Neonatal Pharmacology

The key feature of neonatal physiology is its fast maturation, resulting in extensive variability in pharmacokinetics and -dynamics, further aggravated by other covariates, including pharmacogenetics, but also disease characteristics. Consequently, between and intra-individual variability is the essence of both neonatal care and neonatal pharmacology.The principles of neonatal therapeutics are discussed, with emphasis on maturational pharmacokinetics (absorption, distribution, metabolism, excretion). Thorough understanding of these factors, especially developmental changes, that affect pharmacokinetics (absorption, distribution, metabolism, elimination) in neonates helps to provide accurate dose adjustments to prescribe effective drug therapy. The general aspects of pharmacokinetic principles are discussed, and subsequent applied to commonly administered drugs in neonates.Adverse drug events are frequent and important aspects of drug therapy in neonatal care. Pharmacovigilance is based on prevention, detection and assessment, but all these issues need to be adapted to the specific characteristics of this population. Minimization or prevention of these kinds of events can be achieved and are discussed. Finally, drug excretion in breast milk and guidance on how to retrieve relevant information is provided.