Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Systematic Review of Pharmacologic Treatments for Hypochloremic Metabolic Alkalosis in Critically Ill Children.","authors":"Taylor McLarty, Angela Giglione, Jamie L Miller, Teresa V Lewis, Peter N Johnson","doi":"10.5863/JPPT-25-00038","DOIUrl":"10.5863/JPPT-25-00038","url":null,"abstract":"<p><p>Metabolic alkalosis, characterized by an increase in serum bicarbonate (>28 mEq/L) and serum pH (>7.45), is associated with clinical complications including arrhythmias, mental confusion, and seizures. Non-pharmacologic measures are recommended first-line for treatment of hypochloremic metabolic alkalosis, but pharmacologic treatment may be needed. This review of the literature provides detailed descriptions of dosage regimens, efficacy, safety, and other considerations for use of pharmacologic agents. The literature search included published human studies in the English language from EMBASE and Ovid MEDLINE from 1946 to January 2025. A total of 11 studies representing 736 pediatric patients were included. Use of acetazolamide, hydrochloric acid, ammonium chloride, and arginine hydrochloride have been reported in the literature for pharmacologic management of hypochloremic metabolic alkalosis. Of these agents, acetazolamide and arginine hydrochloride are the only two available for use in the United States. Acetazolamide monotherapy was evaluated in 5 studies, representing 270 patients (36.6%). Arginine chloride monotherapy was evaluated in 2 studies, representing 427 critically ill patients (58.0%). Only 1 study compared the safety and efficacy of acetazolamide and arginine hydrochloride but was limited by variable dosing and undocumented routes of administration and duration of therapy. Adverse effects were reported in 7 patients (0.95%) in the studies included, all of which occurred with acetazolamide. Given that acetazolamide is a US Food and Drug Administration (FDA)-labeled commercially available medication for enteral and intravenous administration, it is the authors' opinion that it should be administered as a first-line pharmacologic agent for pediatric patients refractory to other interventions for hypochloremic metabolic alkalosis.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"4-17"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Survey on Very Low Birth Weight Starter Parenteral Nutrition.","authors":"Ju Eun Jun, Molly Siver, Christine A Robinson, Anita Siu, Rachel S Meyers, Pooja Shah","doi":"10.5863/JPPT-25-00016","DOIUrl":"10.5863/JPPT-25-00016","url":null,"abstract":"<p><strong>Objective: </strong>Parenteral nutrition (PN) is initiated as early as possible in very-low-birth-weight (VLBW) neonates to prevent protein catabolism. Each institution takes a different approach to ensure that appropriate nutrition is administered as soon as possible after birth. This study aimed to describe the initial nutritional management for VLBW infants in various neonatal intensive care units.</p><p><strong>Methods: </strong>A 16-question electronic survey was distributed to Pediatric Pharmacy Association (PPA) members through PPA listservs. The primary outcome was to identify the most common macronutrients and micronutrients in starter PN and their concentrations. Secondary outcomes were starting concentrations of electrolytes in the VLBW starter PN, maximum osmolarity, dextrose and calcium concentration permitted in peripheral PN, and use of fat emulsion, including starting dose, start time, and type of fat emulsion.</p><p><strong>Results: </strong>Of 70 individual institutions included, 64 institutions (91%) stocked standardized starter PN, and 6 institutions (9%) stocked custom-compounded starter PN. The most common contents were amino acids (100%), dextrose (100%), calcium gluconate (73%), and heparin (74%), with mean (range) reported concentrations of 3.5% (1.8%-6%), 8.9% (5%-12.5%), 14 mEq/L (0.2-38 mEq/L), and 0.5 units/mL (0.2-1 units/mL), respectively. Among 66 institutions, the mean initial fat emulsion dose was 1.2 g/kg/day (0.5-3 g/kg/day). Mean maximum osmolarity for peripheral PN was 1016 mOsm/L (900-1250 mOsm/L).</p><p><strong>Conclusions: </strong>This study found that although there are common contents reported in VLBW starter PNs, there is wide variation in their concentrations. Future research on the nutritional needs of VLBW neonates may provide an opportunity to develop more widely accepted standardized starter PNs.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"50-55"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacoepidemiology of Antiviral Treatment for Congenital Cytomegalovirus in Neonates.","authors":"Haejung Yoon, Daniel K Benjamin, Reese H Clark, Matthew Laughon, Rachel G Greenberg, Ashley Stark","doi":"10.5863/JPPT-25-00149","DOIUrl":"10.5863/JPPT-25-00149","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to assess the pharmacoepidemiology of ganciclovir and valganciclovir for treatment of congenital cytomegalovirus (cCMV), adverse events, and hearing screen outcomes in infants treated with antiviral therapy.