PDF(Pubmed)
Abstract：
Antibiotic, analgesic sedative, and antiseizure medications are among the most commonly used medications in preterm/sick neonates, who are at high risk of nosocomial infections, central nervous system complications, and are exposed to numerous painful/stressful procedures. These severe and potentially life-threatening complications may have serious short- and long-term consequences and should be prevented and/or promptly treated. The reported variability in the medications used in neonates indicates the lack of adequate neonatal studies regarding their effectiveness and safety. Important obstacles contributing to inadequate studies in preterm/sick infants include difficulties in obtaining parental consent, physicians\' unwillingness to recruit preterm infants, the off-label use of many medications in neonates, and other scientific and ethical concerns. This review is an update on the use of antimicrobials (antifungals), analgesics (sedatives), and antiseizure medications in neonates, focusing on current evidence or knowledge gaps regarding their pharmacokinetics, indications, safety, dosage, and evidence-based guidelines for their optimal use in neonates. We also address the effects of early antibiotic use on the intestinal microbiome and its association with long-term immune-related diseases, obesity, and neurodevelopment (ND). Recommendations for empirical treatment and the emergence of pathogen resistance to antimicrobials and antifungals are also presented. Finally, future perspectives on the prevention, modification, or reversal of antibiotic resistance are discussed.
摘要：
抗生素,镇静剂,抗癫痫药物是早产/患病新生儿最常用的药物之一，医院感染的风险很高，中枢神经系统并发症,并暴露于许多痛苦/紧张的程序。这些严重且可能危及生命的并发症可能具有严重的短期和长期后果，应预防和/或及时治疗。据报道，新生儿使用的药物差异表明缺乏关于其有效性和安全性的充分新生儿研究。导致早产/患病婴儿研究不足的重要障碍包括难以获得父母的同意，医生不愿招募早产儿，在新生儿中使用许多药物的标签外，以及其他科学和伦理问题。这篇综述是对抗菌药物（抗真菌药物）使用的更新，镇痛药(镇静剂),和新生儿的抗癫痫药物，专注于目前关于其药代动力学的证据或知识差距，适应症,安全,剂量,以及在新生儿中最佳使用的循证指南。我们还讨论了早期使用抗生素对肠道微生物组的影响及其与长期免疫相关疾病的关系。肥胖，神经发育（ND）还提出了经验治疗的建议以及病原体对抗菌药物和抗真菌药物的耐药性的出现。最后,关于预防的未来观点，修改,或抗生素耐药性的逆转进行了讨论。
