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Pediatric Clinical Pharmacology pp 3–49Cite as

Basics and Dynamics of Neonatal and Pediatric Pharmacology

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Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 205))

Abstract

Understanding the role of ontogeny in the disposition and actions of medicines is the most fundamental prerequisite for safe and effective pharmacotherapeutics in the pediatric population. The maturational process represents a continuum of growth, differentiation, and development, which extends from the very small preterm newborn infant through childhood, adolescence, and to young adulthood. Developmental changes in physiology and, consequently, in pharmacology influence the efficacy, toxicity, and dosing regimen of medicines. Relevant periods of development are characterized by changes in body composition and proportion, developmental changes of physiology with pathophysiology, exposure to unique safety hazards, changes in drug disposition by major organs of metabolism and elimination, ontogeny of drug targets (e.g., enzymes, transporters, receptors, and channels), and environmental influences. These developmental components that result in critical windows of development of immature organ systems that may lead to permanent effects later in life interact in a complex, nonlinear fashion. The ontogeny of these physiologic processes provides the key to understanding the added dimension of development that defines the essential differences between children and adults. A basic understanding of the developmental dynamics in pediatric pharmacology is also essential to delineating the future directions and priority areas of pediatric drug research and development.

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Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

ACE:

Angiotensin-converting enzyme

ACh:

Acetylcholine

AN:

Anorexia nervosa

ATR:

Angiotensin receptor

BN:

Bulimia nervosa

CDL:

Chronic lung disease

Clsys:

Systemic clearance

CYP:

CytochromeP450

DCT:

Distal convoluted tubule

GABA:

Gamma-aminobutyric acid

GnRH:

Gonadotropin-releasing hormone

HPG:

Hypothalamic–pituitary–gonadal

KCC2:

Potassium-chloride cotransporter type 2

nAChRs:

Nicotine acetylcholine receptors

NAT:

N-Acetyltransferase

NEC:

Necrotizing enterocolitis

NCCT:

Sodium-chloride cotransporter

NKCC1:

Sodium-potassium-2-chloride cotransporter type 1

PDA:

Patent ductus arteriosus

PDE:

Phosphodiesterase

P-gp:

P-glycoprotein

RDS:

Respiratory distress syndrome

ROP:

Retinopathy of prematurity

SIDS:

Sudden infant death syndrome

SLT:

Salt-losing tubular disorder

SSRI’s:

Selective serotonin reuptake inhibitors

TDM:

Therapeutic drug level monitoring

UGT:

Uridine diphosphate glucuronosyltransferase

V(d):

Volume of distribution

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  1. Hannsjörg W. Seyberth

    Present address: , Lazarettgarten 23, 76829, Landau, Germany

Authors and Affiliations

  1. Klinik fur Kinder- und Jugendmedizin, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany

    Hannsjörg W. Seyberth

  2. Division of Clinical Pharmacology and Medical Toxicology, The Children’s Mercy Hospitals and Clinics, University of Missouri at Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Ralph E. Kauffman

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  1. Klinik für Kinder- und Jugendmedizin, Univ.Klinikum Marburg, Baldingerstr. 12, Marburg, 35043, Germany

    Hannsjörg W. Seyberth

  2. Karolinska Institutet, Dept. Laboratory Medicine, Karolinska University Hostpital, Stockholm, 141 86, Sweden

    Anders Rane

  3. für Klinische Pharmakologie (IKP), Dr. Margarete Fischer-Bosch Institut, Auerbachstr. 112, Stuttgart, 70376, Germany

    Matthias Schwab

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Seyberth, H.W., Kauffman, R.E. (2011). Basics and Dynamics of Neonatal and Pediatric Pharmacology. In: Seyberth, H., Rane, A., Schwab, M. (eds) Pediatric Clinical Pharmacology. Handbook of Experimental Pharmacology, vol 205. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20195-0_1

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