Journal of Pediatric Pharmacology and Therapeutics最新文献

The prevalence of mental disorders in children and adolescents has increased over the years, along with a rise in the prescription of psychotropic medications in this population. Evidence and drug safety studies in children, however, remain scarce, with many treatments being prescribed off-label. Serotonin syndrome and neuroleptic malignant syndrome are both potentially life-threatening conditions associated with the use of psychotropic medications, with symptoms frequently overlapping. This case report describes a mixed presentation of serotonin syndrome and neuroleptic malignant syndrome in a 12-year-old female patient receiving combined treatment with fluoxetine and haloperidol. She presented with intermittent generalized muscle rigidity and dystonia, tremors, muscle clonus, diaphoresis, and hyperreflexia. Blood analysis showed an elevated creatine phosphokinase plasma concentration. She required continuous cardiac monitoring and treatment with intravenous fluids and diazepam, with a complete resolution of symptoms. This case highlights the importance of awareness of the adverse effects of psychotropic treatments in the pediatric population.

Objective: To compare clinical outcomes in neonates receiving empiric vancomycin or nafcillin containing regimens for neonatal late onset sepsis (nLOS).

Methods: This retrospective study evaluated neonates > 72 hours of age initiated on vancomycin/gentamicin (VANC) or nafcillin/gentamicin (NAF) for suspected nLOS. The primary composite endpoint was clinical worsening, defined as a composite of increased respiratory support or vasopressor requirement, both within the first 24 hours, or prolonged bacteremia. Secondary endpoints included acute kidney injury, methicillin-resistant Staphylococcus aureus colonization, deep-seated infection, and mortality.

Results: The final cohort included 97 neonates (46 VANC, 51 NAF). There was no difference in the clinical worsening composite (VANC 15.2% vs NAF 15.7%; p = 0.95) or in the individual components of the composite. Secondary endpoints did not yield statistically significant differences.

Conclusions: Use of nafcillin as the Gram-positive empiric treatment agent did not result in increased clinical worsening compared to vancomycin at our institution.

Thromboembolism in pediatric patients with congenital heart disease (CHD) is a commonly encountered morbidity. Feeding intolerance is also commonly encountered in patients with CHD and has a direct effect on thromboembolism treatment options, as the site of gastrointestinal absorption for each agent varies. Historically, standard anticoagulation options included unfractionated heparin, enoxaparin, or vitamin K antagonists such as warfarin. Non-vitamin K oral anticoagulants, such as rivaroxaban, have become more widely used in pediatrics since obtaining Food and Drug Administration approval, but are often considered poor options for patients receiving post-pyloric enteral feeds. Adult pharmacokinetic data suggest significant variations in volume of distribution and maximum serum concentrations based on the site of administration within the gastrointestinal tract. We report 3 patients with complex CHD and significant feeding intolerance requiring therapeutic anticoagulation who successfully received rivaroxaban through a post-pyloric feeding tube. When using therapeutic serum concentration monitoring, all 4 serum concentrations were within the reported reference range, and 3 of 4 were within the age-related geometric coefficient of variation. Rivaroxaban appears to have adequate post-pyloric absorption in pediatric patients with CHD based on serum concentration monitoring.

Dexmedetomidine is a centrally acting selective α₂-adrenergic agonist that initially received US Food and Drug Administration approval in 1999 for the sedation of intubated and mechanically ventilated adult patients for up to 24 hours. Since then, it has seen widespread use in clinical practice in various clinical scenarios including sedation during mechanical ventilation, provision of adjunctive analgesia, procedural sedation, treatment of withdrawal, and sedation during end-of-life care. Although traditionally administered intravenously, animal investigations and anecdotal clinical experience has reported efficacy with subcutaneous (SC) administration. Clinical applications of SC dexmedetomidine have included procedural sedation; outpatient and home care where IV administration may not be feasible or interfere with patient comfort; the management or prevention of drug withdrawal symptoms; and during end-of-life care. This educational review outlines the basic physiology of dexmedetomidine, and details reports of its SC administration in laboratory animals as well as various clinical scenarios with a specific focus on its applications in pediatric-aged patients. Techniques for SC administration and dosing schemes are presented.

