Journal of Pediatric Pharmacology and Therapeutics最新文献

Methemoglobinemia is a rare, yet life-threatening disorder that occurs due to an accumulation of methemoglobin in the blood. The clinical presentation often includes dyspnea, cyanosis, and hypoxemia that shows little improvement with the administration of supplemental oxygen. The US Food and Drug Administration (FDA) warns against the administration of benzocaine to those younger than 2 years of age and urges manufacturers to add a statement regarding the possible development of methemoglobinemia to the packaging of any products containing this ingredient. However, providers caring for pediatric patients should recognize that methemoglobinemia may occur in toddlers and children outside of the FDA's specific age warning window and must keep a broad differential for patients presenting with respiratory distress. The objective of this article is to highlight a case of a child subsequently found to have benzocaine-induced methemoglobinemia and emphasize the importance of pharmacists in an emergency medicine setting, particularly in the care of patients with uncommon acute conditions requiring lesser-known pharmacologic treatments.

Objective: In the United States, ursodiol is commercially available as solid dosage forms, which represents a problem for children who cannot swallow capsules or tablets. There is a lack of an age-appropriate formulation for ursodiol, and the extemporaneous preparation of an oral suspension with an extended beyond-use-date (BUD) may represent a good therapeutic alternative for the pediatric population. However, all pharmacists need validated stability studies to prepare oral liquids with high quality and safety.

Methods: Oral compounded suspensions for ursodiol 20 to 60 mg/mL were prepared by adding the contents of ursodiol 300-mg commercial capsules (Actavis, KVK Tech, and Mylan) to a proprietary oral suspending vehicle. The BUD of the oral compounded suspensions was determined by using a valid, stability-indicating analytical method. The physical characterization consisted of observing all samples for appearance and color, and testing for pH. Microbiological stability testing followed the United States Pharmacopeia (USP) Chapter 51: Antimicrobial Effectiveness Testing.

Results: The ursodiol oral compounded suspensions exhibited a homogeneous white color and the pH did not change significantly. The potency of the oral suspensions remained within ±10% of the specifications. Considering the microbiological characterization, there was no growth of challenge microorganisms throughout the study for all samples.

Conclusion: This study demonstrates that ursodiol (Actavis, KVK Tech, and Mylan) is physically, chemically, and microbiologically stable in the oral suspending vehicle at room temperature for up to 6 months.

Objective: The use of umbilical artery catheters (UACs) for parenteral nutrition (PN) administration is controversial, and limited data exist on the safety of administration through this route. The objective of this research is to evaluate neonates who received PN through a UAC and assess catheter-related complications and PN composition.

Methods: This retrospective study evaluated all neonates who received PN through their UAC while admitted in the neonatal intensive care unit between January 2019 and December 2022. Neonates were evaluated for development of catheter-related complications such as infiltration, extravasation, thrombus formation, infection, or hypertension.

Results: The administration of PN through UAC was identified in 31 neonates. Among the 31 neonates, 17 (55%) were classified as preterm, and 15 (48%) were classified as low birth weight. No patient experienced a UAC-related complication. Death occurred among 7 (23%) neonates. Two deaths occurred while the neonates were receiving PN via the UAC, but neither death was attributed to UAC complications. In 19 (61%) of the 31 neonates, osmolarity of PN exceeded 900 mOsm/L.

Conclusions: Results of this study suggest that UACs may serve as a safe route for PN administration in neonates. The absence of catheter-related complications and the absence of adverse events support the safety of this approach. Further research with a larger sample size and rigorous study design is warranted to validate these findings and establish guidelines for the use of UACs in PN administration.

