Newborn drug therapy

Effective and safe drug therapy for newborns, infants, and children depends on knowledge of pediatric pharmacokinetics and pharmacodynamics and knowledge of the drug formulation and delivery issues specific to this population. 

Furthermore, the ability of the neonate to eliminate drugs via the kidney, the major excretion pathway, is significantly limited by the state of development of these organs. Penicillin and tetracycline (two antibiotics) are excreted more slowly and hence are more toxic in the young. Consideration of these factors indicates that the susceptibility and responsiveness of newborns to drug therapy are different from those of adults. 

In the neonate with hemorrhagic disease of the newborn, the administration of vitamin K raises the concentration of these clotting factors to the level normal for the newborn infant and controls the bleeding tendency within -6 hours. The routine administration of 1 mg phylloquinone intramuscularly at birth is required by law in the U.S.. This dose may have to be increased or repeated if the mother has received anticoagulant or anticonvulsant drug therapy or if the infant develops bleeding tendencies. Alternatively, some clinicians treat mothers who are receiving anticonvulsants with oral vitamin K prior to delivery (10-20 mg/day for 2 weeks). 

Parenteral Anticoagulant-induced prothrombin deficiency hypoprothrombinemia secondary to conditions limiting absorption or synthesis of vitamin K (eg, obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, regional enteritis) drug-induced hypoprothrombinemias due to interference with vitamin K metabolism (eg, antibiotics, salicylates) prophylaxis and therapy of hemorrhagic disease of the newborn. 

Initiation of therapy - App y one system to the postauricular skin (ie, behind the ear) at least 4 hours before the antiemetic effect is required. To prevent postoperative nausea and vomiting, apply the patch the evening before scheduled surgery. To minimize exposure of the newborn baby to the drug, apply the patch 1 hour prior to cesarean section. Scopolamine approximately 1 mg will be delivered over 3 days. Wear only one disc at a time. Do not cut the patch. 

Children Use with caution and in reduced dosages in premature and full-term infants to avoid gray syndrome toxicity. Monitor drug serum levels carefully during therapy of the newborn. 

A. OTC is a metabolic enzyme required to break down ammonia. Total lack of this enzyme leads to death shortly after birth owing to a buildup of ammonia. The partial presence of OTC also leads to accumulation of ammonia, which can be controlled by drugs and dietary intake. The genetic cause of this disease, its morbidity, and the need for rapid production of OTC by adenoviral vectors may extend the life span of OTC-deficient newborns to allow for drug treatment and dietary manipulation. Jesse Gelsinger, the 18-year-old patient who was the first patient to die on a phase I gene therapy trial, had OTC deficiency. 

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