Cannabis edible products pose significant health risks to children due to a wide variety of reasons. Currently, there is inconsistent governmental regulation and oversight for the manufacturing, packaging, and labeling of these products. Additionally, consumer education and harm reduction strategies are lacking, leading to an increase in the incidence of unintentional cannabis edible ingestions by the pediatric population. The variation of the components and potencies of cannabis products causes a wide range of dose-dependent adverse events within this patient population. This poses a significant challenge for clinicians treating pediatric patients who present with signs and symptoms consistent with cannabis intoxication. This article provides medical and pharmacological context on the current state of cannabis edibles in the United States, with further recommendations for the initial screening, management, and prevention of cannabis ingestions by pediatric patients.

Immunizations are among the most effective public health measures, significantly reducing the prevalence of serious infectious diseases across the population. Their success is so profound that many in the United States have never witnessed the devastating effects of illnesses, such as measles, polio, or diphtheria. Despite this progress, the Centers for Disease Control and Prevention reports a decrease in childhood vaccination rates. These decreases are likely related to the increasing rates of misinformation and disinformation surrounding immunizations. The impact of declining immunization rates is already being felt, as evidenced by the highest number of measles cases reported in more than 30 years. Pharmacists are in a key position to provide evidence-based recommendations and information to the public. As such, the Pediatric Pharmacy Association believes in the importance of ensuring pharmacists' continued access to reliable, evidence-based resources for professional reference and patient education, enabling effective communication and promoting informed decision-making about immunizations and the diseases they prevent.

Neonates are at an increased risk for seizures and are treated based on separate clinical practice guidelines compared with the pediatric patient population. Most seizures in the neonatal population are provoked, with the most common cause being intraventricular hemorrhage in preterm neonates and hypoxic ischemic encephalopathy in term neonates. Prompt recognition and treatment are considered cornerstones of therapy to help optimize long-term neurodevelopmental outcomes. This article focuses on considerations for pharmacological interventions in the treatment of neonatal seizures.

Objective: Pediatric diabetic ketoacidosis (DKA) results in dehydration and electrolyte losses, but there is no standardized potassium salt form for repletion. The objective of this research was to assess time to resolution of ketoacidosis in DKA patients comparing different potassium salts in the 2-bag system during an electrolyte shortage.

Methods: A retrospective cohort study was performed to review pediatric cases that met the institution's criteria for DKA and were started on the 2-bag system. Patients were identified from use of a DKA order set within the electronic health record. Cases were excluded if a patient received both potassium acetate and chloride, deviated from the active protocol product or were transferred to/from another institution. Data collected included patient demographics, and laboratory values including blood glucose, beta-hydroxybutyrate, venous pH, serum bicarbonate, and serum potassium collected at presentation and then per protocol until resolution of DKA. Initial laboratory values were utilized to determine DKA severity. Statistical analysis included descriptive statistics, Kaplan-Meier analysis for time to resolution of DKA, Wilcoxon rank sum test for continuous non-parametric data, and χ² or Fisher exact test for nominal data.

Results: A total of 124 cases were included: 62 in each cohort. There was a similar number of patients presenting with severe DKA in the potassium acetate group compared with the potassium chloride group (48.4% vs 51.6%). Cases in the potassium acetate group showed a median 48-minute faster time to DKA resolution than the potassium chloride group; this was not a statistically significant difference (p = 0.54). There was a statistically significant difference amongst the median length of stay between the potassium acetate and potassium chloride groups (43.7 hours vs 48.6 hours; p = 0.037). There was no noted mortality in either group.

Conclusions: There were no clinically significant differences in outcomes in pediatric DKA patients when comparing potassium acetate and potassium chloride in the 2-bag system.