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Therapeutic drug monitoring in neonates
  1. Steven Pauwels1,2,
  2. Karel Allegaert3,4
  1. 1Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
  2. 2Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
  3. 3Department of Development and Regeneration, KU Leuven, Leuven, Belgium
  4. 4Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Dr Karel Allegaert, Neonatal Intensive Care Unit, University Hospital, Herestraat 49, Leuven 3000, Belgium; karel.allegaert{at}uzleuven.be

Abstract

Therapeutic drug monitoring (TDM) aims to integrate drug measurement results into clinical decision making. The basic rules apply when using TDM in neonates (aminoglycosides, vancomycin, phenobarbital, digoxin), but additional factors should also be taken into account. First, due to both pharmacokinetic variability and non-pharmacokinetic factors, the correlation between dosage and concentration is poor in neonates, but can be overcome with the use of more complex, validated dosing regimens. Second, the time to reach steady state is prolonged, especially when no loading dose is used. Consequently, the timing of TDM sampling is important in this population. Third, the target concentration may be uncertain (vancomycin) or depend on specific factors (phenobarbital during whole body cooling). Finally, because of differences in matrix composition (eg, protein, bilirubin), assay-related inaccuracies may be different in neonates. We anticipate that complex validated dosing regimens, with subsequent TDM sampling and Bayesian forecasting, are the next step in tailoring pharmacotherapy to individual neonates.

  • Neonatology
  • Pharmacology
  • Toxicology

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