Table 1.
Illustrations of clinical relevant adverse drug reactions in neonates, with the mechanisms involved.
| Compound | Clinical Syndrome | Mechanisms Involved | Potential Similarities |
|---|---|---|---|
| Sulfisoxazole | “kernicterus” | Highly albumin bound antibiotic, competitive with endogenous compounds, including bilirubin. This results in higher free bilirubin concentrations and subsequent kernicterus. | Similar effects can be anticipated for other high protein bound medicines such as ceftriaxone or diphantoine. |
| Chloramphenicol | “grey baby syndrome” | Impaired glucuronidation capacity, results in chloramphenicol accumulation and subsequent mitochondrial dysfunction, circulatory collapse and death. | Similar effects can be anticipated for other glucuronidation dependent drug metabolism compounds, such as paracetamol or propofol. |
| Kaletra (lopinavir/ritonavir) | “alcohols” | Kaletra syrup contains both ethanol and propylene glycol. Impaired metabolic clearance results in accumulation, and subsequent hyperosmolality, lactic acidosis, renal toxicity, central nervous system impairment, cardiac arrhythmia, hemolysis and collapse. | Explained by ethanol/propylene glycol, competition for hepatic metabolic elimination. |
| Codeine by breastfeeding | “SIDS” | Exposure to morphine after conversion from codeine, related to an ultrafast metabolizer maternal genotype. The newborn has a poor glucuronidation and renal elimination capacity, resulting in accumulation, sedation, and sudden infant death syndrome. | Similar effects can be anticipated by other analgesics, such as oxycodone. |
| Ceftriaxone + Calcium | “collaps” | Simultaneous administration of calcium containing infusions and ceftriaxone results in intravascular precipitate, as observed during autopsy. | May be similar for other “mixtures” with calcium containing formulations. |
| Topical iodide | “hypothyroidism” | More pronounced skin permeability and higher body surface area results in more effective absorption of iodine with subsequent suppression of thyroid function. | Similar for other topical compounds, e.g., steroids and hexachlorophene. |