Neonates are the most physiologically immature and vulnerable to drug dosing. There is a pronounced difference in the anatomical and physiological profiles between neonates and older people, affecting the absorption, distribution, metabolism, and excretion of drugs in vivo, ultimately leading to changes in drug concentration.
Parameters |
Population |
Main Performance |
---|---|---|
Gastric pH |
Preterm neonates |
1. Relatively higher than term infants [13]. |
Neonates |
1. Drops from approximately 7 to approximately 2 after birth, then rises to above 4 [32][42]. |
|
Infants |
||
Adults |
1. Approximately 1–2. |
|
Gastric volume |
Neonates |
1. Decreased compared with older children and adults. |
Gastric motility |
Highly preterm neonates |
|
Term neonates |
1. Slower than that in older children and adults, and matures rapidly after birth [33][43]. |
|
Adults |
||
Intestinal pH |
Neonates/infants |
1. 6.6 ± 0.4 for duodenal pH; 6.6 ± 0.4 and 6.8 ± 0.7 for the pH of jejunum and ileum, respectively [42][52]. |
Adults |
||
Intestinal transit time |
Preterm newborns |
|
Term neonates |
1. Approximately four hours proven by an in vitro model [38][48]. |
|
Adults |
1. Approximately four hours. |
|
Intestinal surface area |
Neonates/infants/children |
1. Reduced surface-to-volume ratio compared with adults [44][54]. |
Intestinal permeability |
Preterm neonates |
1. The intestinal permeability in preterm neonates (GW 26–36) was higher than full-term newborns [45][55]. |
Intestinal microbiome |
Preterm neonates |
1. Reduced microbial diversity and increased pathogenic organism colonization vs. term neonates [46][56]. |
Term neonates |
1. Immature and matures rapidly during the first year of life [46][56]. |
|
Intestinal fluid composition |
Neonates/infants |
1. Lower bile acid and salt concentration, no secondary bile salts, and higher total protein and lipid concentrations compared to adults [47][57]. |
Digestive enzyme secretion |
Preterm neonates |
1. Enterokinase secretion at GW 24 is approximately 25% of the values of older infants [31][41]. 2. Lactase activity at GW 34 is only 30% of the levels in term neonates [48][58]. |
Term neonates |
1. Trypsin secretion reaches approximately 90% of childhood levels at term [49][59]. 2. Pepsin expression is not completed in neonates and matures with age [38][48]. 3. Pancreatic triglyceride lipase is lower in neonates than in adults [50][60]. |
|
Intestinal P-gp |
Preterm neonates |
1. Expression is lower than term infants, children, and adults [39][49]. |
Term neonates |
||
Intestinal CYP3A4 |
Neonates |
1. Low expression after birth and increases from neonates to adults [36][40][46,50]. |
Abbreviations: CYP, cytochrome P450; GW, gestational week.
Parameters |
Population |
Main Performance |
---|---|---|
Total body water (%) |
Preterm neonates |
|
Term neonates |
||
Adults |
||
Total body fat (%) |
Preterm neonates |
3% in a premature neonate with deficient birth weight [53][54][55][63,64,65]. |
Term neonates |
||
Weight loss |
Preterm neonates |
|
Term neonates |
||
HAS levels |
Preterm neonates |
The mean albumin level in preterm infants (GW 23–34) is 2.36 g/dL [58][68]. |
Term neonates |
The mean albumin level in full-term neonates is 3.43 g/dL [58][68]. |
|
Adults |
||
AAG levels |
Preterm newborns |
Stay stable at a low level until 260 days of GA and significantly increase afterward [59][69]. |
Term neonates |
Abbreviations: AAG, alpha 1-glycoprotein; GW, gestational week, HAS, human serum albumin.
