Ototoxic Drug Exposure and Hearing Loss in Neonates: A Scoping Review

Abstract

Purpose: This scoping review aims to map the effects of dosage levels, dosage intervals, duration of exposure, and serum concentration levels of gentamicin, amikacin, vancomycin, furosemide, and bumetanide on newborn hearing.

Method: Using PubMed, Scopus, and Ovid databases (January 2010-2022), a scoping review was conducted to identify studies on ototoxic drug exposure in neonates. The review included articles that described details on ototoxic drug exposure and hearing status, dosage levels, duration of exposure, and serum concentration levels. The search results were summarized using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Results: Out of 4,395 entries, 28 were selected for inclusion in the scoping review. The studies were separated according to the exposed drugs: gentamicin, amikacin, vancomycin, furosemide, bumetanide, and a combination of drugs. Four out of five studies on amikacin exposure revealed an increased association with ototoxicity and abnormal trough levels. Six of seven studies on gentamicin exposure reported elevated trough concentration levels in a small number of infants, but no studies reported hearing loss. Two out of four studies on vancomycin exposure reported a dose-dependent risk for infants to develop hearing loss.

Conclusions: Gentamicin exposure in neonates has been extensively studied and considered relatively safe, except in cases of elevated peak or trough concentration levels. Amikacin exposure was reported to be more ototoxic, as the elevation of trough concentration levels was associated with refer results in hearing. Loop-diuretic exposure demonstrated a significant ototoxic effect. When used with other ototoxic medications, vancomycin is said to have a greater effect on ototoxicity.

Supplemental material: https://doi.org/10.23641/asha.26814700.