Neonatal pharmacology

Abstract

Neonatal anaesthesia dosing needs to be based on physiological characteristics of the newborn, pharmacokinetic knowledge, pharmacodynamic considerations and the adverse effects profile. Disease processes and treatments in this group are distinct from adults. Immaturity of enzyme, anatomical and physiological systems cause extensive variability of drug disposition and drug response in neonates. This is further compounded by pharmacogenomic influences. Postmenstrual age is a reasonable measure for maturation of clearance pathways. The neonatal response to drugs is altered and monitoring of effect that guides adult drug use is limited. While neuromuscular monitoring is robust, few other clinically applicable tools are available to provide pharmacodynamic effect feedback. Tools that assess depth of anaesthesia, sedation and pain in neonates have potential to improve effectiveness and safety.