Korean J Clin Pharm.  2017 Jun;27(2):63-68. 10.24304/kjcp.2017.27.2.63.

Contributing Factors on Pharmacokinetic Variability in Critically Ill Neonates

Affiliations
  • 1College of Pharmacy, Wonkwang University, Jeonbuk 54538, Republic of Korea. shan7@wku.ac.kr

Abstract

Neonates have large inter-individual variability in pharmacokinetic parameters of many drugs due to developmental differences. The aim of this study was to investigate the factors affecting the pharmacokinetic parameters of drugs, which are commonly used in critically ill neonates. Factors that reflect physiologic maturation such as gestational age, postnatal age, postconceptional age, birth weight, and current body weight were correlated with pharmacokinetic parameters in neonates, especially preterm infants. Comorbidity characteristics affecting pharmacokinetics in critically ill neonates were perinatal asphyxia, hypoxic ischemic encephalopathy, patent ductus arteriosus (PDA), and renal dysfunction. Administration of indomethacin or ibuprofen in neonates with PDA was associated with the reduced clearance of renally excreted drugs such as vancomycin and amikacin. Therapeutic hypothermia and extracoporeal membrane oxygenation were influencing factors on pharmacokinetic parameters in critically ill neonates. Dosing adjustment and careful monitoring according to the factors affecting pharmacokinetic variability is required for safe and effective pharmacotherapy in neonatal intensive care unit.

Keyword

Neonates; neonatal intensive care unit; pharmacokinetics; preterm infants

MeSH Terms

Amikacin
Asphyxia
Birth Weight
Body Weight
Comorbidity
Critical Illness*
Drug Therapy
Ductus Arteriosus, Patent
Gestational Age
Humans
Hypothermia, Induced
Hypoxia-Ischemia, Brain
Ibuprofen
Indomethacin
Infant, Newborn*
Infant, Premature
Intensive Care, Neonatal
Membranes
Oxygen
Pharmacokinetics
Vancomycin
Amikacin
Ibuprofen
Indomethacin
Oxygen
Vancomycin
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