Pharmacotherapy in the NICU: Current Practices, Challenges and Future Perspectives

Pharmacotherapy is an essential component of the management of critically ill newborns in the Neonatal Intensive Care Unit (NICU). However, safe and effective drug therapy in neonates remains a major clinical and scientific challenge. Neonates, particularly preterm and extremely preterm infants, differ substantially from older children and adults in terms of body composition, organ maturation, renal and hepatic function, enzymatic activity, and pharmacokinetic and pharmacodynamic responses. These developmental characteristics, combined with the rapidly changing clinical condition of critically ill newborns, make drug selection, dosing, administration, monitoring, and evaluation of treatment response particularly complex. Despite advances in neonatal medicine, evidence supporting the use of many medications in newborns remains limited. Off-label and unlicensed drug use is particularly common in NICUs, reflecting the lack of neonatal-specific clinical trials, formulations, dosing information, and regulatory data. Medication safety represents another critical concern, as neonates are particularly vulnerable to medication errors involving prescribing, dose calculation, dilution, preparation, administration, and monitoring.This Research Topic aims to bring together clinicians, clinical pharmacologists, pharmacists, researchers, and other healthcare professionals to explore current practices and emerging challenges in neonatal pharmacotherapy. By bringing together multidisciplinary perspectives, this collection aims to identify current knowledge gaps, highlight areas requiring further research, and promote safer, more precise, and evidence-based pharmacotherapy for newborns in the NICU. The ultimate goal is to move from empirical and extrapolated prescribing toward evidence-based, individualized, and precision pharmacotherapy, ensuring that every medication administered to a newborn provides the greatest possible therapeutic benefit with the lowest possible risk.To gather further insights into neonatal pharmacotherapy for critically ill newborns, we welcome articles addressing, but not limited to, the following themes:• Developmental pharmacokinetics and pharmacodynamics• Individualized drug dosing, therapeutic drug monitoring, and pharmacogenomics• Population pharmacokinetic and pharmacodynamic modeling and model-informed precision dosing• Precision dosing and artificial intelligence• Antimicrobial therapy and antimicrobial stewardship• Analgesia and sedation, respiratory and cardiovascular medications, and anticonvulsants• Short- and long-term safety of neonatal drug exposure, including potential effects on neurodevelopment and other organ systems• Real-world prescribing practices and international differences in neonatal pharmacotherapy• Barriers to conducting neonatal clinical trials• Strategies for improving medication safety and developing neonatal-specific formulations and dosing recommendationsWe particularly welcome original research, systematic and narrative reviews, meta-analyses, clinical studies, pharmacokinetic/pharmacodynamic investigations, pharmacovigilance studies, medication safety research, and innovative methodological approaches. Topic editors: Esra Arun Ozer, Senem Alkan Ozdemir, Mehmet Zuhuri Arun Source: https://www.frontiersin.org/research-topics/87148/pharmacotherapy-in-the-nicu-current-practices-challenges-and-future-perspectives