Enzymes |
Measure Methods |
Age-Related Changes |
---|---|---|
CYP1A1 |
Western blot |
1. Detectable in fetal liver during 11–20 weeks, undetectable in adults [93][103]. |
Gene expression |
1. Detectable in human embryonic livers (GW 6–12), and decreases with increasing age [94][95][104,105]. |
|
CYP1A2 |
Western blot |
1. No expression in fetal and neonatal livers, and its levels increased in infants aged 1–3 months to reach 50% of the adult value by 1 year of age [96][106]. |
Gene expression |
||
CYP1B1 |
Gene expression |
|
CYP2A6 |
Immunohistochemistry |
1. Expression approaches adult levels by 1 year of age [99][109]. |
Gene expression |
1. Undetectable in fetal liver, increases with age [100][110]. |
|
CYP2B6 |
Immunohistochemistry |
1. Approximately 10% of adult levels within the 1st year of life [99][109]. |
Gene expression |
||
CYP2C8 |
Western blot |
1. Undetected in fetal livers and matures in the first few weeks after birth, not related to GA [101][111]. |
Gene expression |
1. Low expression in fetuses, approximately 10% of the adult values [100][101][110,111]. |
|
CYP2C9 |
Quantitative proteomics |
1. Increases linearly over age and reaches adult level in the pediatric period [82][92]. |
Gene expression |
1. Undetectable in fetal samples, comparable in pediatric population and adults [82][92]. |
|
CYP2C19 |
Quantitative proteomics |
1. Expression peaked during the pediatric period (>2-fold higher compared to adult) [82][92]. |
Western blot |
1. Expression in children was 140% of that in adult liver [102][112]. |
|
Gene expression |
1. Undetectable in fetuses, higher expression in the pediatric population than in adults [82][92]. |
|
CYP2D6 |
Western blot |
1. Undetectable in fetal livers (GW 11–13) [103][113]. 2. Expression in fetal liver (>GW 30) was comparable to that of newborns aged 1–7 days; increased significantly after birth and reached 50 to 75% of adult level during the neonatal period [93][103]. |
Gene expression |
||
CYP2E1 |
Western blot |
1. CYP2E1 was detectable in the liver as early as the second trimester; its expression in neonates was lower than that of infants 31 to 90 days less than that of older infants, children, and young adults [78 |
Transporters |
Measure Methods |
Expression Related to Age |
|||
---|---|---|---|---|---|
Hepatic Transporters |
|||||
MDR1 |
Quantitative proteomics |
1. P-gp expression was significantly lower in neonatal or infant livers and increased with age [151][161]. 2. Lower expression in neonates than in adults, whereas no difference between preterm and term newborns [152][162]. |
|||
Western blot |
1. Lower expression in S9 liver fractions from children (seven days to 18 years old) than that from adults [153][163]. |
||||
Gene expression |
|||||
BCRP |
Quantitative proteomics |
||||
Western blot |
|||||
Immunohistochemistry |
|||||
Gene expression |
1. Gene expressed in fetuses is 3-fold lower than that in adults [156][166]. 2. Expression in neonates is lower than children > 7 years [149][159]. |
||||
OATP1B1 |
Quantitative proteomics |
1. High expression in fetuses and low expression in term neonates [152][162]. |
|||
Gene expression |
|||||
OATP1B3 |
Quantitative proteomics |
1. Stable from fetuses to adults [152][162]. 2. Expression is lower in neonates than in adults and increased with age [151][161]. |
|||
Immunohistochemistry |
1. Expressed in early childhood; increases with age [147][157]. |
||||
] | |||||
Gene expression |
|||||
OATP2B1 |
Quantitative proteomics |
||||
Immunohistochemistry |
1. Expressed in early childhood, overexpression in neonates and young infants [147][157]. |
||||
Gene expression |
1. Gene expression is much higher in adults than in fetuses and neonates [40][50]. |
||||
NTCP |
Quantitative proteomics |
1. Stable from neonates to adults [151][161]. 2. Lower expression in preterm neonates than that in adults [152][162]. |
|||
