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Pharmacokinetics and renal function in preterm infants.

Abstract

There is an increase in the survival rate of preterm infants due to rapid advances in medical knowledge and technology. However, the research and attention paid to the proper use of pharmacotherapy in these infants is still a relatively underdeveloped field. Effective and safe drug therapy requires a thorough understanding of human developmental biology and of the dynamic ontogeny of drug absorption, drug disposition, drug metabolism, and drug excretion. It is apparent that maturation of organ system function and changes in body composition during gestation and during the neonatal period exert a significant effect on the disposition of drugs. This review focuses on the effects of maturational and drug-induced changes in renal function on clinical pharmacokinetics in the preterm infant.

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BibTeXRIS

J N van den Anker. 1996. Pharmacokinetics and renal function in preterm infants.. https://doi.org/10.1111/j.1651-2227.1996.tb13942.x

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Influence of a single course of antenatal betamethasone on the maternal-fetal insulin-IGF-GH axis in singleton pregnancies.

OBJECTIVE: We examined the hypothesis that a single course of antenatal betamethasone influences the maternal-fetal insulin-IGF-GH axis. DESIGN: A prospective, observational, pilot study consisting of four groups of pregnant women: (I) received betamethasone and delivered <2 weeks post treatment; (II) received betamethasone and delivered >2 weeks post treatment; (III) untreated women who delivered <37 weeks (preterm controls); (IV) untreated women who delivered >37 weeks (term controls). Maternal and mixed umbilical cord blood was collected at delivery and analyzed for insulin, glucose, IGF-I, IGF-II, IGFBP-1, IGFBP-3, GH, and GHBP. RESULTS: Betamethasone increased maternal insulin, glucose and IGF-I levels without affecting IGFBPs. In the fetal compartment, betamethasone treatment was associated with a delayed suppressive effect on GH and a sustained suppressive effect on IGF-II levels. There were no differences in infant size or neonatal morbidities between patients who delivered <2 weeks or >2 weeks post betamethasone treatment. In Group IV, birth weight correlated positively with cord IGF-I levels (r2=0.41, p=0.0098) and negatively with cord IGFBP-1 levels (r2=0.51, p=0.0039), and ponderal index correlated negatively with cord IGFBP-1 levels (r2=0.27, p<0.05). CONCLUSIONS: A single course of antenatal betamethasone influences the maternal-fetal insulin-IGF-GH axis, particularly fetal IGF-II levels, without measurable anthropometric changes at birth. Whether these effects have implications beyond the neonatal period remains to be determined.

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