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Kremer S, Shakhnovich V, Riffel AK, Harvey L, Borges CR. Delta-S-Cys-Albumin as a Marker of Pediatric Biospecimen Integrity. Biopreserv Biobank 2024. [PMID: 38651617 DOI: 10.1089/bio.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Blood plasma storage is a crucial element of pediatric biobanking. Improperly stored or handled specimens (e.g., at > -30°C) can result in altered biomolecular compositions that no longer reflects in vivo reality. We report application of a previously developed assay in adults-the ΔS-Cys-Albumin assay, which facilitates estimation of plasma and serum exposure to thawed conditions-to a population of pediatric EDTA plasma samples from patients aged 3-18 years to determine the assay's applicability, estimate its reference range for pediatric samples, and assess the impact of pre-centrifugation delay at 0°C. In addition, the effect of plasma thawed-state exposure to a range of times at 23°C, 4°C, and -20°C on ΔS-Cys-Albumin was evaluated. Using 98 precollected and processed pediatric EDTA plasma specimens, no difference was found in ΔS-Cys-Albumin under conditions of pre-centrifugation delay for up to 10 hours at 0°C. This lack of change allowed us to estimate a pediatric reference range for ΔS-Cys-Albumin of 7.0%-22.5% (mean of 12.8%) with a modest Pearson correlation between ΔS-Cys-Albumin and age (p = 0.0037, R2 = 0.29). ΔS-Cys-Albumin stability in six specimens at 23°C, 4°C, and -20°C was also evaluated. Plateaus in the decay curves were reached by 1 day, 7 days, and 14-28 days at these respective temperatures. The estimated pediatric reference range observed in children was lower than that previously observed in 180 adults of 12.3%-30.6% (mean of 20.0%), and the slope of the age correlation in children was twice as steep as that from adults. ΔS-Cys-Albumin decay curves at 23°C, 4°C, and -20°C were similar to those previously observed in adults. The data reported here support the use of ΔS-Cys-Albumin in evaluating the integrity and overall exposure of pediatric EDTA plasma specimens to thawed conditions. In doing so, they add an important quality control tool to the biobanker's arsenal.
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Affiliation(s)
- Schuyler Kremer
- School of Molecular Sciences, Arizona State University, Tempe, Arizona, USA
- The Biodesign Institute at Arizona State University, Tempe, Arizona, USA
| | - Valentina Shakhnovich
- Children's Mercy Hospital, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Ironwood Pharmaceuticals, Boston, Massachusetts, USA
| | | | - Lisa Harvey
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Chad R Borges
- School of Molecular Sciences, Arizona State University, Tempe, Arizona, USA
- The Biodesign Institute at Arizona State University, Tempe, Arizona, USA
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2
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van Haren JS, van der Hout-van der Jagt MB, Meijer N, Monincx M, Delbressine FLM, Griffith XLG, Oei SG. Simulation-based development: shaping clinical procedures for extra-uterine life support technology. Adv Simul (Lond) 2023; 8:29. [PMID: 38042828 PMCID: PMC10693037 DOI: 10.1186/s41077-023-00267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure. METHODS Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards. RESULTS Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments. CONCLUSION This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.
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Affiliation(s)
- J S van Haren
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.
| | - M B van der Hout-van der Jagt
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N Meijer
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - M Monincx
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F L M Delbressine
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - X L G Griffith
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Roilides E, Bradley JS, Lonchar J, Huntington JA, Wickremasingha P, Su FH, Bruno CJ, Johnson MG. Subgroup analysis of phase 2 study of ceftolozane/tazobactam in neonates and young infants with pyelonephritis. Microbiol Spectr 2023; 11:e0180023. [PMID: 37698430 PMCID: PMC10581202 DOI: 10.1128/spectrum.01800-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
Ceftolozane/tazobactam is approved for the treatment of patients from birth to <18 y old with complicated urinary tract infections (cUTI). This post hoc analysis evaluated the safety, efficacy, and pharmacokinetics (PK) of ceftolozane/tazobactam compared with meropenem in neonates and young infants. NCT03230838 was a phase 2, randomized, active comparator-controlled, double-blind study of patients from birth to <18 y of age with cUTI, including pyelonephritis, given ceftolozane/tazobactam or meropenem in a 3:1 ratio. This subset analysis included only neonates and young infants < 3 mo of age. The microbiologic modified intent-to-treat population (mMITT) included 20 patients (ceftolozane/tazobactam, n = 14; meropenem, n = 6). All patients had pyelonephritis at baseline; two patients in each treatment group had bacteremia (overall 4/20, 20%). Escherichia coli was the most common baseline pathogen (overall 16/20, 80%). Safety and efficacy results were similar between treatment groups and consistent with the overall pediatric population. There were no serious drug-related adverse events (AEs), no discontinuations due to AEs, and no AEs leading to death in either treatment group. For the ceftolozane/tazobactam and meropenem treatment groups, clinical cure rates in the mMITT population were 92.9% and 100%, respectively. The population PK analysis of neonates and young infants demonstrated similar ceftolozane and tazobactam exposures to those of adults, achieving pharmacodynamic targets associated with clinical and microbiologic cure. Ceftolozane/tazobactam has a favorable safety profile and achieves high clinical cure and microbiologic eradication rates in neonates and young infants < 3 mo of age with cUTI and pyelonephritis. IMPORTANCE Extrapolation of antibacterial agent pharmacokinetics from adults to newborns and young infants may not be appropriate; similarly, the clinical manifestations of infectious diseases and outcomes following antibacterial treatment may not be similar. Ceftolozane/tazobactam is an antibacterial drug combination active against Pseudomonas aeruginosa and other multidrug-resistant gram-negative bacteria. A clinical study led to the approval for ceftolozane/tazobactam in patients from birth to 18 y of age who have complicated urinary tract infections, including those with serious kidney infections. Based on data collected during that clinical study, we compared newborns and young infants who were treated with ceftolozane/tazobactam (14 patients) and those who were treated with meropenem (6 patients). We found that ceftolozane/tazobactam treatment of newborns and young infants up to 3 mo of age who have complicated urinary tract infections demonstrated a favorable safety profile and high clinical cure and microbiologic eradication rates, similar to meropenem.
