Many physiologic differences between children and adults may result in age-related changes in pharmacokinetics and pharmacodynamics. Factors such as gastric pH and emptying time, intestinal transit time, immaturity of secretion and activity of bile and pancreatic fluid among other factors determine the oral bioavailability of pediatric and adult populations. Anatomical, physiological and biochemical characteristics in children also affect the bioavailability of other routes of administration.Key factors explaining differences in drug distribution between the pediatric population and adults are membrane permeability, plasma protein binding and total body water. As far as drug metabolism is concerned, important differences have been found in the pediatric population compared with adults both for phase I and phase II metabolic enzymes. Immaturity of glomerular filtration, renal tubular secretion and tubular reabsorption at birth and their maturation determine the different excretion of drugs in the pediatric population compared to adults.

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Umbilical-cord occlusion has been proposed for the treatment of twin-reverse arterial perfusion syndrome (TRAP). Transection of the umbilical cord is necessary in patients with monoamniotic or 'pseudomonoamniotic' TRAP to avoid subsequent cord entanglement and demise of the pump twin. We present a case of TRAP in which the umbilical cord was successfully ligated with suture and transected with the Versapoint electrode.