Girardi Anna, Raschi Emanuel, Galletti Silvia, Poluzzi Elisabetta, Faldella Giacomo, Allegaert Karel, De Ponti Fabrizio
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, Italy.
Drug Saf. 2015 Jun;38(6):535-51. doi: 10.1007/s40264-015-0288-6.
Only a small fraction of drugs widely used in neonatal intensive care units (NICU) are specifically authorized for this population. Even if unlicensed or off-label use is necessary, it is associated with increased adverse drug reactions, which must be carefully weighed against expected benefits. In particular, renal damage is frequent among preterm babies, and is considered a predisposing factor for the development of chronic kidney disease in adulthood. Apart from specific conditions affecting premature neonates (e.g. respiratory distress syndrome, perinatal asphyxia), drugs play an important role in impairing renal function because of well-known nephrotoxicity and/or interaction with renal developmental factors. From a review of the available studies on drug use in NICU patients, we identified and described the most commonly administered drugs that are correlated to renal damage. Early detection of kidney injury is becoming an essential aspects for clinicians because of the limited number of biomarkers applicable in the neonatal population. Postnatal changes of biochemical processes that influence pharmacokinetic and pharmacodynamic aspects need to be further investigated in order to better understand the mechanisms of drug toxicity in this population. The most promising strategies for dose adjustment and therapeutic schemes are discussed. The purpose of this review was to describe current knowledge on drug use among premature babies and their implication in kidney injury development, as well as to highlight available strategies for early detection of renal damage.
在新生儿重症监护病房（NICU）广泛使用的药物中，只有一小部分是专门批准用于该人群的。即使有必要使用未获许可或超说明书用药，这也会增加药物不良反应，必须仔细权衡预期益处与不良反应。特别是，早产儿中肾损伤很常见，被认为是成年后患慢性肾病的一个诱发因素。除了影响早产儿的特定病症（如呼吸窘迫综合征、围产期窒息）外，由于众所周知的肾毒性和/或与肾脏发育因素的相互作用，药物在损害肾功能方面也起着重要作用。通过对NICU患者用药的现有研究进行综述，我们确定并描述了与肾损伤相关的最常用药物。由于适用于新生儿群体的生物标志物数量有限，早期发现肾损伤正成为临床医生的一个重要方面。为了更好地理解该人群中药物毒性的机制，需要进一步研究影响药代动力学和药效学方面的生化过程的产后变化。本文讨论了最有前景的剂量调整和治疗方案策略。本综述的目的是描述早产儿用药的现有知识及其在肾损伤发展中的影响，并强调早期发现肾损伤的可用策略。
