Neonatal clinical pharmacology: recent observations of relevance for anaesthesiologists.

Abstract

Neonatal drug dosing needs to be based on the physiological characteristics of the newborn, the pharmacokinetic parameters of the drug and has to take maturational aspects of drug disposition into account. We would like to provide the reader with some recently published compound-specific observations (paracetamol, ibuprofen, tramadol, propofol) in neonates of relevance for anaesthesiologists. Age-specific dosing regimes of intravenous paracetamol have been evaluated and were well tolerated, independent of the postnatal age. Administration of ibuprofen or acetyl salicylic acid resulted in a transient reduction of 20% of the glomerular filtration rate and should be used cautiously in newborns. Both postmenstrual age and pharmacogenetics (CYP2D6) were covariates of tramadol metabolism in newborns. Tramadol seems to be a potential useful analgesic for term neonates and infants, but has limited indications in (extreme) preterm neonates. Finally, propofol clearance depends on post-menstrual and postnatal age. There is a risk for accumulation in preterms and in the first two weeks of postnatal life.