Developmental Pharmacokinetics in Premature Infants: A Review of Key Considerations

The intricate and quickly developing field of pharmacokinetics in preterm newborns reflects the distinct physiological traits of this susceptible group. Drug absorption, distribution, metabolism, and excretion are very different from those in term infants, children, and adults because to immature organ systems, changed body composition, and limited metabolic capacity. Significant interindividual heterogeneity in drug response and an increased risk of toxicity or therapeutic failure are caused by these developmental differences. Therefore, it is essential to comprehend the ontogeny of important enzymes, transporters, and renal function in order to optimize dosage regimens in preterm infants. Recent developments in physiologically based pharmacokinetic (PBPK) simulations, population-based pharmacokinetic modeling, and developmental pharmacology have enhanced dose prediction and tailored treatment for this population. However, ethical restrictions, small sample numbers, and sampling technical difficulties continue to make clinical research on preterm newborns difficult. To improve therapy outcomes and revise dose guidelines, ongoing work combining omics technologies, sophisticated modeling, and real-world data are crucial. This review outlines current approaches to maximize safe and efficient medication administration while summarizing the physiological and developmental variables impacting pharmacokinetics in preterm infants.