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Affiliation(s)
- Emmanuel Roilides
- Third Department of Pediatrics, Infectious Diseases Unit, School of Medicine, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - John S. Bradley
- Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children’s Hospital of San Diego, San Diego, California, USA
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4
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Finch-Edmondson M, Paton MCB, Honan I, Galea C, Webb A, Novak I, Badawi N, Trivedi A. Proportion of Infant Neurodevelopment Trials Reporting a Null Finding: A Systematic Review. Pediatrics 2023; 151:190522. [PMID: 36695068 DOI: 10.1542/peds.2022-057860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Discovering new interventions to improve neurodevelopmental outcomes is a priority; however, clinical trials are challenging and methodological issues may impact the interpretation of intervention efficacy. OBJECTIVES Characterize the proportion of infant neurodevelopment trials reporting a null finding and identify features that may contribute to a null result. DATA SOURCES The Cochrane library, Medline, Embase, and CINAHL databases. STUDY SELECTION Randomized controlled trials recruiting infants aged <6 months comparing any "infant-directed" intervention against standard care, placebo, or another intervention. Neurodevelopment assessed as the primary outcome between 12 months and 10 years of age using a defined list of tools. DATA EXTRACTION Two reviewers independently extracted data and assessed quality of included studies. RESULTS Of n = 1283 records screened, 21 studies (from 20 reports) were included. Of 18 superiority studies, >70% reported a null finding. Features were identified that may have contributed to the high proportion of null findings, including selection and timing of the primary outcome measure, anticipated effect size, sample size and power, and statistical analysis methodology and rigor. LIMITATIONS Publication bias against null studies means the proportion of null findings is likely underestimated. Studies assessing neurodevelopment as a secondary or within a composite outcome were excluded. CONCLUSIONS This review identified a high proportion of infant neurodevelopmental trials that produced a null finding and detected several methodological and design considerations which may have contributed. We make several recommendations for future trials, including more sophisticated approaches to trial design, outcome assessment, and analysis.
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Affiliation(s)
- Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Madison C B Paton
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Ingrid Honan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Iona Novak
- Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School.,Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amit Trivedi
- Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Wilson CG, Altamirano AE, Hillman T, Tan JB. Data analytics in a clinical setting: Applications to understanding breathing patterns and their relevance to neonatal disease. Semin Fetal Neonatal Med 2022; 27:101399. [PMID: 36396542 DOI: 10.1016/j.siny.2022.101399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this review, we focus on the use of contemporary linear and non-linear data analytics as well as machine learning/artificial intelligence algorithms to inform treatment of pediatric patients. We specifically focus on methods used to quantify changes in breathing that can lead to increased risk for apnea of prematurity, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and provide a list of potentially useful algorithms that comprise a suite of software tools to enhance prediction of outcome. Next, we provide a brief overview of machine learning/artificial intelligence methods and applications within the sphere of perinatal care. Finally, we provide an overview of the infrastructure needed to use these tools in a clinical setting for real-time data acquisition, data synchrony, data storage and access, and bedside data visualization to assist in clinical decision making and support the medical informatics mission. Our goal is to provide an overview and inspire other investigators to adopt these tools for their own research and optimization of perinatal patient care.
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Affiliation(s)
- Christopher G Wilson
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University, School of Medicine, Loma Linda, CA, 92350, USA; Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA, 92350, USA.
| | - A Erika Altamirano
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University, School of Medicine, Loma Linda, CA, 92350, USA.
| | - Tyler Hillman
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University, School of Medicine, Loma Linda, CA, 92350, USA.
| | - John B Tan
- Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA, 92350, USA; Huckleberry Care, Irvine, CA, 92618, USA.
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6
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Nurses' and Parents' Roles in Drug Development. J Perinat Neonatal Nurs 2022; 36:225-227. [PMID: 35894716 DOI: 10.1097/jpn.0000000000000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Zhou P, Han T. Minimally Invasive Surfactant Therapy vs Sham Treatment and Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome. JAMA 2022; 327:1613-1614. [PMID: 35471523 DOI: 10.1001/jama.2022.2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Tongyan Han
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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8
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Siahanidou T, Spiliopoulou C. Pharmacological Neuroprotection of the Preterm Brain: Current Evidence and Perspectives. Am J Perinatol 2022; 39:479-491. [PMID: 32961562 DOI: 10.1055/s-0040-1716710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite improvements in viability, the long-term neurodevelopmental outcomes of preterm babies remain serious concern as a significant percentage of these infants develop neurological and/or intellectual impairment, and they are also at increased risk of psychiatric illnesses later in life. The current challenge is to develop neuroprotective approaches to improve adverse outcomes in preterm survivors. The purpose of this review was to provide an overview of the current evidence on pharmacological agents targeting the neuroprotection of the preterm brain. Among them, magnesium sulfate, given antenatally to pregnant women with imminent preterm birth before 30 to 34 weeks of gestation, as well as caffeine administered to preterm infants after birth, exhibited neuroprotective effects for human preterm brain. Erythropoietin treatment of preterm infants did not result in neuroprotection at 2 years of age in two out of three published large randomized controlled trials; however, long-term follow-up of these infants is needed to come to definite conclusions. Further studies are also required to assess whether melatonin, neurosteroids, inhaled nitric oxide, allopurinol, or dietary supplements (omega-3 fatty acids, choline, curcumin, etc.) could be implemented as neuroprotectants in clinical practice. Furthermore, other pharmacological agents showing promising signs of neuroprotective efficacy in preclinical studies (growth factors, hyaluronidase inhibitors or treatment, antidiabetic drugs, cannabidiol, histamine-H3 receptor antagonists, etc.), as well as stem cell- or exosomal-based therapies and nanomedicine, may prove useful in the future as potential neuroprotective approaches for human preterm brain. KEY POINTS: · Magnesium and caffeine have neuroprotective effects for the preterm brain.. · Follow-up of infants treated with erythropoietin is needed.. · Neuroprotective efficacy of several drugs in animals needs to be shown in humans..
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Affiliation(s)
- Tania Siahanidou
- Neonatal Unit of the First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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9
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Van der Veken M, Brouwers J, Budts V, Lauwerys L, Pathak SM, Batchelor H, Augustijns P. Practical and operational considerations related to paediatric oral drug formulation: an industry survey. Int J Pharm 2022; 618:121670. [PMID: 35304242 DOI: 10.1016/j.ijpharm.2022.121670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
For over 15 years, US and EU regulations ensure that medicines developed for children are explicitly authorised for such use with age-appropriate forms and formulations, implying dedicated research. To shed light on how these regulations have been adopted by pharmaceutical companies and how various aspects of paediatric oral drug formulation development are currently handled, an exploratory survey was conducted. Topics included: general company policy, regulatory aspects, dosage form selection, in-vitro, in-silico and (non-)clinical in-vivo methods, and food effects assessment. The survey results clearly underline the positive impact of the paediatric regulations and their overall uptake across the pharmaceutical industry. Even though significant improvements have been made in paediatric product development, major challenges remain. In this respect, dosage form selection faces a discrepancy between the youngest age groups (liquid products preference) and older subpopulations (adult formulation preference). Additionally, concerted research is needed in the development and validation of in-vitro tools and physiology based pharmacokinetic models tailored to the paediatric population, and in estimating the effect of non-standard and paediatric relevant foods. The current momentum in paediatric drug development and research should allow for an evolution in standardised methodology and guidance to develop paediatric formulations, which would benefit pharmaceutical industry and regulators.
