Abstract
This chapter discusses the effects various drugs have on the newborn. It discusses the difference between a preterm and a term infant, and their volume of distribution.
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Keywords
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1.
In general, newborns are more sensitive than adults to the depressant effects of drugs
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The seizure threshold is similar in newborns and adults
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Newborns have larger volumes of distribution, requiring a higher dose of local anesthetic for toxic effects compared to adults
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Changes in fetal heart rate after administration of local anesthetics are most often due to indirect effects (e.g. maternal hypotension and uterine hyperstimulation)
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Preterm infant is more vulnerable than term infant to effects of analgesic and anesthetic drugs due to:
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(a)
Less protein available for drug binding
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Higher levels of bilirubin present and competing with drugs for protein binding
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Greater access of drugs to the CNS due to poorly developed blood-brain barrier
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Preterm infant has greater total body water and less fat content
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Preterm infant has diminished ability to metabolize and excrete drugs
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(a)
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Neuraxial opioids have a favorable effect on neonatal outcome compared to systemic opioid
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Better Apgar scores, and umbilical cord blood gas and pH measurements at delivery with neuraxial opioids compared to systemic opioids
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Maternal epidural opioid administration by continuous infusion rarely results in drug accumulation and subsequent neonatal depression
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Possible direct effect on the neonate at delivery due to systemic absorption and indirect effects by opioid-related maternal side effects (i.e., respiratory depression and hypoxemia)
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(a)
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© 2019 Springer Nature Switzerland AG
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Wasson, C., Kelly, A., Ninan, D., Tran, Q. (2019). Drug Effects on Newborn. In: Absolute Obstetric Anesthesia Review. Springer, Cham. https://doi.org/10.1007/978-3-319-96980-0_17
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DOI: https://doi.org/10.1007/978-3-319-96980-0_17
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Publisher Name: Springer, Cham
Print ISBN: 978-3-319-96979-4
Online ISBN: 978-3-319-96980-0
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