18.3.2: Neonatal therapeutics Flashcards
Neonates have decreased plasma proteins compared to adults. What is the significance of this for drug doses?
- This means there is less bound drug and more free
- The increased free (active) fraction of the drug can contribute to toxicity e.g. NSAIDs and GI ulceration/nephrotoxicity
How does the metabolic and excretory capacity differ between the neonate and adult horse?
- Neonates have decreased metabolic and excretory capacity
- This is because additional maturation of hepatic and renal function occurs in the 1-2 weeks post-partum
Every neonate is ____ until proven otherwise.
Every neonate is septic until proven otherwise.
What antibiotic characteristics will you consider when selecting an appropriate antimicrobial(s) to treat a foal with sepsis?
- Antibiotic should be bactericidal rather than bacteriostatic (septic foals often neutropenic and immune system less robust than adult horse)
- Antibiotic should be broad-spectrum as gram +ve, gram -ve, and mixed infections are common in sepsis
- IV route preferred as foals have little muscle mass and may have poor muscle and GI perfusion
What would be your go-to antibiotic choice in the septic foal?
- An aminopenicillin e.g. Ampicillin IV
AND - An aminoglycoside e.g. Gentamicin or Amikacin IV
Await culture results and continue based on sensitivity patterns.
*If the risk of sepsis was lower, and perfusion was good, oral TMPS could be given. *
Your septic foal now decides to have high creatinine on top of everything else. You are suspicious of poor renal function. Currently you are giving gentamicin IV. Do you keep doing this?
- No - risk of nephrotoxicity with gentamicin
- May be appropriate to ceftiofur instead
- Ceftiofur is a protected antibiotic, but sepsis is life-threatening, and with renal compromise, the other option is not appropriate, so this choice can be justified
In adults with sepsis, we might use IM procaine penicillin as part of the treatment. Why is this not appropriate in foals?
- Foals have small muscle mass
- There might be inadequate muscle perfusion in the case of the septic foal
- All horses can have reactions to procaine but we especially don’t need this in the already collapsed septic foal
True/false: Alpha-2 agonists are an appropriate choice for sedation of neonates.
False
Alpha-2 agonists should be avoided due to their bradycardic effects
What options are there for sedation of neonates?
- Benzodiazepines (e.g. Diazepam)
- Opioids (Butorphanol)
- Diazepam + Butorphanol
- Foal squeeze
True/false: it is almost always appropriate to give the sick neonate NSAIDs.
False
* NSAIDs must be used with care in neonates
* The side effects are increased compared to adults and can be life-threatening e.g. gastric and duodenal ulceration -> perforation, renal compromise
* If NSAIDs must be used, flunixin meglumine is usually a sensible choice.
* Use the smallest dose for the shortest amount possible and monitor closely for complications.
What are some possible complications of NSAID usage in neonates?
- Renal toxicity
- Gastric and duodenal ulceration –> rupture
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