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Affiliation(s)
| | - Joachim Brouwers
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Valérie Budts
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Louis Lauwerys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Shriram M Pathak
- Drug Development Consulting, Quotient Sciences, Nottingham, United Kingdom
| | - Hannah Batchelor
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Patrick Augustijns
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
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10
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Meliota G, Lombardi M, Benevento M, Console V, Ciccone MM, Solarino B, Vairo U. Off-Label Use of Cardiovascular Drugs in the Home Therapy of Children With Congenital or Acquired Heart Disease. Am J Cardiol 2022; 166:131-137. [PMID: 34952672 DOI: 10.1016/j.amjcard.2021.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
Most medications are not labeled for use in the pediatric population because they have not been formally studied in children. Data on off-label use of cardiovascular (CV) drugs in the home therapy of children with CV disease are scanty. The study included 325 pediatric patients with CV disease and on ≥1 CV medication who underwent ≥1 visit during 2019 at the Pediatric Cardiology outpatient clinic of Giovanni XXIII Pediatric Hospital in Bari, Italy. A total of 287 patients (88.3%) received ≥1 off-label medication, whereas 113 patients (34.7%) received ≥2 off-label medications, and 22 patients (6.7%) ≥3 off-label medications. In CV medications (n = 27) 85% were used off-label in all cases, and 92.5% were used off-label in ≥50% of patients. Adverse events occurred in 8 patients, leading to drug discontinuation in 2 of them. In all 8 cases, medications were used off-label. In multivariate analysis, congenital heart disease patients with single-ventricle physiology (odds ratio 8.4, 95% confidence interval 2.25 to 54.4) and those with heart failure (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) were at higher risk for receiving ≥2 off-label drugs. The off-label use of CV drugs in the home therapy of children with congenital or acquired heart disease is common and adverse events may occur. Patients with congenital heart disease with single-ventricle physiology and those with heart failure have a higher probability to receive ≥2 off-label medications. This study highlights the need for larger safety and efficacy trials in this specific cohort of pediatric patients.
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Affiliation(s)
- Giovanni Meliota
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, Bari, Italy; Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO) Aldo Moro University of Bari, Bari, Italy.
| | | | - Marcello Benevento
- Institute of Legal Medicine, Department of Interdisciplinary Medicine (DIM), Aldo Moro University of Bari, Bari, Italy
| | - Valentina Console
- Department of Pharmacy, Giovanni XXIII Pediatric Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO) Aldo Moro University of Bari, Bari, Italy
| | - Biagio Solarino
- Institute of Legal Medicine, Department of Interdisciplinary Medicine (DIM), Aldo Moro University of Bari, Bari, Italy
| | - Ugo Vairo
- Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, Bari, Italy
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11
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Degl J, Ariagno R, Aschner J, Beauman S, Eklund W, Faro E, Iwami H, Jackson Y, Kenner C, Kim I, Klein A, Short M, Sorrells K, Turner MA, Ward R, Winiecki S, Bucci-Rechtweg C. The culture of research communication in neonatal intensive care units: key stakeholder perspectives. J Perinatol 2021; 41:2826-2833. [PMID: 34663901 PMCID: PMC8752437 DOI: 10.1038/s41372-021-01220-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/30/2021] [Accepted: 09/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the perspectives of neonatologists, neonatal nurses, and parents on research-related education and communication practices in the neonatal intensive care unit (NICU). STUDY DESIGN Questionnaire circulated through interest groups and administered using the internet. RESULTS 323 respondents responded to the survey. 52 were neonatologists, 188 were neonatal nurses, and 83 were parents of NICU graduates. Analysis was descriptive. Differences were noted between stakeholder groups with respect to whether current medications meet the needs of sick neonates, research as central to the mission of the NICU, availability of appropriate education/training for all members of the research team, and adequacy of information provided to parents before, during, and after a research study is completed. CONCLUSION Engagement of nurses and parents at all stages of NICU research is currently suboptimal; relevant good practices, including education, should be shared among neonatal units.
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Affiliation(s)
- Jennifer Degl
- Speaking for Moms and Babies, Inc., Mahopac, NY, USA
| | | | | | - Sandra Beauman
- CNS Consulting/National Association of Neonatal Nurses, Albuquerque, NM, USA
| | - Wakako Eklund
- Pediatrix Medical Group of TN/National Association of Neonatal Nurses, Nashville, TN, USA
| | - Elissa Faro
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | | | - Carole Kenner
- Council of International Neonatal Nurses, Inc., The College of New Jersey, Ewing, NJ, USA
| | - Ivone Kim
- U.S. Food & Drug Administration, Silver Spring, MD, USA
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12
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Siapkara A, Fracasso C, Egger GF, Rizzari C, Trasorras CS, Athanasiou D, Turner MA. Recommendations by the European Network of Paediatric Research at the European Medicines Agency (Enpr-EMA) Working Group on preparedness of clinical trials about paediatric medicines process. Arch Dis Child 2021; 106:1149-1154. [PMID: 33858819 PMCID: PMC8666697 DOI: 10.1136/archdischild-2020-321433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 12/01/2022]
Abstract
Conduct of clinical trials in babies, children and young people is often hindered by issues that could have been foreseen before the trial opened; that is, some clinical trials are often underprepared. In order to identify a good approach to trial preparedness, the European Network of Paediatric Research at the European Medicines Agency formed a working group. The Working Group included representation from regulators, industry, academics, paediatric clinical research networks and parents.The Working Group consulted widely about how to prepare for paediatric clinical trials. The Group's detailed recommendations have been published (https://www.ema.europa.eu/en/documents/other/preparedness-medicines-clinical-trials-paediatrics-recommendations-enpr-ema-working-group-trial_en.pdf).This paper is a summary of the key recommendations including the following: start early, preferably in parallel to designing the medicine's development plan and individual protocols; identify the rationale and clinical need; listen to the perspectives of children and families, and of patient advocacy groups; identify how many people will be eligible for the trial; identify the resources needed, such as clinical facilities (including play therapy) and out-of-pocket expenditure by participants and their families; use all available data to estimate what is possible; present information about preparedness in a structured way; deploy proportionate resources to support the preparation of trials.A well-prepared, well-designed trial is likely to require fewer changes during its course, be run in a shorter time frame and achieve expected objectives.
