For many drugs, therapeutic drug monitoring (TDM) has become widely available and accepted as an important component of clinical decision making in the intensive care nursery setting. This review analyzes the potential factors that can either expand or restrict neonatal TDM. A case is made for the development of pharmacokinetic services designed to meet the needs of sick neonates. These patients are well known for their extreme physiological instability, often resulting in drug concentrations obtained in non-steady-state conditions. Potential for toxic effects is also increased in this population. Appropriate collection and interpretation of measured concentrations is critical. The future of neonatal TDM is linked to that of TDM services in general. High cost, expensive technology, and ethical and political factors, however, set apart the population of very low birth weight infants from the universe of patients receiving TDM services.
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