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Logo of mjafiGuide for AuthorsAbout this journalExplore this journalMedical Journal, Armed Forces India
Med J Armed Forces India. 2000 April; 56(2): 178.
Published online 2017 June 10. doi:  10.1016/S0377-1237(17)30154-5
PMCID: PMC5532023


Dear Editor,

This is with reference to the original article on the subject of glomerular function in neonates [1]. The ultimate objective of any research should be to translate the benefits to the betterment of patient care. That neonates have a high plasma creatinine levels at birth and normalizing over period of time is a well-established text book fact. However, the riddle of the high plasma creatinine levels in term and particularly in preterms seems to be solved. Once the umbilical cord is severed, the perfect intrauterine maternal-fetal biochemical balance is disturbed. Thereafter, the already transferred exogenous adult level creatinine will rapidly disappear in the first urine specimens passed by the now autonomous newborn infant. A new steady state is achieved in due time, based on independent neonatal factors. One of the factors is the unusual occurrence of tubular creatinine reabsorption. The authors hypothesize that this latter temporary phenomenon is attributable to back flow of creatinine across leaky immature tubular and vascular structures. With time, maturational renal changes will impose a barrier to creatinine [2]. Secondly by suggesting that there is scanty Indian literature on the subject of renal functions in neonates, are the authors contemplating difference in different racial groups? Narang et al [3] have studied the maturation of neonatal glomerular function as evidenced by serum creatinine and creatinine clearance in 15 preterm small for dates infants (group 1) and compared with values obtained in 15 preterm appropriate for date babies (group 2) on 3rd, 7th and 14th postnatal days. Creatinine clearance was shown to be statistically less (p<0.005 on day 3, p,<0.001 on day 7 and p<0.01 on day 14 respectively) in group 1 as compared to group 2, thereby implying slower renal maturation in small for date preterm babies. This highlights the methodology error in the present report [1]. Thirdly adaptation in neonatology of the once daily concept of aminoglycoside administration has been well studied. Langhendries JP et al [4] have been able to demonstrate after a trial period of single dose amikacin in 37 babies that minimum inhibitory concentration profiles tested in 43 successive bacterial, strains remained adequate. A prospective randomized study compared the pharmacokinetics of once daily gentamicin regime in preterms to the conventional twicedaily regime. The observations suggested that once daily dosage regime guarantees initial peak serum concentration above the minimum inhibitory concentration of gram negative bacteria and trough concentration below potentially toxic levels of 2 μg/ml [5].


1. Wilson CG, Sarkar PK, Mazumdar JPS, Bharadwaj B. Study of glomerular functions in neonates. Medical Journal Armed Forces India. 1999;55:183–186.
2. Guignard JP, Drukker A. Why do newborn infants have a high plasma creatinine? Paediatrics. 1999;103(4):e49. [PubMed]
3. Narang A, Bhakoo ON, Majumdar S, Kumar CH. Renal function in SFD and FD preterm babies. Indian Paediatr. 1993;30:201–205. [PubMed]
4. Langhendries JP, Battisti O, Betrand JM, Francois A, Kalenga M, Scalais DJ. Adaptation in neonatology of the once daily concept of aminoglycoside administration: Evalaution of a dosing chart for amikacin in an intensive care unit. Biol Neonate. 1998;74:351–362. [PubMed]
5. Krishnan L, George SA. Gentamicin therapy in preterms: A comparison of two dosage regimens. Indian Pediatr. 1997;34:1075–1080. [PubMed]

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