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TThehe clinicalclinical pharmacology of pharmacology of neonatneonat

Zhou Yanqiong

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Characteristic of medicine reaction Characteristic of pharmacokinetics Significance of drug monitoring Medication of breast milk feeding ne

onat Special reaction of neonatal medicine Rational administration of neonatal c

ommon disease

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DefinitionDefinition of neonatal of neonatal

born

postnatal 28ds

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Characteristic of neonat 1. functional underdevelopment of organ, und

erdevelopment 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 rout

e will be different

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Drug absorption and route of administration Administration by gastrointestinal tract (G

I/GIT): gastric acidity, gastric emptying time, pathologic status (PS)

Administration by nongastrointestinal tract 1. hypodermic injection ， intramuscular inj

ection: regional flow, characteristic of medicine

2. intravenous injection ： fast

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Pay attention to neonatal intravenous injection ①Administration according to specify velo

city ②To bring about constitution necrosis by d

rug effusion ③To cause thrombophlebitis by injecting t

he same blood vessel repeatedly→Injection site should be changed

④To 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 fl

uid 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 enzy

matic activity of glucuronyl transferase of neonat

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binding with glucuronate: indomethacin, salicylate, chloramphenicol

Chloramphenicol graybaby syndrome sulfoconjugation glucuronate

Drug metabolism

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Drug excretion Organ: kidney Underdevelopment of Nephridial tissue; Fe

wer glomcrulus glomerular filtration ＋ tubular secretion

acid-base balance ＋ water-electrolyte metabolism

prime type

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Significance of drug monitoring of neonat

Fetal age

postnatal days

pathologic condition individual difference Not according to therapeutic reaction Safety/toxis margin adverse reaction

drug metabolismdifference

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Drug monitoring

gentamicin 庆大霉素； cefotaxime sodium 头孢噻肟钠； digoxin 地高辛； Phenobarbital 苯巴比妥； Aminophylline 氨茶碱； chloramphenicol 氯霉素

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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 高铁血红蛋白症 hemorrhage 出血 NS toxic reaction 神经系统毒性反应 graybaby syndrome 灰婴综合征

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Haemolysis, jaundice, nuclear jaundice physiological jaundice Drugs to evoke haemolysis/jaundice Pathway of haemolysis/jaundice Nosogenesis of bilirubin encephalopa

thy drug treatment of neonatal jaundice

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Drug treatment of neonatal jaundice enzyme inducer: Phenobarbital, niket

hamide Inhibit haemolysis: prednisone , derm

acort Diminish bilirubin Infuse albumin

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Rational administration of neonatal common disease

neonatal asphyxia 新生儿窒息 neonatal convulsions 新生儿惊厥 neonatal septicemia 新生儿败血症 neonatal respiratory-distress syndrome

新生儿呼吸窘迫综合征

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Neonatal asphyxia Common reason ： fetal 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 convulsionsCommon 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 苯巴比妥 2 ． phenytoin sodium 苯妥英钠 3 ． Diazepam 地西泮 4 ． chloral hydrate 水合氯醛

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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 meningitis;suppurative meningitis Supportive treatment

amikacin

Third generation cephalosporin7ds ﹢ bacillus

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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 disease;membrane syndrome

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Respiratory distress syndrome of newborn

Treatment ： keep warm; oxygen; retrieve electrolyte disturbances and acidosis; infection prevention; depressurization

Oxygen therapy: atomization;mask oxygen inhalation; 40 ％ concentration;interruption

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