Leff RD, Johnson GF, Erenberg A, et al. Evaluation of an extenstion set for intermittent intravenous drug delivery to infants. Am J Hosp Pharm 1985;42:1358.
    Leff RD, Roberts RJ. Problems in drug therapy for pediatric patients. Am J Hosp Pharm 1987;44:865-70.
    Lin PW, Simmons Jr CF. Fluid and electrolyte management. In: Cloherty JP, Eichenwald EC, Stark AR, ed. Manual of neonatal care. 5th ed. Philadelphia: Lippincott Williams&Wilkins;2004,p.101-14.
    Lunn JK, Wilson A. Retrograde medication administration a predictable and smiple system for pediatric drug delivery. Focus Crit Care 1986;13:59-63.
    Makhoul IR, Sujov P, Smolkin T, et al. Epidiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: A national survey. Pediatrics 2002;109:34-9.
    Manotas CJR, Trujillo HS, Londono RG, et al. Clinical and bacteriological response of newborn infants to amikacin. J Int Med Res 1975;3:223-9.
    de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN. An antibiotic policy to prevent emergence of resistant bacilli. Lancet 2000;973-8.
    Matthews SJ. Aminoglycosides. In: Schumacher GE, ed. Therapeutic drug monitoring. Appleton & Lange: Connecticut;1995,p.237-294.
    Matz GJ. Aminoglycoside cochlear ototoxicity. Otolaryngol Clin North Am 1993;26:705-12.
    McCurdy DE, Arnold MT. Development and implementation of a pediatric/neonatal IV syringe pump delivery system. Neonatal netw 1995;14:9-18.
    Myers MG, Roberts RJ, Mirhij NJ. Effect of gestational age, birth weight, and hypoxemia on pharmacokinetics of amikacin in serum of infants. Antimicrob Agents Chemother 1977;11:1027-32.
    Nahata MC, Powell DA, Glazer JP, Hilty MD. Effect of intravenous flow rate and injection site on in vitro delivery of chloramphenicol succinate and in vivo kinetics. J Pediatr 1981;99:463-6.
    Nahata MC, Powell DA, Durell DE et al. Effect of infusion methods on tobramycin serum concentrations in newborn infants. J Pediatr 1984a;104:136-8.
    Nahata MC, Powell DA, Durell DE, Glazer JP. Delivery of tobramycin by three infusion systems. Chemotherapy 1984b;30:84-7.
    Nahata MC. Influence of infusion methods on therapeutic drug monitoring in pediatric patients. Drug Intell Clin Pharm 1986a;20:367-9.
    Nahata MC. Delayed delivery of antibiotics by retrograde intravenous infusion. Am J Hosp Pharm 1986b;43:2237-9.
    Nahata MC. Effect of i.v. drug delivery systems on pharmacokinetic monitoring. Am J Hosp Pharm 1987;44:2538-42.
    Nahata MC. Influence of infusion systems on pharmacokinetic parameters of tobramycin in newborn infants. Chemotherapy 1988;34:361-6.
    Nanri S, Sunakawa K, Yamashita N, et al. A pharmacokinetic study in (mature and premature) neonates treated with amikacin through intravenous drip infusion (abstract). Jpn J Antibiot 1987;40:1135-45.
    Padovani EM, Pistolesi C, Fanos V, Messori A, Martini N. Pharmacokinetics of amikacin in neonates. Dev Pharmacol Ther 1993;20:167-73.
    Petersen PO, Wells TG, Kearns GL. Amikacin dosing in neonates: evaluation of a dosing chart based on population pharmacokinetic data. Dev Pharmacol Ther 1991;4:203-11.
    Philips JB, Cassady G. Amikacin: Pharmacology, indications and cautions for use, and dose recommendations. Semin Perinatol 1982;6:166-71.
    Poblano A, Belmont A, Sosa J, et al. Amikacin alters auditory brainstem conduction time in newborns. J Perinat Med 2003;31:237-41.
    Prober CG, Yeager AS, Arvin AM. The effect of chronologic age on the serum concentrations of amikacin in sick term and premature infants. J Pediatr 1981;636-40.
    Puopolo KM. Bacterial and fungal infections. In: Cloherty JP, Eichenwald EC, Stark AR, ed. Manual of neonatal care. 5th ed. Lippincott Williams &Wilkins:Philadelphia;2004,p.287-308.
    Quinn JP, Rodvold KA. Antibiotic policies in neonatal intensive-care units. Lancet 2000;355:946-7.
    Rajchgot P, Radde IC, MacLeod SM. Influence of specific gravity on intravenous drug delivery. J Pediatr 1981;99:658-61.
    Rajchgot P, Prober CG, Soldin SJ, et al. Toward optimization of therapy in the neonate. Clin Pharmacol Ther 1983;33:551-5.
