Developmental pharmacokinetics of opioids in neonates

Karel Allegaert, MD, PhD; Sinno H. Simons, MD, PhD; Christine Vanhole, MD, PhD; Dick Tibboel, MD, PhD

doi:10.5055/jom.2007.0039

Authors

Karel Allegaert, MD, PhD
Sinno H. Simons, MD, PhD
Christine Vanhole, MD, PhD
Dick Tibboel, MD, PhD

DOI:

https://doi.org/10.5055/jom.2007.0039

Keywords:

opioids, neonates, pharmacokinetics, interindividual variability

Abstract

Recognition and treatment of pain are now important indicators of the quality of care being delivered to neonates. However, population-specific characteristics have to be considered, necessitating an integrated, population-specific approach. Such an approach starts with a systematic evaluation of pain, using a validated pain-assessment instrument, and should be followed by effec-tive interventions, mainly based on appropriate, i.e, safe and effective, administration of analgesics. We will illustrate the impact of age on the pharmacokinetics and metabolism of opioids using recently collected and reported observations of tramadol disposition in early neonatal life. Although distribution volume and clearance display age-dependent maturation, it is important to recognize that important, unexplained interindividual variability in drug metabolism is still observed. Research questions in the field of developmental pharmacokinetics of opioids should focus on covariables of relevance in the interindividual variability of both pharmacokinetics and pharmacodynamics of opioids in neonates and on long-term outcomes in preterm and term neonates to whom opioids were administered, with regard to behavioral consequences and effects on pain thresholds.

Author Biographies

Karel Allegaert, MD, PhD

Neonatal Intensive Care Unit, Division of Woman and Child, University Hospital, Gasthuisberg, Leuven, Belgium.

Sinno H. Simons, MD, PhD

Department of Paediatric Surgery, Erasmus Medical Centre, Sophia’s Children’s Hospital, Rotterdam, the Netherlands.

Christine Vanhole, MD, PhD

Neonatal Intensive Care Unit, Division of Woman and Child, University Hospital, Gasthuisberg, Leuven, Belgium.

Dick Tibboel, MD, PhD

Department of Paediatric Surgery, Erasmus Medical Centre, Sophia’s Children’s Hospital, Rotterdam, the Netherlands.

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