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Affiliation(s)
- Angeliki Siapkara
- VRNN, Medicines and Healthcare products Regulatory Agency (MHRA), London, UK
| | | | - Gunter F Egger
- Scientific Evidence Generation Department, European Medicines Agency, Amsterdam, Netherlands
| | - Carmelo Rizzari
- Department of Paediatrics, University of Milan–Bicocca, Milano, Italy
| | | | | | - Mark A Turner
- Institute if Life Course and Medical Sciences, Liverpool Health Partners, University of Liverpool, Liverpool, UK
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Gharibeh N, Razaghi M, Vanstone CA, Wei S, McNally D, Rauch F, Jones G, Kaufmann M, Weiler HA. Maternal Vitamin D Status and Gestational Weight Gain as Correlates of Neonatal Bone Mass in Healthy Term Breastfed Young Infants from Montreal, Canada. Nutrients 2021; 13:nu13124189. [PMID: 34959742 PMCID: PMC8708298 DOI: 10.3390/nu13124189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022] Open
Abstract
The implications of maternal gestational weight gain (GWG) and vitamin D status to neonatal bone health are unclear. We tested whether maternal 25-hydroxyvitamin D (25(OH)D) and GWG relate to neonatal bone mineral content (BMC) and bone mineral density (BMD). Healthy term appropriate for gestational age breastfed neonates (n = 142) and their mothers were recruited 24–36 h after delivery and followed at 1.0 ± 0.5 month. At birth, obstetric data were collected and newborn serum 25(OH)D was measured. At 1 month, neonatal whole-body (WB) BMC, WB BMC relative to body weight (WB BMC/kg), lumbar spine BMC and BMD, maternal and neonatal 25(OH)D concentrations, and anthropometry were measured. Infant BMC and BMD between maternal 25(OH)D (<50, ≥50 nmol/L) and GWG (insufficient, adequate, and excessive) categories were compared. Maternal 25(OH)D was not related to infant whole-body BMC, BMC/kg, lumbar spine BMC, and BMD. Infants in the excessive maternal GWG category had greater (p = 0.0003) whole-body BMC and BMC/kg and lumbar spine BMC and BMD than inadequate GWG, and greater (p = 0.0063) whole-body BMC/kg and lumbar spine BMC and BMD than adequate GWG. These results suggest that maternal GWG, but not vitamin D status, modestly relates to bone mass in neonates.
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Affiliation(s)
- Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - Maryam Razaghi
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - Catherine A. Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - ShuQin Wei
- Institut National de santé Publique du Québec, Montréal, QC G1V 5B3, Canada;
| | - Dayre McNally
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Frank Rauch
- Shriners Hospital for Children, Montréal, QC H4A 0A9, Canada;
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (G.J.); (M.K.)
| | - Martin Kaufmann
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (G.J.); (M.K.)
| | - Hope A. Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
- Correspondence: ; Tel.: +1-613-297-6158
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14
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Pierce CM, Zhang MH, Jonsson B, Iorga D, Cheruvu N, Balagtas CC, Steinhorn RH. Efficacy and Safety of IV Sildenafil in the Treatment of Newborn Infants with, or at Risk of, Persistent Pulmonary Hypertension of the Newborn (PPHN): A Multicenter, Randomized, Placebo-Controlled Trial. J Pediatr 2021; 237:154-161.e3. [PMID: 34052232 DOI: 10.1016/j.jpeds.2021.05.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of sildenafil added to inhaled nitric oxide (iNO) for newborn infants with persistent pulmonary hypertension of newborn (PPHN) or hypoxic respiratory failure (HRF) at risk of PPHN. STUDY DESIGN Part A of a multinational, randomized, double-blind, placebo-controlled trial. Infants ≤96 hours' old, >34 weeks of gestation, receiving iNO (10-20 ppm on ≥50% FiO2) for PPHN or HRF at risk of PPHN, and oxygen index >15 to <60, were randomized (1:1) to intravenous (IV) sildenafil (loading: 0.1 mg/kg, over 30 minutes; maintenance: 0.03 mg/kg/h) or placebo, for up to 14 days. Coprimary end points were treatment failure rate (day 14/discharge) and time on iNO without treatment failure. Secondary end points included time on ventilation and oxygenation measures. RESULTS Of 87 infants screened, 29 were randomized to IV sildenafil and 30 to placebo; 13 discontinued treatment (sildenafil, n = 6; placebo: n = 7), including 3 deaths (sildenafil: n = 2; placebo: n = 1). Treatment failure rates did not differ with sildenafil (27.6%) vs placebo (20.0%; P = .4935). Mean time on iNO was not different with sildenafil (4.1 days) vs placebo (4.1 days; P = .9850). No differences were noted in secondary end points. Most common adverse events (AEs) with sildenafil (≥10% infants) were hypotension (n = 8/29), hypokalemia (n = 7/29), anemia, drug withdrawal syndrome (n = 4/29, each), and bradycardia (n = 3/29). One serious AE (hypotension) was considered treatment-related. CONCLUSIONS IV sildenafil added to iNO was not superior to placebo in infants with PPHN or HRF at risk of PPHN. A review of AEs did not identify any pattern of events indicative of a safety concern with IV sildenafil. Infants will have developmental follow-up (Part B). TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT01720524.
