6537 Gentamicin levels in neonates – Aminoglycoside induced ototoxicity – An audit to introduce rapid point of care genotyping to detect m.1555A>G in NICU

Objectives Given the rising cases of Aminoglycoside Induced Ototoxicity in the UK and the significant costs associated with cochlear implant surgeries, this study sought to determine the prevalence of elevated gentamicin levels in babies at the Oliver Fisher neonatal unit following sepsis screening and IV Aminoglycoside antibiotic (gentamicin) treatment. The study also aimed to find the correlation between deranged renal function, prematurity, or low birth weight and high Gentamicin levels. Furthermore, the study evaluated the cost-benefit of introducing the gene-drive bedside kit (POCT) in the Oliver Fisher neonatal unit for early detection of the m.1555A>G variant, to advocate for a proactive approach in safeguarding neonates with the m.1555A>G variant from the risk of ototoxicity. Methods A retrospective audit from September 2022 to March 2023 at the Oliver Fisher neonatal unit was conducted, encompassing various care levels, including NICU, HDU, TC, and MAC. 200 babies who underwent sepsis screening and received IV Aminoglycoside antibiotic (gentamicin) were studied. Data sources included BadgerNet for demographic details (e.g. gestational age & birth weight) and Pathology iLab for Gentamicin and Renal function levels. Results The findings indicate that out of 200 babies, 8.5% had deranged renal functions with normal Pre 2nd Gentamicin Levels. 6.5% had high Pre 2nd gentamicin levels, 9.9% of a 131-baby subset. 2.5% had high Pre 5th gentamicin levels, 33.3% of a 15-baby subset. Interestingly, 1.5% with high gentamicin levels are term babies with birth weight >2.5kg and 1.5% had normal renal functions also showed high gentamicin levels. Conclusion The study did not conclusively link deranged renal function, prematurity, or low birth weight to high Gentamicin levels, though they remain risk factors. Given the risk of Aminoglycoside Induced Ototoxicity, introducing the gene-drive bedside kit (POCT) in the Oliver Fisher neonatal unit is recommended. This proactive measure could safeguard neonates with the m.1555A>G variant from the risk of ototoxicity. Efforts are underway to ensure introducing the gene-drive bedside kit (POCT) across the neonatal units in Southeast Network.