Atopic dermatitis, more commonly known as atopic eczema, is a chronic, relapsing inflammatory skin disorder characterized by dry skin, localized erythematous rash, and intense pruritus. The clinical manifestations are variable and age dependent. As one of the most common skin disorders globally, atopic dermatitis poses a significant clinical and economic burden on affected patients. Individual treatment strategies are imperative in improving patient outcomes and reducing these burdens. Recent advances in understanding the genetic, immunologic, and environmental factors influencing atopic dermatitis have opened avenues for novel treatment modalities. This article highlights the clinical presentation, pathophysiology, diagnosis criteria, as well as current recommendations on treatment of atopic dermatitis.

Objective: Data comparing the safety profiles of nafcillin and oxacillin are limited in the pediatric patient setting. This study was conducted to compare adverse effect profiles of nafcillin and oxacillin.

Methods: This was a single center retrospective study including patients admitted to a children's hospital who received either nafcillin or oxacillin. Patients were excluded if they were older than 18 years or if therapy duration was less than 48 hours. The primary objective was to compare the cumulative sum of adverse effects of nafcillin to oxacillin, including incidence of hypokalemia, nephrotoxicity, hepatotoxicity, neutropenia, infusion-related reactions, loss of intravenous access, and early discontinuation of therapy. Secondary endpoints included comparison of the incidence of each adverse effect collected.

Results: Fifty-three patient encounters (representing 46 patients) were included, with 17 patients receiving nafcillin and 36 patients receiving oxacillin. There was no difference between the cumulative sum of adverse effects for nafcillin (n = 16) and oxacillin (n = 45), p = 1. Acute kidney injury (AKI) occurred with both nafcillin and oxacillin at similar rates (21% vs 30%; p = 0.72), as well as hypokalemia for both nafcillin and oxacillin (50% vs 43%; p = 0.46). All but 1 patient who experienced AKI were receiving other nephrotoxin(s) during therapy. Changes in liver transaminases were not significant for either drug. A significant decline in median absolute neutrophil count was noted from pre to post treatment with oxacillin (8400 to 6000 cells/µL; p = 0.002).

Conclusions: Our study found no significant difference in adverse effects of nafcillin and oxacillin. Both treatment groups experienced AKI and hypokalemia. Larger studies are needed to determine if one drug is safer than the other.

Maternal antidepressant use has increased during the past 2 decades, with venlafaxine emerging as a common agent during pregnancy. Both venlafaxine and its active metabolite possess prolonged half-lives in adults; however, abrupt discontinuation may lead to withdrawal including irritability, jitteriness, lethargy, restlessness, and insomnia. The drug and its metabolite readily cross the placenta, posing additional considerations during pregnancy. Two neonates were admitted to our hospital on 5 and 6 days of life with hypothermia and lethargy among other symptoms of neonatal abstinence syndrome (NAS) requiring an extensive medical workup. Both neonates were exposed to venlafaxine in utero and exclusively fed infant formula since birth. Given that venlafaxine crosses the placenta and into breastmilk, NAS was suspected as a result of the abrupt discontinuation of venlafaxine upon delivery, and the decision was made to introduce mothers' breast milk. Symptoms of NAS, including hypothermia, resolved in both patients. The reported incidence of NAS with venlafaxine alone is limited, likely due to variation in breastfeeding practices among new mothers. Diagnosis of NAS due to venlafaxine requires a high index of suspicion because symptoms are nonspecific and the presentation may be delayed after birth. The effective treatment of NAS using mothers' breast milk illustrates the importance of counseling mothers to provide breast milk as a preventative strategy for withdrawal in their newborns. The cases involving the 2 neonates described in this article emphasize the importance of assessing in utero exposure to medications beyond the immediate newborn period and their possible role in causing unusual symptoms in newborns.

Peer review is an essential step in the publication process and dissemination for scientific information to improve patient care and future research in pediatric patients. It is a professional obligation to ensure high quality, reliable, and relevant information is published. Despite this, many journals face problems finding peer reviewers. Several journals and organizations have developed resources to aid in the training of peer reviewers. The purpose of this primer is to provide an overview of the steps of peer review and to emphasize key points on how to conduct a peer review.