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Affiliation(s)
- Christine M Pierce
- Pediatric and Neonatal Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom.
| | - Min H Zhang
- Global Biometrics and Data Management, Pfizer Inc, La Jolla, CA
| | - Baldvin Jonsson
- Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | | | | | | | - Robin H Steinhorn
- Rady Children's Hospital and University of California San Diego, San Diego, CA
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15
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Haslund-Krog SS, Jorgensen IM, Henriksen TB, Dalhoff K, Debes NM, van den Anker J, Holst H. Challenges in conducting paediatric trials with off-patent drugs. Contemp Clin Trials Commun 2021; 23:100783. [PMID: 34258467 PMCID: PMC8253945 DOI: 10.1016/j.conctc.2021.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction For more than two decades several initiatives have emerged to increase recruitment of paediatric patients in drug trials. While trials of newly approved drugs have successfully included paediatric patients in their drug development plan, the collection of safety and efficacy data in paediatric patients treated with off-patent drugs poses a major challenge. Aim This paper aims to draw attention to problems and solutions across countries in investigator-initiated trials with off-patent drugs and recommendations for improvement. Discussion Off-patent drugs represent a particular challenge when they are included in a paediatric trial; these trials are frequently investigator-initiated and have limited resources, off-patent drugs are used in clinical settings and the trial protocol must accommodate e.g. flexible dosing and specimen sampling schedules, off-patent drugs typically exist in few formulations and concentrations which necessitates special or imported formulations. Paediatric trials are in some countries confined by e.g. consent from both parents, regardless of whether the Investigational Medicinal Product (IMP) is a well-known drug or a new experimental drug. Conclusion Facilitation of research in off-patent drugs can improve evidence-based and safe treatment for the paediatric population. The following supportive initiatives are recommended: Harmonised regulatory change that improves the consent process in low risk trials to prevent inadequate recruitment. Pharmaceutical expertise should be prioritized to secure the best choice of IMP and supply. Constant focus on flexibility in design to accommodate a multifaceted paediatric population and ensure that trial protocols fit in well with routine clinical care and family life.
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Affiliation(s)
- S S Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - I M Jorgensen
- Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - T B Henriksen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - N M Debes
- Department of Paediatric and Adolescent Medicine, Herlev Hospital, Borgmester Ib Juuls Vej 25C, 2730, Herlev, Denmark
| | - J van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, 20010, USA.,Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Switzerland
| | - H Holst
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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16
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Ruggieri L, Ceci A, Bartoloni F, Elie V, Felisi M, Jacqz-Aigrain E, Lupo M, Malik S, Manfredi C, Reggiardo G, Demotes J, Bonifazi D. Paediatric clinical research in Europe: an insight on experts' needs and perspectives. Contemp Clin Trials Commun 2021; 21:100735. [PMID: 33665471 PMCID: PMC7905444 DOI: 10.1016/j.conctc.2021.100735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023] Open
Abstract
PedCRIN is a Horizon 2020 project aimed to develop a paediatric component of ECRIN (European Clinical Research Infrastructure Network) including tools supporting the conduct of neonatal and paediatric trials. A structured, cross-sectional, closed-ended questionnaire was electronically administered from April to May 2017 to stakeholders involved in paediatric clinical research to capture their needs to receive infrastructural support to cover specific research gaps. The questionnaire included 6 headings and 29 subheadings. Each item was evaluated using a Likert-scale. 147 questionnaires were returned (response rate of 24.6%). The application of innovative study design and the preparation of protocols for paediatric interventional clinical trials had the highest frequency of high need for support (123 and 117 respondents, respectively). Similarly, the identification and applications to relevant calls for funding was acknowledged as an area in which support is needed (123 respondents declaring high need). In 14 out of 29 activities, need for support was significantly higher in the respondents not being part of a Paediatric Research Network or Consortium (especially for regulatory expertise, pharmacovigilance and GCP training). Conclusions: These results document that the achievement of PedCRIN objectives would greatly advantage the paediatric research community.
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Affiliation(s)
- Lucia Ruggieri
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70100, Valenzano, BA, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70100, Valenzano, BA, Italy
| | - Franco Bartoloni
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70100, Valenzano, BA, Italy
| | - Valèry Elie
- Assistance Publique Hôpitaux de Paris, Clinical Investigation Center, Hôpital Universitaire Robert Debré, 48 Boulevard Serrurier, 75019, Paris, France
| | - Mariagrazia Felisi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Nicolò Putignani 178, 70122, Bari, Italy
| | - Evelyne Jacqz-Aigrain
- Assistance Publique Hôpitaux de Paris, Clinical Investigation Center, Hôpital Universitaire Robert Debré, 48 Boulevard Serrurier, 75019, Paris, France
| | - Mariangela Lupo
- TEDDY - European Network of Excellence for Paediatric Research, Via Luigi Porta, 14 27100, Pavia, Italy
| | - Salma Malik
- The European Clinical Research Infrastructure Network (ECRIN), 5-7 Rue Watt, 75013, Paris, France
| | - Cristina Manfredi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Nicolò Putignani 178, 70122, Bari, Italy
| | - Giorgio Reggiardo
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Nicolò Putignani 178, 70122, Bari, Italy
| | - Jacques Demotes
- The European Clinical Research Infrastructure Network (ECRIN), 5-7 Rue Watt, 75013, Paris, France
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Nicolò Putignani 178, 70122, Bari, Italy
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17
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Wilkinson D, Zayegh A. Valuing life and evaluating suffering in infants with life-limiting illness. THEORETICAL MEDICINE AND BIOETHICS 2020; 41:179-196. [PMID: 33331998 PMCID: PMC7745707 DOI: 10.1007/s11017-020-09532-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 05/20/2023]
Abstract
In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child's future life? Third, if the life of a child with life-limiting illness is prolonged, how much suffering will she experience and can any of it be alleviated? Is there a risk that negative experiences for such a child (suffering) will remain despite the provision of palliative care? We argue that both the subjective and objective components of well-being for children could be greatly reduced if they are anticipated to have a short life that is affected by profound cognitive impairment. This does not mean that their overall well-being will be negative, but rather that there may be a higher risk of negative overall well-being if they are expected to experience pain, discomfort, or distress. Furthermore, we point to some of the practical limitations of therapies aimed at relieving suffering, such that there is a risk that suffering will go partially or completely unrelieved. Taken together, these considerations imply that some life-prolonging treatments are not in the best interests of infants with severe life-limiting illness.
