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Related Concept Videos

Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Factors Affecting Drug Response: Overview01:21

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When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
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High-flow nasal oxygen versus standard care during flexible bronchoscopy in children under general anaesthesia - the BUFFALO randomised controlled pilot trial.

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Antithrombin Dosing Guidelines in Children Underestimate Dose Needed for Plasma Level Increase.

Adrian C Mattke1,2,3,4,5,6, Kerry E Johnson1,2,3,4,5,6, Suzanne Parker5

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Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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Current antithrombin concentrate dosing guidelines overestimate effectiveness in critically ill children, leading to under-dosing. Adjustments for age, disease state, and extracorporeal life support are crucial for optimal antithrombin levels.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Hematology

Background:

  • Antithrombin concentrate is vital for coagulation and heparin potentiation.
  • Existing dosing guidelines for antithrombin concentrate lack precision, varying by manufacturer.
  • Optimal dosing strategies considering patient-specific factors are needed.

Purpose of the Study:

  • To establish evidence-based antithrombin concentrate dosing recommendations for pediatric intensive care unit (PICU) patients.
  • To identify factors influencing the effectiveness of antithrombin concentrate administration.
  • To refine dosing based on age, disease state, and extracorporeal circulatory support.

Main Methods:

  • Retrospective analysis of 562 antithrombin concentrate doses administered to 155 PICU patients over 5 years.
  • Multivariable analysis to determine factors affecting plasma antithrombin level increases.
  • Calculation of antithrombin level increase per unit/kg, indexed by body weight.

Main Results:

  • Each unit/kg of antithrombin concentrate increased plasma antithrombin levels by 0.86% (SD 0.47%) overall.
  • Dosing effectiveness varied significantly by patient weight (0.76% increase for <5kg vs. 1.38% for >20kg).
  • Liver failure and extracorporeal life support were associated with reduced antithrombin level increases; heparin dose did not influence outcomes.

Conclusions:

  • Current antithrombin concentrate dosing guidelines overestimate plasma antithrombin level increases in critically ill children.
  • Existing recommendations may lead to under-dosing, necessitating revised protocols.
  • Dosing should be individualized considering patient age, specific disease states (e.g., liver failure), and extracorporeal circulatory support status.