Optimizing Pediatric Dosing: A Developmental Pharmacologic Approach

Gail D. Anderson, Ph.D.; Anne M. Lynn, M.D.

Disclosures

Pharmacotherapy. 2009;29(6):680-690. 

In This Article

Renal Clearance

At birth, the glomerular filtration rate is approximately 40 ml/minute/1.73 m2 in the fullterm neonate. This rate increases steadily to 50–75% of adult function by 6 months. Tubular secretion lags behind maturation of glomerular filtration by 7 months–1 year, leading to a glomerular-tubular maturational imbalance.[89] Renal function fully matures by around 1 year of age.[90] Transporter proteins participate in active renal excretion and reabsorption of many drugs; however, knowledge regarding their maturation remains scant.[91] In general, weight-normalized doses of drugs excreted predominantly unchanged by the kidneys must be reduced for only neonates and infants. By 1 year of age, dosing based on body weight is similar in children and in adults.

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