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0:00
Welcome to this lecture on
the Principles of
Clinical Pharmacology
applied to analgesics' use in
neonates and infants.
I'm Karel Allegaert.
I'm a Consultant
Neonatologist and
Clinical Pharmacologist
working at both
Erasmus University, Rotterdam,
as well as KU Leuven, Belgium.
0:20
As we likely all know,
there are some specific aspects,
if you try to use drugs
in the appropriate way,
in newborns or infants.
This has to do
with the fact that
pediatrics does not
simply deal with
miniature men and women.
The children are not
just small adults.
Likewise, a newborn is
not just a small child,
and a micro-preemie is
not just a small preterm.
0:48
If you look at the
general concept of
clinical pharmacology,
as you can see on this slide,
you can actually appreciate that
this will start anyhow
with giving a compound,
it will go through a
biological system on
a system pharmacological
approach and
will result in a given
exposure and response.
From DNA, mRNA, protein,
function, to outcome.
Obviously, if you apply
this general concept
as commonly used for adults.
You have to realize that if
you assess this in children,
especially if you do it
in newborns or preterms,
that growth,
maturation as well as
disease-related, environmental,
or polymorphisms
(genetic-related issues)
can further modulate
the pattern of developmental
pharmacokinetics
and pharmacodynamics.
1:39
As you can also see over here,
assuming that, let's say,
the most commonly used
aspect of clinical pharmacology
when based on a receptor.
This will have an impact on
receptor binding
characteristics,
have an impact on
synaptic signaling
and subsequently also
have an impact on
the exposure-response
relationship.
It should be obvious that
developmental pharmacodynamics
further add to
the variability
that's already there,
based on developmental
pharmacokinetics.
Besides differences in
dosing and exposure, also,
the same concentration
may result in
another effect because of
receptor-mediated
pharmacodynamics.
However, it should
be clear that,
