Some Aspects of Perinatal Pharmacology

Abstract

The perinatal period extends from the completion of embryonic dif ferentiation into recognizable anatomic organ structures to the end of the first month of postnatal extrauterine existence. As such it encompasses the most rapid rate of growth and development with accompanying biochemical and physiological changes noted during the total lifespan of the mammalian organism (1).The effects of pharmacologically active agents when administered during this critical period have attracted considerable notoriety in scientific, governmental , industrial, and public circl es because of a number of recent therapeutic misadventures associated with their use. The vulnerability of the developing fetus and newborn infant to chemical agents prescribed on the basis of investigations conducted in adult subjects has been repeatedly demonstrated. The response elicited on the part of the perinatal subject has often been qualitatively and quantitatively dissimilar to that seen in the more mature subject. It is the purpose of this paper to discuss selected aspects of perinatal pharmacology which contribute to our understanding of drug action during this critical period of development. This represents but one aspect of the recently recognized discipline of developmental pharmacology which, in its broadest sense, includes the influence of aging (and the maturational status of the organism) on pharmacologic responses as well as the converse effects of drugs upon maturation and development. Done (2) has recently published a comprehensive review emphasizing these principles as they relate to the neonatal period. THE ROLE OF THE PLACENTAIt is logical to subdivide perinatal pharmacology into prenatal (fetal) and postnatal events. Apart from the recent experimental introduction of blood transfusions directly into the peritoneal cavity of the fetus (3a, 3b), all chemical agents which effect the fetus must traverse the placenta or fetal membranes after maternal administration.The fact that substances may reach the fetus by routes other than the placenta has been shown in many species. In the guinea pig and rabbit, Brambell (4) has demonstrated that antibodies may be transferred

Common Errors of Drug Administration in Infants

“…[96] Dead space within syringes delivering small volumes can result in the patient receiving more than the intended dose. [96,97] …”

“…Look-alike and sound-alike names must be avoided. [87,97] Administration of inappropriately large doses could be reduced if appropriate paediatric-sized packaging existed. For example, the label 'single-dose vial' has resulted in administration of the entire contents because it was incorrectly presumed to be the appropriate dose.…”

“…[2] The use of standardised dose tables, [97] limited floor stock medications, unit dose systems, bedside technology for checks and reminders, and nonpunitive reporting systems decrease these errors. [2] Nursing errors resulting in disciplinary action occur most often in the first 6 months of employment and peak again after the second year.…”

Factors affecting drug‐protein binding in the plasma of newborn infants.

“…The investigation of drug binding in the newborn infant is of particular interest, since the neonate's body composition differs from that of the adult, with greater susceptibility to the action of drugs and chemical agents (Yaffe, 1966;Mirkin, 1970).…”

Development Pharmacology

“…It seems desirable that the actions of pharmacologic agents on devel oping biologic systems be viewed from a perspective which permits not only the analysis of drug effects upon embryogenesis but also allows for an eval uation of how physiologic maturation basically influences the disposition of and response to pharmacologically active molecules. Several reviews which approach developmental pharmacology from a more fundamental viewpoint are available for the interested reader (3)(4)(5).…”