[ | ]. 2. Expression increased gradually, reaching 30 to 40% of adult levels by one year and approaching adult levels by 10 years [104][114]. 3. Expression in fetal liver (GW 16) was about 10 to 30% of adult levels, and remained stable for up to 24 weeks [105][115]. |
||||
Gene expression |
1. Low expression in fetal livers and increased after birth [106][116]. |
||||
Western blot |
|||||
Gene expression |
1. Lower gene expression in neonates than in adults [40][50]. |
CYP2J2 | |||
OCT1 |
Quantitative proteomics |
1. Lower expression in term neonates than in adults [152][162]. 2. Lower expression in neonates than in young infants and increases to adult age [151][161]. |
|||
Western blot | Western blot |
1. Low expression in newborns, increases from birth up to 8–12 years old [157][167]. 1. Expression in fetal liver (GW 13–18) was comparable to the adult level [107][117]. |
|||
CYP3A4 |
Quantitative proteomics |
1. Increased after birth and reached adult levels around 1 year of age [82] | |||
MRP2 | [ |
Quantitative proteomics]. |
|||
1. Lower expression in term neonates than in adults [152][162]. |
Western blot |
1. Expression in fetal livers was low, and increased after birth to reach 30%–40% of adult levels [75][85]. 2. Expression increased with age [108] | |||
Gene expression |
Lower gene expression in fetuses and neonates than that in adults [40][50]. [118]. 3. Expression in children was 60% of adult levels [102][112]. |
||||
Gene expression |
|||||
MRP3 |
1. Low expression in fetuses, increased during childhood, and then became comparable with adults in pediatric period [82][92]. 2. Expression increased rapidly after birth and reached a plateau at the first week of age [75][85]. 3. Only detectable after birth and was highly variable (10-fold) among adults [109][119]. 4. Expression exhibited a 29–fold increase after a postnatal surge [108][118]. |
||||
Quantitative proteomics |
1. Lower expression in term neonates than in adults [152][162]. 2. Lower expression in infants and adolescents than that in adults [151][161]. |
CYP3A5 |
|||
Gene expression | Quantitative proteomics |
1. Lower gene expression in fetuses than that in adults [156][166]. |
|||
Gene expression |
|||||
MRP1 |
1. Expression remained stable in fetuses, pediatrics, and adults [82][92]. 2. Detectable in all the fetal and 23% of adult samples [109][119 |
Quantitative proteomics ]. |
|||
CYP3A7 |
Quantitative proteomics |
1. Very high expression in fetal samples, then decreased in the pediatrics and adults [82][92]. |
|||
2. Lower expression in term neonates than in adults | |||||
Immunohistochemistry |
Western blot |
||||
MRP4 |
1. High expression in the fetal livers; its activity peaked in the first week after birth, then decreased [75][85]. |
||||
Gene expression |
Gene expression |
1. High expression in fetal livers and decreased with age to be undetectable in adults [82][92] | |||
MRP6 | . 2. Detectable in fetal livers at GA 50–60 days, continued to be expressed at a significant levels during the perinatal period, then decreased after first week of age until undetectable by 1 year old [75][85]. 3. Expression in adults was proven [109] |
Gene expression [ 119]. |
|||
1. Expression increases in an age-dependent manner from neonates to adults [149][159]. |
CYP4A1 |
||||
BSEP |
Western blot |
1. Expression in fetal livers reached 40% of the adult levels and continued to increase during the first week after birth [110][120]. |
|||
Quantitative proteomics |
1. Lower expression in fetuses and term neonates than in adults [152][162]. |
Carboxylesterases |
Western blot |
1. No significant difference in expression of carboxylesterases between infants (2–24 months) and adults (20–36 years) [80] | |
Immunohistochemistry |
[90]. 2. Expression was age-dependent: adult > children > fetuses [81][91]. |
||||
Gene expression |
1. The liver expressed two major carboxylesterases: HCE1 and HCE2. Expression was age-dependent: adult > children > fetuses [81 | ||||
Gene expression | ][91]. |
||||
1. Lower expression in fetuses and neonates than that in adults [149][156][159,166]. |
FMO1 |
Quantitative proteomics | |||
