Clinics in perinatology
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Clinics in perinatology · Mar 2012
ReviewTherapeutic drug monitoring--the appropriate use of drug level measurement in the care of the neonate.
Neonates and young infants are in a unique and dynamic pharmacokinetic state, in which they undergo relatively rapid maturational changes in drug absorption, distribution, metabolism, and excretion. In addition to these maturational changes, most drug pharmacokinetic studies in neonates show wide interindividual variability despite similar gestational and postnatal ages. Therapeutic drug monitoring is a necessary tool in the neonatal intensive care unit, despite the relative lack of outcome data. This article discusses therapeutic drug monitoring for several frequently used drugs in neonates.
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Painful procedures in the neonatal intensive care unit are common, undertreated, and lead to adverse consequences. A stepwise approach to treatment should include pain recognition, assessment, and treatment, starting with nonpharmacologic and progressing to pharmacologic methods for increasing pain. ⋯ The indications, advantages, and disadvantages of the commonly used analgesic drugs are discussed. Guidance and references for drugs and dosing for specific neonatal procedures are provided.
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Clinics in perinatology · Mar 2012
ReviewA quality improvement approach to optimizing medication use in the neonatal intensive care unit.
Despite many years of heavy use in premature and critically ill newborns, surprisingly few medications have been rigorously tested in neonatal multicenter randomized clinical trials. Little is known about the pharmacology of these drugs at various birth weights, gestational ages, and chronologic ages. This article describes a quality improvement approach to evaluating and improving neonatal intensive care unit (NICU) medication use, with an emphasis on adaptation of drug use to the specific clinical NICU context and use of system-based changes to minimize harm and maximize clinical benefit.
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Clinics in perinatology · Mar 2012
ReviewNeonatal blood pressure support: the use of inotropes, lusitropes, and other vasopressor agents.
A solid understanding of the mechanisms of action of cardiovascular medications used in clinical practice along with efforts to develop comprehensive hemodynamic monitoring systems to improve the ability to accurately identify the underlying pathophysiology of cardiovascular compromise are essential in the management of neonates with shock. This article reviews the mechanisms of action of the most frequently used cardiovascular medications in neonates. Because of paucity of data from controlled clinical trials, evidence-based recommendations for the clinical use of these medications could not be made. Careful titration of the given medication with close monitoring of the cardiovascular response might improve the effectiveness and decrease the risks associated with administration of these medications.
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Clinics in perinatology · Mar 2012
Obstetric interventions beneficial to prematurely delivering newborn babies: antenatal corticostetroids, progesterone, magnesium sulfate.
Although improvements in neonatal care have continued to result in reduced mortality and morbidity of prematurely delivering newborns for decades, the results of a myriad of obstetric efforts and interventions have failed to reduce the overall rate of prematurity or prolong pregnancy at any gestational age. A few new developments or refinements of established interventions give increased hope for an improved obstetric contribution to the problem of prematurity. These include a better understanding of how best to use antenatal corticosteroids, and the newer options of magnesium sulfate to ameliorate or avoid cerebral palsy associated with prematurity and maternal progesterone administration to selected at-risk populations to decrease the likelihood of premature delivery.