    Rajchgot P, Prober CG, Soldin S, et al. Aminoglycoside-related nephrotoxicity in the premature newborn. Clin Pharmacol Ther 1984;35:394-401.
    Reilly KM. Problems in administration techniques and dose measurement that influence accuracy if i.v. drug delivery. Am J Hosp Pharm 1987;44:2245-50.
    Riff L, Schauf V. Use of aminoglycosides in neonate. Semin Perinatol 1982;6:155-63.
    Ristuccia AM, Cunha BA. An overview of amikacin. Ther Drug Monit 1985;7:12-25.
    Roberts RJ. Intravenous administration of medication in pediatric patients: problems and solutions. Pediatr Clin North Am 1981;28:23-34.
    Roberts RJ. Issues and problems associated with drug delivery in pediatric patients. J Clin Pharmacol 1994;34:723-4.
    Robinson RF, Nahata MC. Safety of intravenous bolus administration of gentamicin in pediatric patients. Ann Pharmacother 2001;35:1327-31.
    Rubin LG, Sanchez PJ, Siegel J, et al. Evaluation and treatment of neonates with suspected late-onset sepsis Pediatrics 2002;110:e42-8.
    Rusconi F, Cavanna PG, Assael BM. Monitoring of amikacin in the neonates. Ther Drug Monit 1983;5:179-83.
    Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in neonatal intensive care unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000;19:319-24.
    Saiman L. Introduction. Semin Perinatol 2002a;26:313-4.
    Saiman L. Risk factors for hospital-qcquired infections in the neonatal intensive care unit. Semin Perinatol 2002b;26:315-21.
    Santeiro ML, Sagraves R, Allen LV Jr. Osmolality of small-volume i.v. admixtures for pediatric patients. Am J Hosp Pharm 1990;47:1359-64.
    Schulze KF, Graff M, Schimmel MS, Schenkman A, Rohan P. Physiologic oscillations produced by an infusion pump. J Pediatr 1983;103:796-8.
    Shulman ST, Yogev R. Treatment of pediatric infections with amikacin as first-line aminoglycoside. Am J Med 1985;79:43-50.
    Spruyt LL, Kirsten GF, Parkin DP, Muller GJ, Kriegler A. Therapeutic monitoring as an aid in rationalising aminoglycoside dosage techniques in the neonates. S Afr Med J 1987;72:463-5.
    Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002a;347:240-7.
    Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics 2002b;110:285-91.
    Stoll BJ. Infections of the neonatal infant. In: Behrman RE, Kliegman RM, Jenson HB, ed. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders;2004,p.637.
    Stull JC, Erenberg A, Leff RD. Flow rate variability from electronic infusion devices. Crit Care Med 1988;16:888-91.
    Taketomo CK, Hodding JH, Kraus DM. Pediatric dosage handbook. 10th ed. Lexi-comp:Hudson;2003,p.6-8.
    Tang HY, Hutcheson E, Neill S, et al. Genetic susceptibility to aminoglycoside ototoxicity: How many are at risk? Genet Med 2002;4:336-45.
    The Vermont-Oxford Trials Network. Very low birth weight outcomes for 1990. Investigators of the Vermont-Oxford Trials Network Database Project. Pediatrics 1993;91:540-5.
    Tseng YC, Chiu YC, Wang JH, et al. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review. J Microbiol Immunol Infect 2002;35:168-72.
    Young TE, Magnum B. NeoFaxâ: A manual of drugs used in neonatal Care, 15th ed. Acorn Publishing:Raleigh;2002,p.4-5.
    Wang SM, Liu CC, Tseng HW, et al. Staphylococcus capitis bacteremia of very low birth weight premature infants at neonatal care units: Clinical significance and antimicrobial susceptibility. J Microbiol Immunol Infect 1999;32:26-32.
    Wermeling DP, Rapp RP, Deluca PP, Piecoro Jr JJ. Osmolality of small-volume intravenous admixtures. Am J Hosp Pharm 1985;42:1739-44.
    Williams BS, Ransom JL, Gal P, et al. Gentamicin pharmacokinetics in neonates with patent ductus arteriosus. Crit Care Med 1997;25:273-5.
    Wood BR, Huddleston K, Kolm P. A comparison of infusion devices at 1 ml/hr. Neonatal Intensive Care 1993;6:20-2.
    Yu JL, Wu SX, Jia HQ. Study on antimicrobial susceptibility of bacteria causing neonatal infections: a 12 year study(1987-1998). Singapore Med J 2001;42:107-10.
    Zenk KE. Intravenous drug delivery in infants with limited i.v. access and fluid restriction. Am J Hosp Pharm 1987;44:2542-5.

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