MATE1 |
Immunohistochemistry 1. High expression in fetuses, and undetectable in pediatrics and adults [82][92]. |
||||
1. No age-dependent changes in protein abundance |
Western blot |
1. Highest expression in the embryo (GW 8–15) and suppressed within 3 days after birth [111][121]. |
|||
Gene expression |
1. Expression increase in an age-dependent behavior [149][159]. |
Gene expression |
|||
GLUT1 |
Quantitative proteomics |
1. Higher in fetal livers than in term neonates, children, and adults [152][162]. |
FMO3 |
||
MCT1 |
Quantitative proteomics |
Quantitative proteomics 1. A linear increase from the fetal period into adulthood [82][92]. |
|||
1. Stable expression from fetuses to adults |
Western blot |
1. Low expression in embryo, undetectable in the fetus, increased to be detectable by 1–2 years of age, continued to increase up to 18 years of age [111][121]. 2. Higher expression in children 2–8 years of age than in adults [102] | |||
ATP1A1 | [ 112]. |
||||
Quantitative proteomics |
1. Stable expression from fetuses to adults [152][162]. 2. Lower expression in neonates and increases with age [151][161]. |
Gene expression |
|||
Renal Transporters |
ADH1A |
Western blot |
1. High expression in the fetus, particularly in the first trimester, decreased in the last trimester, and finally undetected in neonates and adults | ||
MDR1 |
Quantitative proteomics | ||||
1. Lowest protein abundance in neonates and reaches adult level during childhood (2–12 yr) |
ADH1B |
||||
Immunohistochemistry | Western blot |
1. Detectable in the kidney by GW 5.5 [147][157]. 1. Detectable in the fetal liver at 17th GW, and dominated by week 36 [112][122]. |
|||
ADH1C |
|||||
Gene expression | Western blot |
1. Expression in premature and/or term newborns was significantly lower than in the older age groups, no difference between preterm and term newborns [159][169]. |
|||
ADH2 |
Gene expression |
||||
BCRP |
Quantitative proteomics |
1. Detected only in fetal livers at concentrations equivalent to adults [113][123]. |
|||
1. Protein abundance is similar between neonates and adults |
ADH3 |
||||
Immunohistochemistry |
Gene expression |
1. High in newborns and reduces with age [147][157]. 1. Widely distributed in fetal tissues at concentrations equivalent to adults [113][123]. |
|||
ADH5 |
|||||
Gene expression |
Gene expression |
1. Detected only in fetal livers at concentrations equivalent to adults [113] |
1. mRNA expression is higher in term newborns than in children and adolescents [159][169]. [123]. |
||
EPHX1 |
Immunocytochemistry |
1. Expression in fetal livers was approximately 25–50% of adult levels, and its activity was detected in fetal livers at GW 6 and increased linearly with age [114][115][124,125]. |
|||
MRP1 |
Immunohistochemistry |
PON1 |
|||
MRP2 |
Gene expression |
||||
Gene expression |
1. Expression is similar between all age groups (preterm newborn, term newborn, infants, children, adolescents, and adults [159][169]. |
PON2 |
Gene expression |
||
MRP4 |
Immunohistochemistry |
AOX |
Western blot |
||
Gene expression |
1. Expression is similar between all age groups (preterm newborn, term newborn, infants, children, adolescents, and adults [159][169]. |
1. Detectable in infants > 4 months old; Undetectable in infants of 13 days old and 2 months old [117][127]. |
|||
UGT1A1 |
Quantitative proteomics |
||||
OCT2 |
Quantitative proteomics |
1. Neonatal abundances of UGT1A1 were 12.2% of adult levels whereas infant abundances (% of adult abundance) were 43; UGT1A1 is the most abundant of the UGT1As in neonates [85][95]. |
|||
1. Protein abundance was lower in term neonates and infants than in older populations |
Gene expression |
||||
Gene expression |
1. Undetected in the fetal liver (GW 20) and stayed stable after 6 months of age [118][128]. |
||||
1. Expression in premature and/or term newborns was significantly lower than in older age groups [159][169]. |
UGT1A3 |
Gene expression |
