In the infants to the adult age group, we have been given a concrete guideline for dose adjustment on the basis of CKD-Stages or creatinine clearance. this pathway is missing in neonates but still, we need renal adjustment of antibiotics and a few others. What is the rational and evidence-based approach to optimize therapy in neonates in order to avoid adverse rug events?
Thank You!
As of now, there are no separate guidelines for neonates. Even the dosage for most of the drugs used in neonates is derived from adults or children. So best is to use eGFR based guidelines used in children.
this is a great question, with only a 'poor' answer, as discrimination between normal physiology and pathophysiology in creatinine trends remains a major burden. suggest to read
Renal Precision Medicine in Neonates and Acute Kidney Injury: How to Convert a Cloud of Creatinine Observations to Support Clinical Decisions.
Allegaert K, Smits A, van Donge T, van den Anker J, Sarafidis K, Levtchenko E, Mekahli D.Front Pediatr. 2020 Jul 28;8:366. doi: 10.3389/fped.2020.00366
as it provides a recent overview on the topic and the research field, cfr references.
Studies are lacking when it comes to dose adjument in neonates as most studies focus on adult and a few on children, therefore I will suggest the best and practical thing to do is to estimated GFR guidelines used in children to determine how to adjust doses in neonate, it may has some draw back
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