</p><p><strong>Methods: </strong>We included infants discharged from Pediatrix Medical Group neonatal intensive care units (NICUs) between 2010 and 2020. We calculated the number of infants with cCMV and the proportion treated per year. We identified infants with cCMV treated with antivirals and used logistic regression models to compare adverse events (neutropenia, thrombocytopenia, and hepatic dysfunction) before and during treatment. Hearing screen outcomes were assessed using a logistic regression model as our primary analysis, with further sensitivity analyses to allow for the possibility of endogenous treatment.</p><p><strong>Results: </strong>A total of 465 infants from 144 sites met our inclusion criteria, of whom 262 received antiviral treatment. From 2010 to 2020, the annual number of infants with cCMV fell by one-third and the proportion of infants receiving antiviral treatment more than doubled. Neutropenia (absolute neutrophil count ANC <1000 μL) was significantly more common among infants receiving antiviral treatment after adjustment for gestational age and postnatal age (OR 3.2, 95% CI: 1.4-7.3). Neither thrombocytopenia nor hepatic dysfunction was associated with treatment. The primary logistic regression analysis and sensitivity analyses indicated that antiviral exposure was associated with elevated risk of hearing screen failure.</p><p><strong>Conclusions: </strong>Our data support previous studies identifying neutropenia as an adverse effect of antiviral treatment. In our cohort of infants with cCMV, treatment was associated with increased likelihood of failed hearing screen; this finding could be a result of unmeasured confounding variables or other limitations of retrospective analysis. Further studies should focus on identifying which infants with cCMV will most likely benefit from treatment, the optimal duration of treatment, and long-term outcomes.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"161-169"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why the Birth Dose Matters for Hepatitis B Vaccination.","authors":"Jennifer E Girotto, J Hunter Fly, Selena Warminski, Jessica Forster, Tamara Oz","doi":"10.5863/JPPT-26-00107","DOIUrl":"10.5863/JPPT-26-00107","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"102-105"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical Changes in Cardiovascular Function During the Neonatal Period in Infants Born to Mothers With Diabetes.","authors":"Colman I Freel, Ibrahim Alhaji Mohammed, Alice Lynch, Gauri Murali, Uma Subrayan, Shivi Tripathi, Fiona Xu, Daniel K Benjamin, Rachel G Greenberg, Melissa M Campbell, Rebekah A Rapoza, Corrine K Hanson, Paras Kumar Mishra, Daniel K Benjamin, Ann L Anderson-Berry","doi":"10.5683/JPPT-25-00163","DOIUrl":"10.5683/JPPT-25-00163","url":null,"abstract":"<p><strong>Objective: </strong>The link between maternal diabetes and congenital heart defects is well-established; however, few studies have investigated subclinical cardiovascular dysfunction at birth, which may serve as an early indicator of future risk.</p><p><strong>Methods: </strong>We analyzed cardiovascular metrics, including heart rate and blood pressure during the postnatal hospital stay, in 1927 maternal-infant dyads at Nebraska Medicine (2012-2023), including 226 with gestational diabetes mellitus (GDM), 27 with type 1 DM (T1DM), 67 with type 2 DM (T2DM), and 1607 with no DM. Relationships between maternal diabetes subtype and neonatal cardiovascular metrics were examined using treatment effects modeling. Correlations between maternal glycemic burden, as assessed by average HbA1c and 1-hour oral glucose tolerance test (OGTT) during pregnancy, and newborn cardiovascular metrics were also evaluated.</p><p><strong>Results: </strong>Compared with no DM, T1DM was associated with higher newborn systolic blood pressure (SBP) (+4.6 mm Hg, p = 0.002), pulse pressure (PP) (+3.1 mm Hg, p = 0.006), and SBP variability (+1.2 mm Hg, p = 0.048). T2DM was associated with higher newborn SBP (+2.9 mm Hg, p = 0.03) and PP (+2.0 mm Hg, p = 0.02) and lower SBP variability (-1.3 mm Hg, p = 0.049). There were sigsnificant positive correlations between maternal HbA1c and newborn heart rate (p = 0.009, <i>R</i> ² = 0.27), mean arterial pressure (p = 0.004, <i>R</i> ² = 0.20), SBP (p < 0.001, <i>R</i> ² = 0.22), diastolic BP (p = 0.03, <i>R</i> ² = 0.17), and PP (p = 0.001, <i>R</i> ² = 0.17). No correlations were observed between maternal 1-hour OGTT and newborn cardiovascular metrics.</p><p><strong>Conclusions: </strong>These findings indicate early subclinical changes in cardiovascular physiology in offspring of women with DM. The differential impacts of diabetes subtypes on newborn BP and strong link to maternal glycemic burden suggest severity and timing of maternal diabetes influence neonatal cardiovascular physiology.