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Affiliation(s)
- Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- John Radcliffe Hospital, Oxford, UK.
| | - Amir Zayegh
- John Radcliffe Hospital, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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18
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Al Qadrah BH, Al-Saleh AM, Al-Sayyari A. Saudi pediatric residents' confidence in handling ethical situations and factors influencing it. Int J Pediatr Adolesc Med 2020; 8:160-164. [PMID: 34350328 PMCID: PMC8319651 DOI: 10.1016/j.ijpam.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
Abstract
Background During their residency program, pediatric residents frequently face ethical challenges. The aim of the study is to evaluate the pediatric residents’ knowledge and confidence to handle common ethical dilemmas during their training. Methods This is a survey-based cross-sectional study on all pediatric residents in the largest pediatric training center in Saudi Arabia. The survey had six sections: a) Demographics and self-assessment of religiosity, b) Sources of ethics education, c) Degree of confidence in dealing with ethical challenges in clinical practice, d) Rating of the quality of ethics education during residency, e) Agreement or disagreement regarding ten ethical scenarios, and f) Confidence level in handling 21 different ethical situations. The response to the survey questions was based on a Likert scale; the survey was electronically distributed to all pediatrics residents. Mean knowledge scores and 95% confidence intervals (CI) were calculated for each independent variable to test for associations. Comparisons were made using an independent t-test or an ANOVA test when there were more than two groups. Result Eighty residents responded to the study (85.1% response rate). Over 60% reported that the best source of ethical education for them was through discussions with a senior physician and it was through formal lecturers in 13.8%. One-fifth felt confident in dealing with ethical challenges. Only 2.5% rated the ethics education as “very good/excellent” and 12.5% rated the “support from residency program for ethics education” as being “very good/excellent.” Agreement of more than 80% was only noted for 4 of 10 of the ethical scenarios. Overall, only 16.4% felt “confident/extremely confident” in handling different ethical situations while 38.5% felt “not confident/a little confident” with more confidence among male residents (35.3% versus 18.7% p = 0.01). Marital status, year of residency, religiosity, and source of ethics knowledge had no impact on the level of confidence. Conclusion Overall, the ethics education was considered inadequate. Only one fifth had the confidence in dealing with ethical situations. Gender but not marital status, year of residency, religiosity, or source of ethics knowledge had an impact on the level of confidence in handling ethical situations.
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Affiliation(s)
- Bedoor H Al Qadrah
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Al-Saleh
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulla Al-Sayyari
- Department of Medicine, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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19
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Germovsek E, Barker CIS, Sharland M, Standing JF. Pharmacokinetic-Pharmacodynamic Modeling in Pediatric Drug Development, and the Importance of Standardized Scaling of Clearance. Clin Pharmacokinet 2020; 58:39-52. [PMID: 29675639 PMCID: PMC6325987 DOI: 10.1007/s40262-018-0659-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pharmacokinetic/pharmacodynamic (PKPD) modeling is important in the design and conduct of clinical pharmacology research in children. During drug development, PKPD modeling and simulation should underpin rational trial design and facilitate extrapolation to investigate efficacy and safety. The application of PKPD modeling to optimize dosing recommendations and therapeutic drug monitoring is also increasing, and PKPD model-based dose individualization will become a core feature of personalized medicine. Following extensive progress on pediatric PK modeling, a greater emphasis now needs to be placed on PD modeling to understand age-related changes in drug effects. This paper discusses the principles of PKPD modeling in the context of pediatric drug development, summarizing how important PK parameters, such as clearance (CL), are scaled with size and age, and highlights a standardized method for CL scaling in children. One standard scaling method would facilitate comparison of PK parameters across multiple studies, thus increasing the utility of existing PK models and facilitating optimal design of new studies.
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Affiliation(s)
- Eva Germovsek
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK. .,Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, PO Box 591, 751 24, Uppsala, Sweden.
| | - Charlotte I S Barker
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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20
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O’Hara K, Martin JH, Schneider JJ. Barriers and Challenges in Performing Pharmacokinetic Studies to Inform Dosing in the Neonatal Population. PHARMACY 2020; 8:E16. [PMID: 32033361 PMCID: PMC7151681 DOI: 10.3390/pharmacy8010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/22/2022] Open
Abstract
A number of barriers and challenges must be overcome in order to conduct the pharmacokinetic studies that are urgently needed to inform the selection and dosing of medication in neonates. However, overcoming these barriers can be difficult. This review outlines the common barriers researchers are confronted with, including issues with ethics approval and consent, study design for pharmacokinetic studies and the ability to measure the drug concentrations in the blood samples obtained. Strategies to overcome these challenges are also proposed.
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Affiliation(s)
- Kate O’Hara
- Discipline of Clinical Pharmacology, School of Medicine, University of Newcastle, Hunter Medical Research Institute Newcastle, Newcastle 2308, Australia; (J.H.M.); (J.J.S.)
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21
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Pressler RM, Lagae L. Why we urgently need improved seizure and epilepsy therapies for children and neonates. Neuropharmacology 2019; 170:107854. [PMID: 31751548 DOI: 10.1016/j.neuropharm.2019.107854] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/22/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
In contrast to epilepsy in adolescents and adults, neonatal seizures and early onset epilepsy poses unique challenges with significant repercussion for treatment choices. Most importantly, high seizure burden and epileptic encephalopathy are associated with developmental, behavioural and cognitive problems. The causes are multifactorial and include etiology, seizure burden, epileptic encephalopathy, but also antiseizure medication. In contrast to adults and older children only very few drugs have been licenced for infants and neonates, and after a long delay. Very recently, extrapolation of adult data has become possible as a path to speed up drug development for younger children but this is not necessarily possible for infants and neonates. With the advances in understanding the molecular basis of many epilepsies, targeted therapies become available, for example for KCNQ2 mutation related epilepsies, Dravet syndrome or tuberous sclerosis complex. Drug trials in neonates are particularly challenging because of their inconspicuous clinical presentation, the need for continuous EEG monitoring, high co-morbidity, and poor response to antiepileptic drugs. There is an urgent need for development of new drugs, evaluation of safety and efficacy of current antiseizure drugs, as well as for national policies and guidelines for the management of seizures and epilepsy in neonates and infants. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Affiliation(s)
- Ronit M Pressler
- Neuroscience Unit, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Lieven Lagae
- Department Paediatric Neurology, University Hospitals, Leuven, Belgium
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22
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Sivanandan S, Jain K, Plakkal N, Bahl M, Sahoo T, Mukherjee S, Gupta YK, Agarwal R. Issues, challenges, and the way forward in conducting clinical trials among neonates: investigators' perspective. J Perinatol 2019; 39:20-30. [PMID: 31485015 PMCID: PMC8075906 DOI: 10.1038/s41372-019-0469-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clinical trials are essential to test the safety and efficacy of new treatments in any population. The paucity of drug trials especially in the neonatal population has led to the widespread use of unlicensed or off-label medications, exposing them to the risks of drug toxicity and ineffective treatment. Ethical and operational challenges are no longer considered valid excuses for not conducting drug trials in neonates. We recently participated in a combined phase-2 and phase-3 trial investigating a new indigenous goat lung surfactant extract (GLSE) for the treatment of respiratory distress syndrome (RDS) in preterm neonates. In this article, we share pertinent challenges faced by us during the trial to better inform and foster-positive discussion among drug developers, administrators, regulatory authorities, patient advocacy groups, and researchers. Also, we provide many tools developed for the GLSE trial that can be modified and used by prospective trialists.
