Chemotherapy in Neonates and Infants by Carolina Witchmichen Penteado Schmidt

Author:Carolina Witchmichen Penteado Schmidt
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Infants’ renal clearance reaches adult levels only at 1–2 years of age [26].

Drug depuration in the kidneys happens in three phases: glomerular filtration, proximal tubular secretion , and distal tubular reabsorption [53]. Renal elimination of drugs, in general, is also reduced during the neonatal period —as is renal blood flow —and full-term newborns have pronounced reductions in the glomerular filtration rate (2–4 mL/min/1.73 m2), while premature newborns tend to have further reduced renal function ; therefore, the dose regimens of some drugs for newborns must be reduced to avoid toxic accumulation of the drugs. The glomerular filtration rate gradually increases to adult levels (corrected on the basis of body surface area) from 8 to 12 months of age; it is age dependent [1, 61]. Active tubular secretion is also reduced in term neonates [61]. Distal tubules are immature in preterm neonates . Reabsorption of creatinine is only present in the first postnatal days. Probably, it can be explained by passive reabsorption of filtered creatinine across immature leaky tubules ; this leads to an underestimation of the true glomerular filtration rate in these babies. According to some studies, the true creatinine clearance still is the best index of the glomerular filtration rate measure in neonates and i nfants [62].

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