Newborn drugs

Other Factors Affecting Newborn Drug Disposition... 

Kwong TC, Ryan RM. Detection of intrauterine illicit drug exposure by newborn drug testing. Clin Chem 1997 43 235-42. 

Fanos V, Cataldi L. Antibacterial-induced nephrotoxicity in the newborn. Drug Safety 1999 20(3) 245-267. 

More complex detective work is required to analyze large biomolecules and drugs. However, fragmentation generally follows predictable patterns, and one compound can be identified by comparing its mass spectrum with those of other known compounds with similar structures. In Fig. 2, we see the spectrum of a sample of blood from a newborn infant. The blood is being analyzed to determine whether the child has phenylketonuria. The presence of the compound phenylalanine is a positive indication of the condition. Some... 

Toxicological problems among infants are relatively common. For example, it is now routine to follow the course of changes in Dilantin levels of patients who are being treated for various convulsive disorders (12). It is also important to be able to detect and assay for other drugs that are used in the newborn, such as various other anticonvulsants, salicylates, and a host of others. 

As with urine, saliva (spumm) is easy to collect. The levels of protein and lipids in saliva or spumm are low (compared to blood samples). These matrices are viscous, which is why extraction efficiency of xenobioties amoimts to only 5 to 9%. By acidifying the samples, extraction efficiencies are improved as the samples are clarified, and proteinaceous material and cellular debris are precipitated and removed. Some xenobioties and their metabohtes are expressed in hair. Hair is an ideal matrix for extraction of analytes to nonpolar phases, especially when the parent xenobioties are extensively metabolized and often nondetectable in other tissues (parent molecules of xenobioties are usually less polar than metabolites). Hair is a popular target for forensic purposes and to monitor drug compliance and abuse. Human milk may be an indicator of exposure of a newborn to compounds to which the mother has been previously exposed. The main components of human milk are water (88%), proteins (3%), lipids (3%), and carbohydrates in the form of lactose (6%). At present, increasing attention is devoted to the determination of xenobioties in breath. This matrix, however, contains only volatile substances, whose analysis is not related to PLC applications. 

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. 

J. Aranda, S. MacLeod, K. Renton, and N. Eade, Hepatic microsomal drug oxidation and electron transport in newborn infants, J. Pediatr, 85, 534 (1974). 

Cephalexin is considered safe and effective. Nitrofurantoin should not be used after week 37 due to concern for hemolytic anemia in the newborn. Sulfa-containing drugs may increase risk for kernicterus in the newborn and should be avoided during the last weeks of gestation. Folate antagonists, such as trimethoprim, are relatively contraindicated during the first trimester because of their association with cardiovascular malformations. Fluoroquinolones and tetracyclines are contraindicated. 

Newborn jaundice, photochemical treatment of, 79 120 New chemicals, pricing of, 75 641-642 New Chemicals Program (EPA), 9 456 New Drug Application (NDA), 27 574 New drug approval (NDA) process, 78 698-701... 

The activity of glucuronidation is low in the newborn, especially in premature babies (6). This is evident in the jaundice observed in many newborns because the major clearance pathway for bilirubin is glucuronidation. This can also lead to increased toxicity of some drugs in the newborn such as the grey baby syndrome seen in newborns treated with chloramphenicol. 

The standard urine immunoassay for detection of cocaine (23a) abuse during the gestation period of newborn babies was frequently found to yield negative results in cases where positive results were shown by extraction of meconium with a solvent, followed by HPLC. The drug and metabolites such as norcocaine (23b) and cocaethyline (23c) were detected140. See Section IV.C for an alternative analysis of cocaine. 

There are many examples of systems for which one or more important responses were unknown. One of the most tragic involved the drug thalidomide. It was known that one of the responses thalidomide produced when administered to humans was that of a tranquilizer it was not known that when taken during pregnancy it would also affect normal growth of the fetus and result in abnormally shortened limbs of the newborn. 

The age of a patient can be important with regard to drug-metabolizing capacity. The newborn baby often has deficient drug-metabolizing capacity (Gll). In the elderly, drug metabolism has not been carefully studied, but it is probably reduced (Gll). 

It is nsed for treating stable forms of pulmonary hypertension in newborns, and in cases where systemic arterial oxygenation cannot be achieved in the usual manner under careful observation of professionals. Synonyms of this drug are prixol, prixofen, imadalin, and others. 

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. 

Drug dependence Administer cautiously to people who are known or suspected to be physically dependent on opioids, including newborns of mothers with narcotic dependence. Reversal of narcotic effect will precipitate acute abstinence syndrome. Repeat administration The patient who has satisfactorily responded should be kept under continued surveillance. Administer repeated doses as necessary, because the duration of action of some narcotics may exceed that of the narcotic antagonist. Respiratory depression Not effective against respiratory depression due to nonopioid drugs. 

Labor and delivery - The use of flumazenil to reverse the effects of benzodiazepines used during labor and delivery is not recommended because the effects of the drug in the newborn are unknown. 

Hypersensitivity to the drug conditions that might predispose patients to priapism (eg, sickle cell anemia or trait, multiple myeloma, leukemia) patients with anatomical deformation of the penis patients with penile implants (intracavernosal) use in women, children, or newborns use in men for whom sexual activity is inadvisable or contraindicated for sexual intercourse with a pregnant woman unless the couple uses a condom barrier. 

Lactation Trospium (2 mg/kg orally and 50 mcg/kg IV) was excreted, to a limited extent (less than 1%), into the milk of lactating rats. It is not known whether this drug is excreted in human milk. Exercise caution when administering trospium to a nursing mother. Use during lactation only if the potential benefit justifies the potential risk to 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. 

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