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Hepatic injury to the newborn liver due to drugs

Peter Van Eyken1, Sonia Nemolato, Gavino Faa

  • 1Department of Pathology, K.U. Leuven, Leuven, Belgium.

Current Pharmaceutical Design
|May 9, 2012
PubMed

Insights

Neonatal drug use is impacted by immature drug processing, affecting bioavailability and toxicity. Common neonatal drugs like ampicillin, gentamicin, and indomethacin can cause liver toxicity, requiring careful review.

Area of Science:

  • Pharmacology
  • Neonatal Medicine
  • Hepatology

Background:

  • Neonatal drug response is significantly altered by physiological immaturity affecting drug absorption, distribution, metabolism, and excretion.
  • Factors such as gestational age, birth weight, and liver function immaturity critically influence drug bioavailability and toxicity in newborns.
  • Neonates' susceptibility to infections leads to widespread antibiotic use, including ampicillin and gentamicin.

Purpose of the Study:

  • To review the acute and chronic liver toxicity associated with commonly used drugs in neonates.
  • To highlight the impact of neonatal physiological immaturity on drug pharmacokinetics and pharmacodynamics.
  • To discuss specific drugs like antibiotics (ampicillin, gentamicin), erythromycin, azithromycin, and indomethacin and their potential hepatotoxicity.

Main Methods:

  • Literature review of studies on drug use in neonates.
  • Analysis of factors influencing drug pharmacokinetics and toxicity in the neonatal population.
  • Examination of documented cases of drug-induced liver injury in newborns.

Main Results:

  • Commonly prescribed neonatal drugs, including ampicillin, gentamicin, erythromycin, azithromycin, and indomethacin, are associated with potential hepatotoxicity.
  • Neonatal liver function immaturity is a key determinant of drug metabolism and elimination, increasing susceptibility to toxicity.
  • Specific drug classes like antibiotics and prostaglandin synthesis inhibitors pose risks for both acute and chronic liver damage.

Conclusions:

  • The use of essential drugs in neonates carries a significant risk of liver toxicity due to immature physiological processes.
  • Careful consideration of drug choice, dosage, and monitoring is crucial to mitigate hepatotoxicity in this vulnerable population.
  • Further research is needed to optimize drug therapy and minimize liver injury in neonates.

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