Neonatal pharmacology

Skinner, Adam

doi:10.1016/j.mpaic.2010.12.001

Cited by 12 publications

(18 citation statements)

References 16 publications

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“…In infants less than 6-7 months of age liver metabolism is immature so metabolism of drugs is delayed, and plasma protein levels are lower [124]. There are low levels of plasma alpha-1-acid glycoprotein, which increases the free fraction of circulating lidocaine and therefore increases the risk of toxicity [125].…”

Section: Myoclonic Jerks Dysphoria/hallucinationsmentioning

confidence: 99%

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

Lauder¹

2017

Pain Relief - From Analgesics to Alternative Therapies

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Pediatric acute and chronic pain experiences involve the interaction of physiological, psychological, behavioural, developmental, pharmacological and situational factors. In the acute perioperative pain setting preventative multimodal analgesia is required to provide comfort and minimise the potential for "wind-up" and central sensitisation. When pain is recurrent, ongoing or chronic some children embark on a downward spiral of decreased physical, psychological and social functioning. The multidisciplinary team management approach is a well-established standard of care for children with complex chronic pain. Intravenous lidocaine has peripheral and central mediated analgesic, anti-inflammatory and anti-hyperalgesic properties. Intravenous lidocaine infusion therapy (IVLT) has been shown to be effective in the management of acute and chronic pain in adults. This chapter will present the rational for IVLT in pediatric pain management with emphasis on preventative multimodal therapy in acute pain and the multidisciplinary treatment approach in chronic pain. Large multi-centre randomised controlled trials are required to provide the evidence-base to confirm that IVLT is indeed an effective and safe treatment option in acute preventative multimodal analgesia and as an adjunct in the multidisciplinary care of chronic pain in the pediatric population. Keywords

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Section: Myoclonic Jerks Dysphoria/hallucinationsmentioning

confidence: 99%

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

Lauder¹

2017

Pain Relief - From Analgesics to Alternative Therapies

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“…In a low pH environment, acidic drugs with a low pK are more un-ionized and more able to cross lipid membranes. 1 This mechanism can explain the greater absorption of acid-labile drugs (eg, penicillin and ampicillin) compared to other drugs such as phenobarbital and phenytoin.…”

Section: Gastrointestinal Absorptionmentioning

confidence: 99%

“…In fact, unlike the absorption via the upper rectal veins, the absorption via the inferior and middle rectal veins bypasses the hepatic firstpass metabolism. 1 …”

Section: Intramuscular Dermal and Rectal Absorptionmentioning

confidence: 99%

“…On the contrary, water-soluble drugs such as atracurium need to be administered at a higher dose per kilogram in the newborn to achieve adequate plasma and tissue concentrations. 1 An increased membrane permeability allowing easier drug diffusion into compartments such as the central nervous system (CNS) is observed especially in preterm neonates but also in term neonates, particularly those with sepsis, hypoxia, and acidosis. This feature, combined with increased receptor sensitivity to many drugs, makes neonates more susceptible to the effects of centrally acting pharmacological agents.…”

Section: Distributionmentioning

confidence: 99%

“…The "off-label" medication use may expose infants to the risk of adverse effects due to under-or overdosing, or of other effects not predictable from experience in adults. 1 the newborn can be considered as an extremely dynamic organism in which the absorption, distribution, metabolism, and excretion systems are rapidly developing. 2 Consequently, the individual response to a drug in terms of efficacy and toxicity is highly variable in this group of patients, and predicting drug doses for them is complex.…”

Section: Introductionmentioning

confidence: 99%

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Current pharmacotherapy in the newborn

Antonucci¹,

Porcella²

2012

RRN

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Several drugs are used in newborns in spite of the lack of specific clinical research in this particularly vulnerable population with particular needs. In the newborn, the individual response to a drug in terms of efficacy and safety is highly variable, and predicting drug dosing is complex since rapid physiological changes occurring during the perinatal and early postnatal periods affect the pharmacokinetic profile of many drugs. Neonatal disorders such as renal and hepatic diseases may also have significant implications for drug pharmacokinetics. Therefore, pharmacotherapy in the newborn brings difficulties in accurate drug delivery and carries a high risk of adverse drug reactions. In addition, the neonatal population, especially that treated in neonatal intensive care units, is highly exposed to the risk of medication errors, with potentially serious adverse events. This paper reviews some current issues related to neonatal pharmacotherapy that are of paramount importance for the clinician. In particular, the peculiar pharmacokinetics of drugs during the neonatal period and its clinical implications are discussed. The use of therapeutic drug monitoring to individualize drug dosage and to optimize pharmacotherapy is also described. Finally, the relevant issue of medication errors in neonatology is examined in order to highlight their main causes and key strategies in preventing these type of errors. In the future, pharmacometabolomics and other "omic" sciences could play an important role in designing personalized neonatal health care.

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