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Affiliation(s)
- Sindhu Sivanandan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kajal Jain
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nishad Plakkal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Monika Bahl
- Clinical Development Services Agency, Faridabad, India
| | - Tanushree Sahoo
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shirshendu Mukherjee
- Grand Challenges India, Biotechnology Industry Research Assistance Council, New Delhi, India
| | | | - Ramesh Agarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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23
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Soul JS, Pressler R, Allen M, Boylan G, Rabe H, Portman R, Hardy P, Zohar S, Romero K, Tseng B, Bhatt-Mehta V, Hahn C, Denne S, Auvin S, Vinks A, Lantos J, Marlow N, Davis JM. Recommendations for the design of therapeutic trials for neonatal seizures. Pediatr Res 2019; 85:943-954. [PMID: 30584262 PMCID: PMC6760680 DOI: 10.1038/s41390-018-0242-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/04/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
Abstract
Although seizures have a higher incidence in neonates than any other age group and are associated with significant mortality and neurodevelopmental disability, treatment is largely guided by physician preference and tradition, due to a lack of data from well-designed clinical trials. There is increasing interest in conducting trials of novel drugs to treat neonatal seizures, but the unique characteristics of this disorder and patient population require special consideration with regard to trial design. The Critical Path Institute formed a global working group of experts and key stakeholders from academia, the pharmaceutical industry, regulatory agencies, neonatal nurse associations, and patient advocacy groups to develop consensus recommendations for design of clinical trials to treat neonatal seizures. The broad expertise and perspectives of this group were invaluable in developing recommendations addressing: (1) use of neonate-specific adaptive trial designs, (2) inclusion/exclusion criteria, (3) stratification and randomization, (4) statistical analysis, (5) safety monitoring, and (6) definitions of important outcomes. The guidelines are based on available literature and expert consensus, pharmacokinetic analyses, ethical considerations, and parental concerns. These recommendations will ultimately facilitate development of a Master Protocol and design of efficient and successful drug trials to improve the treatment and outcome for this highly vulnerable population.
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Affiliation(s)
- Janet S Soul
- Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.
| | - Ronit Pressler
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Geraldine Boylan
- INFANT Research Centre & Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Heike Rabe
- Brighton and Sussex Medical School, Brighton, England
| | | | | | - Sarah Zohar
- INSERM, UMRS1138, University Paris V and University Paris VI, Paris, France
| | | | | | - Varsha Bhatt-Mehta
- C.S.Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Cecil Hahn
- Division of Neurology, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Scott Denne
- Riley Children's Hospital, Indiana University, Indianapolis, Indiana, USA
| | - Stephane Auvin
- Pediatric Neurology Department & INSERM U1141, APHP, Robert Debré University Hospital, Paris, France
| | - Alexander Vinks
- College of Medicine & Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - John Lantos
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Neil Marlow
- UCL Institute for Women's Health, University College London, London, UK
| | - Jonathan M Davis
- The Floating Hospital for Children at Tufts Medical Center and the Tufts Clinical and Translational Science Institute, Boston, MA, USA
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Moultrie F, Shriver A, Hartley C, Wilkinson D, Ewer AK, Rogers R, Adams E, Slater R. A universal right to pain relief: balancing the risks in a vulnerable patient population. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:62-64. [DOI: 10.1016/s2352-4642(18)30269-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
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Lavan M, Byrn SR, Knipp G. Pediatric Formulations: Knowledge Gaps Limiting the Expedited Preclinical to Clinical Translation in Children. AAPS PharmSciTech 2019; 20:73. [PMID: 30631973 DOI: 10.1208/s12249-018-1253-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/18/2018] [Indexed: 11/30/2022] Open
Abstract
Traditionally, drug discovery and development research have been primarily focused on the mitigation of disease treatment for the general adult population, often overlooking the medical needs of pediatric patients. While remarkable progress toward the discovery of better medicines has been made, the pharmacological differences between children and adults are often neglected as part of the translation process. In fact, until recently, children have been considered therapeutic orphans due to the lack of significant drug discovery, formulation development, and dosage form design specifically tailored for pediatric patients. Perhaps the least understood is the significant physiological changes that occur during the maturation process from birth to adulthood. It requires careful considerations to achieve age-specific-desired therapeutic outcomes with minimal toxicity. This introduces considerable risk into the preclinical and clinical testing of new medicaments, which until recently, was avoided based on the conventional approach where a demonstration of safe and efficacious use in adults over several years potentially would minimize the chance of adverse juvenile responses. However, the lack of appropriate drug products for children has led to off-label use of adult medicines with potential life-threatening adverse reactions and health complications. Recent developments and future considerations regarding pediatric drug discovery and development using a patient-centric approach in the context of ontogenic biopharmaceutical considerations are discussed below.
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Anaya-Flórez MS, Barbosa-Cortés L, Villasis-Keever MA, Aguilar-Monroy S, Montalvo-Velarde I, López-Alarcón M, Lledias-Corona M, Huerta-Tecanhuey A, Maldonado-Hernández J, Madrigal-Muñiz O, González-Cabello H. Two parenteral amino acid solutions and plasma levels of amino acids in the neonate: A randomized trial. Nutrition 2018; 65:202-207. [PMID: 30879954 DOI: 10.1016/j.nut.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/23/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In neonates on total parenteral nutrition (TPN), amino acids may be a risk factor for developing total parenteral nutrition-associated cholestasis (TPNAC). We aimed, first, to compare methionine, cysteine, and taurine plasma levels between neonates on TPN who were receiving an intravenous amino acid solution based on a breast milk aminogram and those on an intravenous solution of pediatric amino acids based on an umbilical cord aminogram, and second, to determine the frequency of TPNAC. METHODS A double-blind randomized controlled trial was conducted. Ninety-four neonates with a birthweight of 1000g or more and a gestational age of 30 wk or older were admitted and enrolled. Blood samples were obtained at 0, 7, and 14 d of TPN, and plasma amino acid concentrations were determined by ultra-high-resolution liquid chromatography. Continuous variables were compared using the Wilcoxon rank-sum test or Student's t test; categorical variables were compared using the Fisher exact test. RESULTS Thirty-five neonates completed the study (Primene, n = 14; TrophAmine, n = 21). On day 14, methionine plasma concentrations were significantly lower in the Primene group than in the TrophAmine group (27 µmol/L versus 32.9 µmol/L, P = 0.044); the taurine concentration was significantly higher in the same group (72.4 µmol/L versus 45.3 µmol/L, P < 0.0001). There were no differences in TPNAC incidence. CONCLUSIONS Administering an intravenous solution of pediatric amino acids based on the umbilical cord aminogram yielded a higher taurine and lower methionine plasma concentration than did administering a similar solution based on the breast milk aminogram.