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"138-149"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressor Strategy in Pediatric Sepsis: A Clinical Pharmacology Perspective.","authors":"Danielle J Green, Kevin M Watt","doi":"10.5863/JPPT-25-00090","DOIUrl":"10.5863/JPPT-25-00090","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"112-114"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12889004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Role of Artificial Intelligence in Clinical Pharmacometrics and Model-Informed Precision Dosing in Pediatrics.","authors":"Tomoyuki Mizuno, Michael N Neely","doi":"10.5863/JPPT-25-01207","DOIUrl":"10.5863/JPPT-25-01207","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"106-111"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Ibuprofen Arginine, Ibuprofen Lysine, and Indomethacin for Patent Ductus Arteriosus Closure in Neonates.","authors":"Meghna Basnet, Densley Perez, Eileen Chung, Caitlin Murtagh","doi":"10.5863/JPPT-24-00104","DOIUrl":"10.5863/JPPT-24-00104","url":null,"abstract":"<p><strong>Objective: </strong>Given the limited data on the use of ibuprofen arginine for the closure of patent ductus arteriosus (PDA), this study aims to retrospectively assess PDA closure rates and the safety profile of ibuprofen arginine as compared with ibuprofen lysine and indomethacin in neonates across a multicenter hospital system.</p><p><strong>Methods: </strong>This retrospective cohort study included neonates with symptomatic PDA admitted between July 2021 and August 2023, who received at least 1 dose of injectable indomethacin, ibuprofen lysine, or ibuprofen arginine. The primary aim was to compare closure rates of the PDA during the initial course of pharmacologic therapy. Secondary outcomes included the failure of therapy necessitating a repeat course or surgical ligation and adverse effects such as gastrointestinal bleeding, acute kidney injury, necrotizing enterocolitis, chronic lung disease, and intraventricular hemorrhage.</p><p><strong>Results: </strong>A total of 54 patients were included in the analysis; 26 received indomethacin, 13 received ibuprofen lysine, and 15 received ibuprofen arginine. There was no significant difference among groups in terms of closure rates after 1 course (53% indomethacin, 39% ibuprofen lysine, and 47% ibuprofen arginine; p = 0.66). Similarly, no differences were found in the need for a repeat course (35% indomethacin, 54% ibuprofen lysine, and 53% ibuprofen arginine; p = 0.29) or surgical ligation. Adverse effects rates were comparable across the groups.</p><p><strong>Conclusions: </strong>Indomethacin, ibuprofen lysine and ibuprofen arginine can all be considered viable options for pharmacologic closure of PDA in this population. Future prospective studies are needed to confirm these results and optimize patient outcomes.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"37-42"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Low and High Dose Clonidine for Infants Admitted to the Neonatal Intensive Care Unit.","authors":"Jacob Kelner, Clare Riotte, Ursula Marquis, Jessica Askew, Michael Brimacombe, Shabnam Lainwala","doi":"10.5863/JPPT-24-00140","DOIUrl":"10.5863/JPPT-24-00140","url":null,"abstract":"<p><strong>Objective: </strong>This study compares the efficacy of starting with low-dose vs high-dose enteral clonidine for the treatment of pain, agitation, and opioid withdrawal in high-risk infants admitted to the neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>This was a retrospective chart review study of infants admitted to a level IV NICU between September 2014 and December 2022 who were started on enteral clonidine before 50 weeks post-menstrual age (PMA) for pain, agitation, or opioid withdrawal. Data were collected over the first 30 days of clonidine treatment. Infants started on low-dose (LDC: <4 mcg/kg/day) and high-dose clonidine (HDC: ≥4 mcg/kg/day) were compared using SPSS V29.0 (IBM) for statistical analyses.</p><p><strong>Results: </strong>Ninety-five infants met the inclusion criteria; 41 received LDC, and 54 received HDC. There were no statistically significant differences in any demographic parameter between the groups before starting clonidine. There was no difference in reduction in Neonatal-Pain, Agitation, and Sedation Scale (N-PASS) scores during the 30-day treatment period, despite the LDC group having a lower maximum clonidine dose (4 vs 8 mcg/kg/day, p ≤ 0.01) than the HDC group.</p><p><strong>Conclusion: </strong>Our observational study suggests that starting with LDC may be as effective as HDC in treating pain, agitation, and opioid withdrawal in infants admitted to the NICU.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"56-61"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12889002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duke STAR Program and the Pediatric Trials Network.","authors":"Daniel K Benjamin, Sarah C Armstrong, Rachel G Greenberg","doi":"10.5863/JPPT-25-00143","DOIUrl":"https://doi.org/10.5863/JPPT-25-00143","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"31 1","pages":"118-119"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12889010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}