Pharmaceutical Care In Neonates And Pediatric

Paediatric pharmacy is relatively new and hence paediatric pharmaceutical care. Paediatric pharmaceutical care is pharmaceutical care applied in the paediatric population. Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families.

Neonates and pediatric

Pediatric Age

The paediatric population represents a heterogeneous group consisting of infants (birth-1 year), and children (1-12 years). Neonates are those aged from birth-4 weeks. Children represent a significant proportion of the population requiring pharmacy services in a variety of hospital and community settings.

Challenge Of Pediatric Pharmaceutical Care

More than any other patient group, drug treatment in children needs to be adjusted to response. Monitoring and adjustment of therapy requires a detailed knowledge of variations in pharmacokinetics and pharmacodynamics as well as other factors that influence efficacy, such as administration, formulation and absorption.

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Due to advances in paediatric medicine, the increasing complexity of childhood diseases and unique dosing and pharmacokinetic challenges, there is a growing need to educate pharmacists in basic paediatric competencies. The paediatric population is a more vulnerable group than the adults. Though this population suffers similar adverse drug reactions as in adults, the prevalence is higher and detection of adverse drug reactions in children is more difficult because infants cannot communicate their problems and hence the health behaviour is dependent on the mother.

Furthermore, as a result of immature organ systems, there is high variability in pharmacodynamic and pharmacokinetic profiles of drugs. Changes that occur with age include volume of distribution, protein binding, metabolism and renal excretion, muscle mass and fluid requirements. Disease-specific conditions that might affect drug choice or administration include pharmacogenetic variations such as G6PD deficiency, short-gut syndrome and lactose intolerance.

The provision of pharmaceutical care to children can be challenging, especially with regards to the appropriate drug, dosage and route of administration. Because of their relative lack of chronic ailments, children usually require fewer medications compared to adults; this, compounded with the various ethical and logistical barriers to studying the effects of medications among children, means that there are very few medications licensed for use among children. Medications without the proper marketing authorisation are referred to as ‘unlicensed’, while off-label medications indicate licensed medicines which are prescribed or used in a manner not consistent with recommendations, for instance in terms of dose, route of administration or recommended age.

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General Principles Of Pediatric Pharmaceutical Care

Considering that pediatric patients are more likely to experience adverse drug misadventures, they may need a narrower follow-up period than their adult counterparts, and pharmacists are able to apply advanced pharmaceutical and therapeutic knowledge to monitor for adverse, as well as positive outcomes. Some important general principles when treating children should be followed:

1. If the infant is very young (less than 3-6 months), then most often a referral would be appropriate. 

2. If the child is very ill (lethargic, listless, and inconsolable), referral is required. 

3. If a medication is to be given, then make sure the dose explained to the caregiver is correct (many medicines will be dosed according to weight). 

4. Show the caregiver how to effectively administer/use the medication (e.g., show them how to use a syringe for measuring liquid medications). 

5. Involve the child (when old enough to take part) in their own care and encourage communication between the child and their parents, because at some stage the child will be responsible for their own medication use.

Paediatric Pharmaceutical Care Activities

Paediatric Dosage

Most commercial products come as adult doses. It requires the knowledge of the pharmacist to reconstitute pediatric dose. Accurate dosing is a major problem when pediatric dosing is concerned.

Medication use and administration: children fear health facilities because of the fear of injection. This can be reduced with other options and how to pacify a child.

Off-label Medications

Few medications routinely prescribed for children have actually been studied for paediatric use. Medications that are safe for adults may have detrimental effects on children. The lack of paediatric data leads to "off-label" prescribing by health care providers. This is a situation whereby children are commonly treated with drugs that have not been approved for paediatric use. The continued “off-label” use of medications by practitioners for paediatric clients can lead to dangerous outcomes. Examples of poor outcomes due to the absence of paediatric data include tetracycline-induced dental dysplasia and neonatal deaths due to chloramphenicol-induced “gray baby” syndrome.

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Drug Information

Pharmacists should familiarise themselves with drug information on the pediatric population. There are few books out there. They are also in position to enlighten other healthcare professionals. This may be accomplished through educational presentations, seeing patients in conjunction with other care- givers (ground ward round), and printed materials (e.g., newsletters).

Examples of references include, but not limited to the Nelson Textbook of Paediatrics, Neonatology, Pathophysiology and Management of the Newborn, the Neofax, the Paediatric Dosage Handbook, the Harriet Lane Handbook, the Teddy Bear Book: Paediatric Injectable Drugs, and Drugs in Pregnancy and Lactation.

Providing Pharmaceutical Care To The Paediatric Population

Providing pharmaceutical care to the paediatric population follows the same systematic step wise approach. However, pharmacists can interact with the caregiver in neonates and also with the child that is old enough or both. The target outcome is clinical and economical as humanistic outcomes cannot be measured.