Management of the surgical newborn: physiological foundations and practical considerations

Use of Antibiotics in Preterm Newborns

Due to complex maturational and physiological changes that characterize neonates and affect their response to pharmacological treatments, neonatal pharmacology is different from children and adults and deserves particular attention. Although preterms are usually considered part of the neonatal population, they have physiological and pharmacological hallmarks different from full-terms and, therefore, need specific considerations. Antibiotics are widely used among preterms. In fact, during their stay in neonatal intensive care units (NICUs), invasive procedures, including central catheters for parental nutrition and ventilators for respiratory support, are often sources of microbes and require antimicrobial treatments. Unfortunately, the majority of drugs administered to neonates are off-label due to the lack of clinical studies conducted on this special population. In fact, physiological and ethical concerns represent a huge limit in performing pharmacokinetic (PK) studies on these subjects, since they limit the number and volume of blood sampling. Therapeutic drug monitoring (TDM) is a useful tool that allows dose adjustments aiming to fit plasma concentrations within the therapeutic range and to reach specific drug target attainment. In this review of the last ten years’ literature, we performed Pubmed research aiming to summarize the PK aspects for the most used antibiotics in preterms.

Premature birth: topics in physiology and pharmacological characteristics

OBJECTIVE

To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice.

METHODS

This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020.

RESULTS

Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics.

CONCLUSIONS

Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.

Discerning Post Anesthesia Readiness for Transition (DPART): A Measurement Tool

PURPOSE

To develop a valid reliable measurement tool that accurately quantifies postanesthesia recuperation in adult and pediatric patients.

DESIGN

A descriptive factor-isolating design guided by measurement theory.

METHODS

Instrument development was based on collaborative discussions of professional evidence. A five-person expert panel was consulted for content and face validity. Reliability testing took place in the adult and pediatric postanesthesia care units.

FINDINGS

The expert panel's final review yielded a kappa statistic of 1 and scale content validity index based on universal agreement between raters of 1, suggesting high content validity. Reliability testing yielded a kappa statistic of 1, demonstrating complete agreement for all items.

CONCLUSIONS

The Discerning Post Anesthesia Readiness for Transition measurement tool is a valid and reliable instrument that can be used in practice or future research to assess postanesthesia recuperation in pediatric and adult patients.