While the limit for possible survival for premature neonates has improved over the past few decades, the knowledge of how these special patients handle medications has not kept up. This can lead to possible sub-optimal as well as toxic drug concentrations and subsequent adverse drug effects. Most of the literature does not venture into the premature ( 40 weeks gestation), let alone those that are extremely ( 28 weeks) premature neonates and clinicians are faced wih decisions based on limited information.
Drugs that are affected by the major CYP enzyme systems are poorly studied and mature at different rates, making assumptions on drug therapy common. As only 40% of the most commonly used medicaions have FDA labeling in infants, information on the premature is even less so. The challenges of performing pharmacokinetic studies in this population does not make this a simple solution. We will discuss what is known and what challenges lie ahead.
Learning Objectives:
1. Describe the general methods of drug metabolism and what anatomical and physiological conditions in preterm neonates lead to alterations
2. List which drugs common in neonatology are influenced by pathophysiological conditions of the neonate, leading to potential adverse outcomes
3. Describe areas where collaborative research efforts between centers can increase our knowledge of drug metabolism and refine the pharmacological treatments in this population
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