Precision Dosing and Therapeutic Drug Monitoring Across the Perinatal Continuum: From Maternal Exposure to Neonatal and Pediatric Intensive Care

Few areas of clinical pharmacology are as challenging, or as consequential, as getting drug doses right during pregnancy, in the newborn period, and in critically ill children. Physiology shifts rapidly across gestation, birth, and early life. Organ function matures unevenly, body composition changes week to week, and many of the drugs used in these settings have narrow therapeutic windows, where too little means treatment failure and too much means toxicity. Yet the evidence guiding dose selection remains thin. Neonates and pregnant patients are routinely excluded from trials, and dosing is often extrapolated from adults or older children with little adjustment for the biology at hand.This Research Topic brings together two ends of a single continuum that are usually studied apart: maternal drug exposure and its transfer to the fetus, and the model-informed precision dosing of high-risk drugs once the infant or child reaches intensive care. Drug exposure does not begin at birth. It accumulates before birth, at delivery, and through the course of critical illness. Treating the perinatal period as one connected story, rather than a series of disconnected episodes, offers a more realistic foundation for safer, more effective dosing.We aim to advance the science and practice of therapeutic drug monitoring (TDM) and pharmacometric modelling across this continuum. We welcome work that uses population pharmacokinetic (PK) and physiologically based pharmacokinetic (PBPK) approaches to describe how drugs behave from pregnancy through the neonatal and pediatric intensive care unit, and that translates those models into dosing that clinicians can act on at the bedside.Contributions may address, but are not limited to:o Population PK and PBPK modelling spanning pregnancy, the neonate, the infant, and the older child;o Model-informed precision dosing of narrow-therapeutic-index agents, including antimicrobials such as vancomycin, meropenem, and other drugs where target attainment is difficult to achieve;o TDM and target attainment in the NICU and PICU, including dosing adjusted for renal replacement therapy and dialysis;o Maternal drug exposure and placental transfer - for example, betamethasone, misoprostol, and furosemide - and their links to neonatal drug safety and outcomes;o Integrated obstetric and neonatal monitoring, including data linkage that follows exposure across the perinatal period;o Real-world clinical experience, including catheter-related infection and other case series that inform practical dosing decisions.By connecting maternal exposure to neonatal and pediatric outcomes, this Research Topic seeks to move dosing in these vulnerable populations away from extrapolation and toward evidence built specifically for them. We hope to draw together pharmacologists, neonatologists, pediatric intensivists, obstetricians, clinical pharmacists, and modelers around a shared goal: dosing decisions grounded in the biology of the perinatal continuum.We invite original research, population PK and PBPK modelling studies, systematic reviews, methods and study protocols, and clinical case series. Together, these contributions will help build a clearer, more integrated picture of how to dose safely and effectively from maternal exposure through to intensive care. Topic editors: Jhohann Richard de Lima Benzi, Mara Medeiros Source: https://www.frontiersin.org/research-topics/85012/precision-dosing-and-therapeutic-drug-monitoring-across-the-perinatal-continuum-from-maternal-exposure-to-neonatal-and-pediatric-intensive-care