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Neonatal/Pediatric Pharmacology

Neonatal/Pediatric Pharmacology. Fred Hill, MA, RRT. Special Considerations. Effects on developing fetus Special susceptibilities in neonates and children for certain drugs ~25% of drugs are labeled as safe and effective for children. Placental Drug Transfer.

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Neonatal/Pediatric Pharmacology

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  1. Neonatal/Pediatric Pharmacology Fred Hill, MA, RRT

  2. Special Considerations • Effects on developing fetus • Special susceptibilities in neonates and children for certain drugs • ~25% of drugs are labeled as safe and effective for children

  3. Placental Drug Transfer • How easily does a drug pass through the placental barrier? • What are known effects of drugs on fetus? • Teratogens: drugs which are likely to cause physical/mental developmental abnormalities: spontaneous abortion, congenital malformations, intauterine growth retardation, mental retardation, carinogenesis. • First trimester most critical time of avoidance.

  4. Thalidamide & Teratogenesis • Had been considered drug of choice for morning sickness in pregnant women • Thalidamide: 1956-1960s, >40,000 birth defects, 17 in U.S.

  5. FDA Hero Chemie GrÜenthal attempted introduction of thalidomide into U. S. in 1961 Frances Kelsey repeatedly denied application.

  6. Some Other Teratogens • Alcohol: IUGR, microcephaly, dysmorphic facies, cleft palate, cardiac anomalies • ACE inhibitors (captopril, enalapril, Lisinopril): hypotension, oliguria with renal failure, hyperkalemia, complications of oligohydramnios • Carbamazepine: neural tube defects • Cocaine: abruptio placentae, prematurity, microcephaly, limb defects, etc. • Coumarin anticoagulents • Diethylstilbestrol • Lithium • Misoprostol • Tetracyclines: yellow-brown discoloration of teeth during calcification of teeth after 17th week

  7. Special Neonatal/Pediatric Applications • Ribavirin: Anti-viral given by aerosolization for RSV. Potential for teratogenicity • Indomethacin: close patent ductusarteriosis (PDA), may help prevent IVH • Ibuprofen lysine (Neo Profen): close patent ductusarteriosis (PDA) • Alprostadil-Prostaglandin E1 (PGE1): maintain PDA in certain heart defects • Tolazoline: persistent pulmonary hypertension of the newborn • Methylxanthines (theophylline & caffeine): neonatal apnea

  8. Assessment of Oxygenation/Ventilation Fred Hill, MA, RRT

  9. Sites of ABG Samples • Umbilical artery catheter (UAC): preferred source • Radial artery • Brachial artery • Simultaneous UAC and right radial sample when R → L shunting suspected • Capillary samples (CBG) in place of ABG: useful for pH and PCO2

  10. Umbilical Artery Catheter

  11. “Heel Stick”

  12. Transcutaneous Monitoring • Especially useful in neonates • May not correlate with ABG values • Useful for trending. • Many factors affect values • Thermal injury the major problem • Maximum temperature = 44o C • Change sites periodically • Greater problem with premature infants

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