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Affiliation(s)
- María Salomé Anaya-Flórez
- Department of Parenteral and Enteral Nutrition, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Lourdes Barbosa-Cortés
- Medical Unit of Nutrition Research, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico.
| | - Miguel Angel Villasis-Keever
- Unit of Analysis and Synthesis of the Evidence, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Silvia Aguilar-Monroy
- Medical Unit of Nutrition Research, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Irene Montalvo-Velarde
- Medical Unit of Nutrition Research, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Mardia López-Alarcón
- Medical Unit of Nutrition Research, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Martha Lledias-Corona
- Department of Parenteral and Enteral Nutrition, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Andrea Huerta-Tecanhuey
- Department of Parenteral and Enteral Nutrition, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Jorge Maldonado-Hernández
- Medical Unit of Nutrition Research, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Olivia Madrigal-Muñiz
- Neonatal Intensive Care Unit, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Héctor González-Cabello
- Neonatal Intensive Care Unit, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
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Safety, dosing, and pharmaceutical quality for studies that evaluate medicinal products (including biological products) in neonates. Pediatr Res 2017; 81:692-711. [PMID: 28248319 DOI: 10.1038/pr.2016.221] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/21/2016] [Indexed: 12/13/2022]
Abstract
The study of medications among pediatric patients has increased worldwide since 1997 in response to new legislation and regulations, but these studies have not yet adequately addressed the therapeutic needs of neonates. Additionally, extant guidance developed by regulatory agencies worldwide does not fully address the specificities of neonatal drug development, especially among extremely premature newborns who currently survive. Consequently, an international consortium from Canada, Europe, Japan, and the United States was organized by the Critical Path Institute to address the content of guidance. This group included neonatologists, neonatal nurses, parents, regulators, ethicists, clinical pharmacologists, specialists in pharmacokinetics, specialists in clinical trials and pediatricians working in the pharmaceutical industry. This group has developed a comprehensive, referenced White Paper to guide neonatal clinical trials of medicines - particularly early phase studies. Key points include: the need to base product development on neonatal physiology and pharmacology while making the most of knowledge acquired in other settings; the central role of families in research; and the value of the whole neonatal team in the design, implementation and interpretation of studies. This White Paper should facilitate successful clinical trials of medicines in neonates by informing regulators, sponsors, and the neonatal community of existing good practice.
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Crawford C, Anderson M, Cooper G, Jackson G, Thompson J, Vale A, Thomas SHL, Eddleston M, Bateman DN. Overdose in young children treated with anti-reflux medications: Poisons enquiry evidence of excess 10-fold dosing errors with ranitidine. Hum Exp Toxicol 2017; 37:343-349. [DOI: 10.1177/0960327117705430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C Crawford
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Anderson
- National Poisons Information Service – Newcastle, Regional Drugs & Therapeutics Centre, Newcastle upon Tyne, UK
| | - G Cooper
- National Poisons Information Service – Cardiff, University Hospital Llandough, Cardiff, UK
| | - G Jackson
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Thompson
- National Poisons Information Service – Cardiff, University Hospital Llandough, Cardiff, UK
| | - A Vale
- National Poisons Information Service – Birmingham, City Hospital, Birmingham, UK
| | - SHL Thomas
- National Poisons Information Service – Newcastle, Regional Drugs & Therapeutics Centre, Newcastle upon Tyne, UK
| | - M Eddleston
- National Poisons Information Service – Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - DN Bateman
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Montgomery SM, Kusel J. The prevalence of child-specific utilities in NICE appraisals for paediatric indications: rise of the economic orphans? Expert Rev Pharmacoecon Outcomes Res 2016; 16:347-50. [PMID: 27082293 DOI: 10.1080/14737167.2016.1179116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children are not mini-adults, and thus require studies to be conducted in the population of interest to inform decisions about their care. The paucity of such studies for clinical efficacy lead them to be termed 'therapeutic orphans'. Following the introduction of the 'fourth hurdle' of reimbursement approval on the basis of cost-utility analysis, utility data is now a key requirement for patients to access treatments in England and many other countries. This special report considers whether a paucity of utility valuation studies in children may have made them 'economic orphans' as well and presents results of a review of NICE appraisals as a window on this problem over time.
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Ferro A. Paediatric prescribing: why children are not small adults. Br J Clin Pharmacol 2015; 79:351-3. [PMID: 25371355 DOI: 10.1111/bcp.12540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Albert Ferro
- Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, SE1 9NH, United Kingdom
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Samardzic J, Turner MA, Bax R, Allegaert K. Neonatal medicines research: challenges and opportunities. Expert Opin Drug Metab Toxicol 2015; 11:1041-52. [PMID: 25958820 DOI: 10.1517/17425255.2015.1046433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The key feature of the newborn is its fast age-dependent maturation, resulting in extensive variability in pharmacokinetics and -dynamics, further aggravated by newly emerging covariates like treatment modalities, environmental issues or pharmacogenetics. This makes clinical research in neonates relevant and needed, but also challenging. AREAS COVERED To improve this knowledge, tailoring research tools as well as building research networks and clinical research skills for neonates are urgently needed. Tailoring of research tools is illustrated using the development of dried blood spot techniques and the introduction of micro-dosing and -tracer methodology in neonatal drug studies. Both techniques can be combined with sparse sampling techniques through population modeling. Building research networks and clinical research skills is illustrated by the initiatives of agencies to build and integrate knowledge on neonatal pharmacotherapy through dedicated working groups. EXPERT OPINION Challenges relating to neonatal medicine research can largely be overcome. Tailored tools and legal initiatives, combined with clever trial design will result in more robust information on neonatal pharmacotherapy. This necessitates collaborative efforts between clinical researchers, sponsors, regulatory authorities, and last but not least patient representatives and society.
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Affiliation(s)
- Janko Samardzic
- University of Belgrade, Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, Belgrade, Serbia
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