Drug Toxicity in the Neonate

@article{McIntyre2004DrugTI,
  title={Drug Toxicity in the Neonate},
  author={John McIntyre and Imti Choonara},
  journal={Neonatology},
  year={2004},
  volume={86},
  pages={218 - 221}
}
The incidence of adverse drug reactions in neonates is thought to be at least 10%. The physiology of the newborn infant is different to that of both paediatric patients and adults. This therefore predisposes to certain types of drug toxicity, which are described below. Medication errors are also a significant problem in the neonatal period due to the lack of appropriate formulations designed for neonates. 
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TLDR
The complexity and the need for neonatal clinical pharmacology based on the gap between current and likely best clinical practice for two commonly administered compounds and one new compound is illustrated.
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Computerised physician order entry and interventions by clinical pharmacists were the most common interventions suggested to improve medication safety in the NICU, but only very limited data was available on evaluation of the effects of such interventions in NICUs.
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TLDR
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TLDR
Population PK models accurately described the PK profiles of piperacillin/tazobactam in infants less than 2 months of age and indicated that higher doses or more frequent dosing regimens may be required for controlling infection in this population in NICU.
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The pharmacokinetic changes throughout the neonatal period, childhood and into adolescence are described along with some practical advice on managing medications in these populations.
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TLDR
A systematic review of paediatric drug randomised controlled trials (RCTs) published in 2007 found that children participating in drug RCTs experience a significant amount and a wide range of ADRs.
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References

SHOWING 1-10 OF 28 REFERENCES
Chloramphenicol in the newborn infant. A physiologic explanation of its toxicity when given in excessive doses.
TLDR
The use of antibiotics for prophylaxis as well as for treatment of nursery infections has increased with the increased incidence of nursery infection.
Epidemiology of adverse drug reactions in the newborn.
TLDR
Most commonly suspected drugs associated with the ADR were cardiovascular drugs (tolazoline, digoxin, methoxamine), antibiotics, diuretics and components of intravenous nutrition solutions.
A difference in mortality rate and incidence of kernicterus among premature infants allotted to two prophylactic antibacterial regimens.
TLDR
A controlled clinical trial was designed to test the relative effectiveness of two prophylactic antibacterial regimens administered to premature infants in the first 5 days of life, and the incidence of kernicterus was significantly higher among infants who received penicillin/sulfisoxazole (diethanolamine).
The teratogenicity of drugs for nausea and vomiting of pregnancy: perceived versus true risk.
TLDR
To facilitate rational use of medicinal and nonmedicinal therapy for nausea and vomiting of pregnancy, an algorithm is developed based on a recent systematic review of safety and efficacy in management of the problem.
Incidence of adverse drug reactions in paediatric in/out-patients: a systematic review and meta-analysis of prospective studies.
TLDR
The results show that ADRs in children are a significant public health issue and methodologically sound drug surveillance studies are necessary for an effective promotion of a safer use of drugs in children.
Surveillance for fatal suspected adverse drug reactions in the UK
TLDR
A wide range of suspected ADRs are associated with fatalities in children, and anticonvulsants were associated with the greatest number of reports of fatalities and hepatotoxicity in particular.
The use of opioids in neonates. A retrospective study of 933 cases
TLDR
The administration of opioids by nurses occurred most frequently in the late evening and early hours of the morning, when medical cover is at its lowest level.
THE POSSIBLE RELATIONSHIP BETWEEN THE MATERNAL ADMINISTRATION OF SULPHAMETHOXYPYRIDAZINE AND HYPERBILIRUBINAEMIA IN THE NEWBORN
  • P. Dunn
  • Medicine
    The Journal of obstetrics and gynaecology of the British Commonwealth
  • 1964
TLDR
The possible relationship of the antenatal maternal administration of one of the long-acting sulphonamides, sulphamethoxypyridazine (“Lederkyn”; “Midicel” ; “Kynex”) and severe jaundice in the newborn is the subject of this paper.
Morphine use and adverse effects in a neonatal intensive care unit.
TLDR
A DUE prompted policy changes that improved documentation of indications for and efficacy of morphine use and reduced adverse reactions to the drug in an NICU and nearly complete compliance with the new guidelines for morphine use was shown.
Goitre and hypothyroidism in the newborn after cutaneous absorption of iodine.
Iodine goitre and hypothyroidism in 5 newborn infants in an intensive care unit were induced by cutaneous absorption of iodine, after numerous skin applications of iodine alcohol. The infant's skin
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