Aminoglycosides may cause significant muscles weakness in neonates and young infants.

Mechanism: neuromuscular blockade


Patient selection: neonatal hypotonia


Clinical features:

(1) history of aminoglycoside therapy

(2) prolonged apnea

(3) respiratory depression

(4) flaccid paralysis

(5) reversal after discontinuation of the aminoglycoside antibiotics and/or administration of calcium gluconate or calcium chloride

(6) exclusion of other causes of hypotonia


Risk factors:

(1) rapid administration of a high aminoglycoside dose

(2) reduced renal function (including immaturity in premature infants)


Aminoglycosides are contraindicated in neonates with other disorders of the neuromuscular junction (botulism, congenital mysasthenia, etc) since the aminoglycosides could worsen the blockade.

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