Applied pharmacokinetics to improve pharmacotherapy in neonatal and paediatric intensive care units: focus on correct...

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Pediatrics

Background:

• Drug dosing in children is influenced by maturational changes (weight, age, body surface area).
• Neonatal and Paediatric Intensive Care Units (NICU/PICU) introduce non-maturational factors impacting drug exposure, such as sepsis, cardiac failure, acute kidney injury, extracorporeal circuits, and drug-drug interactions (DDIs).
• These factors can lead to significant intrapatient and interpatient drug exposure variability, necessitating individual dosage adjustments.

Purpose of the Study:

• To highlight the complexities of drug dosing in NICU/PICU settings.
• To emphasize the need for individualized dosage adjustments for both loading and maintenance doses.
• To provide recommendations for optimizing drug dose selection in critically ill pediatric populations.

Main Methods:

• Review of factors affecting drug pharmacokinetics in NICU/PICU patients.
• Illustration of dosing challenges using phenobarbital and vancomycin as examples.
• Discussion of strategies for optimizing dose selection.

Main Results:

• Maturational and non-maturational factors significantly alter drug pharmacokinetics in pediatric intensive care.
• Individual dosage adjustments are often required to manage drug exposure variability.
• Phenobarbital and vancomycin dosing serve as case studies for these complexities.

Conclusions:

• Optimizing drug dose selection in NICU/PICU settings requires a multifaceted approach.
• Integration of therapeutic drug monitoring with model-informed precision dosing is recommended.
• Utilizing paediatric drug formularies and DDI databases, with guidance from paediatric clinical pharmacologists and pharmacists, is crucial for safe and effective drug therapy.