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Neonatology pp 693–707Cite as

Developmental Pharmacology and Therapeutics in Neonatal Medicine

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Abstract

Knowledge about the safe and effective use of medicines in neonates has increased substantially but resulted in few label changes. Despite the extent of these drug exposures, newborns remain the last therapeutic orphans. Drugs, initially developed for use in adults, are reshaped and tailored to specific neonatal indications. However, neonatal pharmacotherapy not only mirrors adult pharmacotherapy but should be driven by their own specific needs. This is because both pharmacokinetics (absorption, distribution, metabolism, elimination, concentration-time) and pharmacodynamics (concentration-effect) display extensive maturation in early infancy, reflecting maturational physiology. We describe and illustrate the relevance of these maturational changes. We subsequently focus on specific aspects related to therapeutic drug monitoring, the need for population tailored neonatal formulations (including dose flexibility and excipients), and the difficulties related to the recognition of adverse drug reactions in neonates (how to recognize a signal in the noise).

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Acknowledgments

Karel Allegaert is supported by the Fund for Scientific Research, Flanders (fundamental clinical investigatorship 1800214 N), and the research activities are further facilitated by the agency for innovation by Science and Technology in Flanders (IWT) through the SAFEPEDRUG project (IWT/SBO 130033). Janko Samardzic is supported by ERAWEB II scholarship for postdoctoral program at the KU Leuven, Belgium (2014–2015). Milica Bajcetic is supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (project No 173014) and the European Commission (LENA, 602295). John van den Anker is supported by NIH (K24DA027992, R01HD048689, U54HD071601) and the European Commission (TINN [223614], TINN2 [260908], NEUROSIS [223060]).

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium

    Karel Allegaert

  2. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Karel Allegaert

  3. Intensive Care and Department of Pediatric Surgery, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands

    Karel Allegaert & John N. van den Anker

  4. Department of Paediatric Pharmacology, University Children’s Hospital Basel, Basel, Switzerland

    Janko Samardzic

  5. Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, University of Belgrade, Belgrade, Serbia

    Janko Samardzic & Milica Bajcetic

  6. Clinical Pharmacology Unit, University Children’s Hospital, Belgrade, Serbia

    Milica Bajcetic

  7. Division of Pediatric Clinical Pharmacology, Children’s National Health System, Washington, DC, USA

    John N. van den Anker

  8. Departments of Pediatrics, Integrative Systems Biology, Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

    John N. van den Anker

Authors
  1. Karel Allegaert
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  2. Janko Samardzic
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  3. Milica Bajcetic
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  4. John N. van den Anker
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Corresponding author

Correspondence to Karel Allegaert .

Editor information

Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Allegaert, K., Samardzic, J., Bajcetic, M., van den Anker, J.N. (2018). Developmental Pharmacology and Therapeutics in Neonatal Medicine. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_193

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_193

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29487-2

  • Online ISBN: 978-3-319-29489-6

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