58: An Evaluation of a Vancomycin Dosing Protocol in the Neonatal Intensive Care Unit (NICU)
Bibliographic record
Abstract
Vancomycin is often prescribed in the NICU for suspected or proven gram-positive infections. Achieving therapeutic serum concentrations can be challenging in neonates, particularly if aiming for high trough concentrations (15–20 mg/L) when MRSA is a concern. To evaluate our vancomycin dosing protocol to determine the proportion of infants with adequate dosing at first check and assess safety. Retrospective chart review of neonates admitted to two university-affiliated NICUs who received IV vancomycin between January 1st and December 31, 2012 (Period 1, 15–20 mg/kg/dose) and January 1, 2013 and February 28th, 2014 (Period 2, 20–22 mg/kg/dose). The outcomes were the proportion of neonates with target trough levels (5–15 mg/L), the proportion with higher trough levels (15–20 mg/L) and the proportion with toxic trough levels (>20 mg/L). 116 neonates received vancomycin, including 74 (mean gestational age 29.8+/− 4.8 weeks, mean birth weight 1.5 +/− 0.9 kg) with trough levels pre-3rd dose. There was no difference between the dose/kg of vancomycin between the two periods (Period 1 mean 20.4 mg/kg; Period 2 mean 20.9 mg/kg). 56 of 74 neonates (75.7%) achieved the target trough (Table 1). Only seven (9.5%) achieved a higher trough. Four (5.4%) infants had a trough level >20 mg/L. Less than 2/3 of infants ≤28 weeks and ≤14 days achieved an adequate trough. Our vancomycin dosing protocol is effective when targeting trough levels of 5–15 mg/L, except in the most immature infants. It is suboptimal if targeting higher trough levels. Further research is needed to develop a protocol that effectively achieves therapeutic trough levels in extremely preterm infants in their first weeks of life.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".