Maturation of midazolam clearance in critically ill children with severe bronchiolitis: A population pharmacokinetic analysis

Kos, Mojca Kerec; Miksić, Mirjana; Jovanović, Marija; Roškar, Robert; Grosek, Štefan; Grabnar, Iztok

doi:10.1016/j.ejps.2019.105095

Cited by 4 publications

(3 citation statements)

References 41 publications

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“…e children's nutritional risks have not been screened in time. us, the malnutrition of critically ill children is neglected [10][11][12][13] X ± s). e horizontal axis from left to right represents before intervention and after intervention, and the vertical axis represents the IgG level (μmol/L).…”

Section: Discussionmentioning

confidence: 99%

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Jie

Jin

Cheng

et al. 2022

Journal of Healthcare Engineering

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The aim of this study was to study the effect of early nutritional assessment and nutritional support on immune function and clinical prognosis of critically ill children. 90 critically ill children at the same level of severity admitted to the pediatric intensive care unit (PICU) of our hospital (June 2019–June 2020) were chosen as the research objects and were equally separated into the experimental group and the control group by the random number table method. The children in the control group were admitted to the PICU according to the routine process, and the nutritional support was provided to the malnourished ones. After admission to the PICU, the children in the experimental group were given nutritional assessment, nutritional risk screening, and nutritional support according to the screening results. The PICU stay time and total hospitalization time of the experimental group were obviously shorter than those of the control group ( P < 0.05 ), the hospitalization expenses of the experimental group were obviously lower than those of the control group ( P < 0.05 ), the clinical outcomes and immune function of the experimental group were obviously better than those of the control group ( P < 0.05 ), and the nutrition indicators of the experimental group were obviously higher than those of the control group ( P < 0.05 ). Early nutritional assessment and nutritional support can effectively improve the immune function and reduce the incidence of adverse clinical outcomes of critically ill children, which are worthy of clinical application and promotion.

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Section: Discussionmentioning

confidence: 99%

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Jie

Jin

Cheng

et al. 2022

Journal of Healthcare Engineering

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“…To overcome this, allometric scaling with a single fixed or estimated exponent is combined with the maturation factor to adjust for age. Maturation is usually described by sigmoidal function based on postmenstrual age or some other age descriptor (5,6,20,21,(29)(30)(31). Another way is to use or estimate an allometric exponent which changes with either weight or age (30,32).…”

Section: Innovative Methods For Pharmacokinetic Modeling Of Maturationmentioning

confidence: 99%

Pediatric pharmacokinetic considerations and implications for drug dosing

Jovanović,

Vučićević

2022

Arhiv za farmaciju

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Optimizing the dosing of medicines for pediatric patients in routine clinical practice and determining the dose for clinical trials is still a challenging task. Children differ from adults in their response to drugs due to inherent differences in pharmacokinetics and/or pharmacodynamics, and responses may also vary among pediatric patients of different ages. However, the greatest disparities compared to adult pharmacokinetic profiles are observed in children below 2 years of age. The maturation of the liver and the kidneys, as well as the variation in body composition, are considered to be the main sources of pharmacokinetic variability. Hence, besides specific pharmacodynamic features, understanding age-related changes in drug absorption, distribution, and elimination is fundamental for optimizing drug efficacy and avoiding toxicity. This paper summarizes the pharmacokinetic changes throughout the childhood, along with the effect of developmental changes on drug dosage calculation. In clinical practice, age and body weight-based dosing regimens are usually used. In spite of dosing recommendations based on age and/or body weight, variabilities in pharmacokinetics and pharmacodynamic response remain, implying a need to monitor patients and optimize the dosing regimen according to physiological characteristics, disease characteristics and therapy.

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“…The influence of developmental changes can be assessed by using size and/or age as covariates in population analysis (32,91). One approach used to describe midazolam clearance in critically ill children is based on allometric scaling combined with sigmoidal maturation function (92). On the other hand, in older critically ill patients, the reduction of elimination organ function should be accounted for.…”

Section: Special Populationsmentioning

confidence: 99%

Concept and utility of population pharmacokinetic and pharmacokinetic/pharmacodynamic models in drug development and clinical practice

Roganović¹,

Homšek²,

Jovanović³

et al. 2021

Arhiv za farmaciju

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Due to frequent clinical trial failures and consequently fewer new drug approvals, the need for improvement in drug development has, to a certain extent, been met using model-based drug development. Pharmacometrics is a part of pharmacology that quantifies drug behaviour, treatment response and disease progression based on different models (pharmacokinetic - PK, pharmacodynamic - PD, PK/PD models, etc.) and simulations. Regulatory bodies (European Medicines Agency, Food and Drug Administration) encourage the use of modelling and simulations to facilitate decision-making throughout all drug development phases. Moreover, the identification of factors that contribute to variability provides a basis for dose individualisation in routine clinical practice. This review summarises current knowledge regarding the application of pharmacometrics in drug development and clinical practice with emphasis on the population modelling approach.

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Maturation of midazolam clearance in critically ill children with severe bronchiolitis: A population pharmacokinetic analysis

Cited by 4 publications

References 41 publications

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

Pediatric pharmacokinetic considerations and implications for drug dosing

Concept and utility of population pharmacokinetic and pharmacokinetic/pharmacodynamic models in drug development and clinical practice

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