# Effect of Local Administration of Vancomycin to the Wound on Renal and Hepatic Function After Cardiac Surgery in Neonates

## TL;DR

This study found that applying vancomycin to surgical wounds in newborns after heart surgery does not harm kidney or liver function.

## Contribution

The study provides evidence that local vancomycin application is safe for neonatal renal and hepatic function post-surgery.

## Key findings

- Local vancomycin application did not cause significant increases in ALT, AST, or creatinine levels.
- Creatinine levels decreased after vancomycin application, indicating no negative renal impact.
- Liver enzyme levels remained within normal ranges post-surgery despite vancomycin use.

## Abstract

The development of sternal infection in neonates after cardiac defect correction using median sternotomy is a serious complication, increasing the length of hospital stay, mortality, and treatment costs. One effective method for preventing this complication is the local administration of antibiotics to the wound. The objective of this study was to evaluate the effect of local antibiotic application on renal and hepatic function in the postoperative period. Methods: A retrospective analysis of the treatment of 130 newborns with congenital heart defects (CHDs) was conducted. A local antibiotic (vancomycin, 0.5–1 g) was administered to the wound during sternotomy closure to prevent sternal infection. Liver and kidney function were assessed based on changes in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatinine levels preoperatively and at 1 and 3 days postoperatively. Data were analyzed using repeated-measures analysis of variance (ANOVA) and Friedman’s chi-square test. Results: In total, local vancomycin was administered to the wound during sternotomy closure in 130 newborns after the correction of CHDs. Thirty-three patients were excluded from the study because intraoperative signs of acute kidney injury were noted. Thus, 97 newborns were included in the study and there were no cases of sternal infection in this cohort of patients. According to the results from the statistical data analysis, the preoperative ALT level was lower (Md = 19.2) than the postoperative ALT level on the first day (Md = 23, p = 0.076). On the third day of postoperative observation, after the local application of vancomycin, the ALT level increased slightly, but remained within the normal range (Md = 26, p < 0.001). The AST level on the first day was higher (Md = 43.2) than the preoperative AST level (Md = 39, p = 0.002). However, on the third day after surgery, the AST level decreased (Md = 36.4, p = 0.059) and remained within the normal range. The differences in the dynamics of ALT levels on the third day and AST on the first day after surgery were statistically significant. These levels corresponded to normal levels, leading to the conclusion that the local application of vancomycin has no effect on the levels of AST and ALT. On the first day after surgery, creatinine values were lower (M = 58.3) than before (M = 62.3, p = 0.073). On the third day of postoperative observation, the creatinine values were lower than before surgery (M = 56.8, p = 0.009). Creatinine levels decreased after the local application of vancomycin. Conclusions: The use of vancomycin locally in the wound intraoperatively in newborns after CHD repair did not result in a clinically significant increase in ALT, AST, or creatinine in the blood plasma in the early postoperative period, proving that there were no negative effects on renal and hepatic function during three postoperative days.