Pharmacogenomics In Neonatal Care: Tailoring Drug Therapy Based on Genetic Profiles in Infants
Keywords:
Pharmacogenomics, Neonates, Precision medicine, CYP450, Personalized therapy, Neonatal drug metabolismAbstract
Neonatal pharmacotherapy remains a clinical challenge due to the immaturity of organ systems and the absence of robust age-specific pharmacokinetic and pharmacodynamic data. As most drugs used in Neonatal Intensive Care Units(NICUs) are prescribed off-label, there is a heightened risk of adverse drug reactions, therapeutic inefficacy, and unpredictable dosing. Pharmacogenomics, the study of how genetic variation influences drug response, offers a promising strategy to individualize therapy in neonates. However, its application in this vulnerable population is complicated by ontogeny, the dynamic kinetics of metabolic enzymes and transport systems. This review explores the fundamental principles of pharmacogenomics in the neonatal context, detailing gene-drug interactions of clinical significance involving CYP450 enzymes, uridine diphosphate glucuronosyltransferases (UGTs), thiopurine methyltransferase (TPMT), Dihydropyrimidine dehydrogenase (DPYD) and transporters. The current genomic tools, such as next-generation sequencing and point-of-care genotyping, address implementation barriers, including ethical considerations, data interpretation challenges, and provider preparedness are evaluated in this review. Real-world applications, such as the prevention of aminoglycoside-induced cytotoxicity and optimization of sedative dosing, highlight the clinical value of early genotyping. Looking forward, the integration of electronic health records, AI-driven decision support, and neonatal-specific pharmacogenomic databases will be pivotal in mainstreaming personalized medicine in NICUs. Pharmacogenomics thus holds the potential to reshape neonatal care by improving drug safety, efficacy, and health outcomes since the earliest stages of life.
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