TY - CHAP M1 - Book, Section TI - Pediatrics: Neonatal Critical Care A1 - Ohler, Kirsten H. A1 - Pham, Jennifer T. A2 - DiPiro, Joseph T. A2 - Yee, Gary C. A2 - Posey, L. Michael A2 - Haines, Stuart T. A2 - Nolin, Thomas D. A2 - Ellingrod, Vicki Y1 - 2020 N1 - T2 - Pharmacotherapy: A Pathophysiologic Approach, 11e AB - KEY CONCEPTS Pharmacokinetic parameters are altered across the age spectrum of the neonatal population (ie, preterm to term) because of developmental maturation and the effect of various disease states on these processes. Therefore, medication selection and monitoring is of utmost importance in this population. Treatment guidelines for neonatal resuscitation have been extrapolated from studies in older children and adults which may not be optimal because of differences in the pathophysiology of cardiopulmonary arrest among these populations. Neonatal sepsis can be categorized as either early-onset sepsis (EOS) or late-onset sepsis (LOS). Pathogens associated with neonatal sepsis vary depending on the onset of sepsis (EOS vs LOS). Empiric antibiotic therapy should be initiated in infants with suspected sepsis and should target the most common pathogens. Patent ductus arteriosus occurs commonly in preterm neonates and, if hemodynamically significant, requires pharmacologic (with a cyclooxygenase inhibitor) or surgical closure. In certain congenital heart defects (eg, tetralogy of Fallot, hypoplastic left heart syndrome, transposition of the great arteries), it is imperative that the ductus arteriosus remains patent. Prostaglandin E1 (alprostadil) is the drug of choice in these cases. Neonatal hypotension can result in impaired cerebral perfusion and ischemic damage if left untreated. Because there is no clear consensus on the definition of neonatal hypotension, clinical judgment and review of the physiological parameters of the infant are important when making diagnosis and treatment. Pharmacologic therapy should be selected based on the etiology of hemodynamic instability and may include fluid bolus, vasopressors (such as dopamine, dobutamine, epinephrine, and norepinephrine), hydrocortisone, and vasopressin. Dopamine is the preferred initial vasopressor agent for hemodynamic support in neonates with hypotension. Assessment of the degree of pain and sedation in the preverbal neonatal population is difficult. Assessment tools should be used, but it is important to recognize the population and pain type for which each tool has been validated. Opioids and benzodiazepines are commonly used to provide analgesia and sedation for critically ill neonates; however, there are concerns about their effects on long-term neurodevelopment. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1182427619 ER -