Features of pharmacotherapy in newborns, children and lactating women. From general to specific issues

Pharmacotherapy in neonates and nursing mothers faces unique risks due to the physiological immaturity of the child's body. In infants, delayed drug clearance due to underdevelopment of cytochrome P450 enzymes and renal function can lead to accumulation of toxins even at standard dosages. For nursing mothers, the problem is aggravated by the fact that about 80% of drugs penetrate into breast milk, creating a risk of dysbiosis, allergies, other adverse reactions, and long-term developmental disorders in the baby. Peculiarities of pharmacokinetics in newborns aggravate the risks. Metabolism and excretion are also critically different: glucuronidation deficiency provokes chloramphenicol toxicity, and low glomerular filtration increases the half-life of furosemide by 8 times. Dosage errors increase hospitalization by 30%, and treatment of complications in premature babies can reach 5 million rubles per case. All this dictates the need to develop age-oriented protocols, take into account transplacental transfer of drugs, carry out strict monitoring during lactation, and create specialized dosage forms to protect the most vulnerable groups of patients.