Abstract
Drug dosing in neonates should be based on physiological characteristics of the neonate, pharmacokinetic/pharmacodynamic considerations, and the adverse effects profile. Disease processes and treatments in this group are distinct from adults. Age, size, comorbidities, coadministration of drugs, and genetic polymorphisms explain the extensive variabilities between individual pharmacokinetic (PK) and pharmacodynamic (PD) profiles in this population. Postmenstrual age (PMA) may range from extreme preterm birth at 22 weeks up to 50 weeks PMA, whereas weight may range from 0.5 to 5 kg. Characterization of maturation pharmacokinetics has improved our ability to predict appropriate doses, but the neonatal response to drugs remains, in many respects, poorly understood. Although neuromuscular monitoring is robust in neonates, there remains a need to develop other clinically applicable tools to assess anaesthesia depth, sedation, or analgesic response and to provide effect feedback. Physiological immaturities such as cardiac calcium disposition in the neonatal heart or plasma-binding proteins create unanticipated adverse effect profiles: for example, calcium channel blockers may cause bradycardia and unbound amide anaesthetic concentrations cause toxicity. The usability of many adult medications in neonates is limited without detailed investigations to identify unknown adverse effects.
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Anderson, B.J., Lerman, J. (2023). Anesthesia and Ancillary Drugs and the Neonate. In: Lerman, J. (eds) Neonatal Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-031-25358-4_3
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