Drug Toxicity in Neonates, Infants and Young Children

Neonates, infants and young children may experience the same drug toxicity as adults. They may also experience specific drug toxicity that adults do not experience. This may be associated with toxicity related to growth and development, for example the adverse effect of corticosteroids on growth or development of the brain following exposure in the early period of neonatal life. Alternatively they may develop a specific toxicity in relation to a condition that does not occur in adults, for example Reye's syndrome following exposure to salicylates during the presence of a viral infection. The altered drug metabolism within paediatric patients is an additional risk factor for drug toxicity. This is most marked in the neonatal period and is illustrated by the impaired metabolism of chloramphenicol which results in cardiovascular collapse. Similarly, the altered metabolism of antiepileptic drugs such as sodium valproate in children less than two years of age predisposes this particular age group to hepatotoxicity. Other specific examples of drug toxicity in paediatric patients are given in this chapter and these include examples of percutaneous and excipient toxicity. Keywords: drug toxicity; children; percutaneous; chloramphenicol; sulfonamides; dexamethasone; sodium valproate; salicylates; vigabatrin; propofol; diethylene glycol