期刊
INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS
卷 54, 期 7, 页码 514-523出版社
DUSTRI-VERLAG DR KARL FEISTLE
DOI: 10.5414/CP202561
关键词
newborn; pain; pain management; developmental pharmacology; pharmacogenetics
资金
- Fund for Scientific Research, Flanders [1800214N]
- agency for innovation by Science and Technology in Flanders (IWT) through the SAFEPEDRUG project [IWT/SBO 130033]
- NIH [K24DA027992, R01HD060543, U54HD071601]
- European Commission [223614, 260908, 223060]
Inadequate pain management but also inappropriate use of analgesics in early infancy has negative effects on neuro-developmental outcome. As a consequence, neonatal pain management is still in search for the Holy Grail. At best, effective pain management is based on prevention, assessment, and treatment followed by a re-assessment of the pain to determine if additional treatment is still necessary. Unfortunately, epidemiological observations suggest that neonates are undergoing painful procedures very frequently, unveiling the need for effective preventive, non-pharmacological strategies. In addition, assessment is still based on validated, multimodal, but subjective pain assessment tools. Finally, in neonatal intensive care units, there is a shift in clinical practices (e.g., shorter intubation and ventilation), and this necessitates the development and validation of new pharmacological treatment modalities. To illustrate this, a shift in the use of opioids to paracetamol has occurred and short-acting agents (remifentanil, propofol) are more commonly administered to neonates. In addition to these new modalities and as part of a more advanced approach of the developmental pharmacology of analgesics, pharmacogenetics also emerged as a tool for precision medicine in neonates. To assure further improvement of neonatal pain management the integration of pharmacogenetics with the usual covariates like weight, age and/or disease characteristics is needed.
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