The clinical pharmacology of neonat

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The clinical pharmacology of neonat

Zhou Yanqiong
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• Characteristic of medicine reaction
• Characteristic of pharmacokinetics
• Significance of drug monitoring
• Medication of breast milk feeding neonat
• Special reaction of neonatal medicine
• Rational administration of neonatal common disease

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Definition of neonatal
born
postnatal 28ds
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Characteristic of neonat

• 1. functional underdevelopment of organ,
  underdevelopment of enzymatic system,
• slow drug metabolism and evacuation
• 2.Variation of drug metabolism and evacuation
  velocity according to the birth weight, fetal age
  and postnatal days
• 3.individual difference among the sick babies
• 4.Function weaken
• So, dosage, dosing interval and administration
  route will be different

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Drug absorption and route of administration

• Administration by gastrointestinal tract
  (GI/GIT) gastric acidity, gastric emptying time,
  pathologic status (PS)
• Administration by nongastrointestinal tract
• 1. hypodermic injection,intramuscular
  injection regional flow, characteristic of
  medicine
• 2. intravenous injectionfast

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Pay attention to neonatal intravenous injection

• ?Administration according to specify velocity
• ?To bring about constitution necrosis by drug
  effusion
• ?To cause thrombophlebitis by injecting the same
  blood vessel repeatedly?Injection site should be
  changed
• ?To avoid using hypso-concentration

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Drug disposition

• Drug distribute to sys by blood circulation
• organization, fat, pH
• Liposolubility, molecular wieght,
• protein binding rate, barrier

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Characteristic of drug disposition of neonat

• More total body water and extracellular fluid
  volume
• Less fat mass
• Low degree of plasma protein binding
• Underdevelopment of blood-brain barrier

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Drug metabolism

• Organ liver
• Accretion rate size of hepar, metabolic
  capability of enzymatic system
• Liposoluble substances excreted by binding with
  glucuronate or sulfate
• A decline of the accretion rate low enzymatic
  activity of glucuronyl transferase of neonat

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Drug metabolism

• binding with glucuronate indomethacin,
  salicylate, chloramphenicol
• Chloramphenicol graybaby syndrome
• sulfoconjugation glucuronate

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Drug excretion

• Organ kidney
• Underdevelopment of Nephridial tissue Fewer
  glomcrulus
• glomerular filtration tubular secretion
• acid-base balance water-electrolyte metabolism

prime type
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Significance of drug monitoring of neonat
drug metabolism

• Fetal age
• postnatal days
• pathologic condition
• individual difference
• Not according to therapeutic reaction
• Safety/toxis margin
• adverse reaction

difference
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Drug monitoring

• gentamicin????
• cefotaxime sodium?????
• digoxin???
• Phenobarbital????
• Aminophylline???
• chloramphenicol???

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Administration of breast milk feeding neonat

• Banned in lactation
• Prudent in lactation
• suspend lactation

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Unusual reaction

• hypersensitivity
• Haemolysis, jaundice, nuclear jaundice
• methemoglobinemia???????
• hemorrhage??
• NS toxic reaction????????
• graybaby syndrome?????

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Haemolysis, jaundice, nuclear jaundice

• physiological jaundice
• Drugs to evoke haemolysis/jaundice
• Pathway of haemolysis/jaundice
• Nosogenesis of bilirubin encephalopathy
• drug treatment of neonatal jaundice

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Drug treatment of neonatal jaundice

• enzyme inducer Phenobarbital, nikethamide
• Inhibit haemolysis prednisone , dermacort
• Diminish bilirubin
• Infuse albumin

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Rational administration of neonatal common disease

• neonatal asphyxia?????
• neonatal convulsions?????
• neonatal septicemia??????
• neonatal respiratory-distress syndrome??????????

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Neonatal asphyxia

• Common reasonfetal distress respiratory center
  inhibited/damaged
• Drug treatment
• 1. Retrieve acidosis
• 2. Intracardiac injection of cardiac
• 3. Supply of oxygen
• 4. Infection prevention

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Neonatal convulsions

• Common reason
• hypoxic-ischemic encephalopathy,
• intracranial hemorrhage,
• hypocalcemia
• Drug treatment
• treat primary disease,
• retrieve metabolic disorder,
• anticonvulsant

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Treatment of neonatal convulsions

• To retrieve metabolic disorder
• 1.Retrieve hypoglycaemia
• 2.Retrieve hypocalcemia
• 3.Retrieve hypomagnesemia
• 4 . Retrieve VitB6 defect
• Anticonvulsant application
• 1.Phenobarbital????
• 2.phenytoin sodium????
• 3.Diazepam???
• 4.chloral hydrate????

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Neonatal septicemia

• High case-fatality rate
• Fast pathogenetic condition
• Intravenous injection

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Neonatal septicemia

• Coccobacteria
• blood-brain barrier
• purulent meningitissuppurative meningitis
• Supportive treatment

amikacin
7ds
? bacillus
Third generation cephalosporin
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Respiratory distress syndrome of newborn

• dyspneic respiration respiratory
  failure
• alveolar surfactant insufficient
• Characteristic of pathobiology
• asphyxial membrane --- pulmonary closure

hyaline membrane diseasemembrane syndrome
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Respiratory distress syndrome of newborn

• Treatmentkeep warm oxygen retrieve electrolyte
  disturbances and acidosis infection prevention
  depressurization
• Oxygen therapy atomizationmask oxygen
  inhalation 40concentrationinterruption

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