1. Undetected in the fetal liver (GW 20) and stayed stable after 6 months of age [118][128 | ||
OAT1 |
Quantitative proteomics | ]. |
|||
1. Protein abundance is lowest in term newborns and infants, approaching adult levels in children or adolescents |
UGT1A4 |
Quantitative proteomics | |||
Gene expression |
1. Expression in premature and/or term newborns was significantly lower than in older age groups [159][169]. 1. Neonatal abundances of UGT1A4 were 1.8% of adult levels whereas infant abundances (% of adult abundance) were 16 [85][95]. |
Gene expression |
1. Undetected in the fetal liver (GW 20) and stayed stable after 6 months of age [118 | ||
OAT3 | ][128]. |
||||
Quantitative proteomics |
1. Protein abundance is lowest in term newborns and infants, reaching adult levels in adolescence [159][169 |
UGT1A6 |
Quantitative proteomics |
1. Neonatal abundances of UGT1A6 were 2.9% of adult levels whereas infant abundances (% of adult abundance) were 15 [85][95]. |
|
Gene expression |
1. Undetected in the fetal liver (GW 20) and stayed stable after 6 months of age [118][128]. |
||||
UGT1A9 |
Quantitative proteomics |
1. Neonatal abundances of UGT1A9 were 3.0% of adult levels whereas infant abundances (% of adult abundance) were 24 [85][95]. |
|||
Gene expression |
1. Undetected in the fetal liver (GW 20), increased with age from 6 to 24 months, reaching 70% of the adult levels [118][128]. |
||||
UGT2B4 |
Gene expression |
1. Undetectable in the fetal liver (GW 20), increased progressively [118][128]. |
|||
] | . | ||||
Gene expression |
1. Expression in premature and/or term newborns was significantly lower than in older age groups [159][169]. |
||||
URAT1 |
Quantitative proteomics |
1. Protein abundance is lower in term newborns and infants, reaching adult levels during childhood [159][169]. |
|||
Gene expression |
1. mRNA expression in infants and children is higher in term neonates and adults [159][169]. |
||||
MATE1 |
Quantitative proteomics |
||||
Gene expression |
UGT2B7 |
Quantitative proteomics |
1. Neonatal abundances of UGT2B7 were 13.0% of adult levels whereas infant abundances (% of adult abundance) were 41 [85][95]. |
||
Transporters in the blood–brain barrier |
Western blot |
1. Low protein levels and activity at <1 year of age, increased progressively with age, but still less than adult levels at 17 years of age [119][129]. |
|||
MDR1 |
Immunohistochemistry |
1. Low expression at birth (approximately 30% to 50% of adults), increases with postnatal maturation, reaching adult levels at around 3–6 months [160][170]. |
Gene expression |
1. Undetectable in the fetal liver (GW 20) and reached adult levels at 6 months of age [118][128]. |
|
Intestinal transporters |
UGT2B15 |
Quantitative proteomics |
|||
MDR1 |
Quantitative proteomics |
1. Neonatal abundances of UGT2B15 were 38.6% of adult levels whereas infant abundances (% of adult abundance) were 60 [85][95]. |
|||
1. Similar levels in preterm newborns, full-term neonates, and adults |
UGT2B17 |
||||
Immunohistochemistry | Quantitative proteomics |
1. Similar between children of different ages and adults [147][157]. 1. Undetectable in children under 9 years, and increased by about 10-fold to reach adult levels during pubertal development [120][130]. |
|||
SULT1A1 |
Western blot |
||||
Gene expression |
1. Detectable at GW 14-22 [161][171]. 2. Expression in duodenal and jejunal was stable in children from 1 month to adulthood [39][49]. 3. Expression in neonatal and infant intestines is similar to that in adult intestines [40][50]. |
1. Detectable in fetuses at GW 10 and remained stable in fetal and postnatal periods, then increased [89][121][122][99,131,132]. |
|||
SULT1A3 |
Western blot |
1. High expression in early fetal stage and decreased substantially in late fetal stage, then reached low levels in adults | |||
MRP2 | [ | ||||
Immunohistochemistry |
1. Similar between children of different ages and adults [147][157]. |
Gene expression |
1. High expression in early fetal stage and decreased substantially in late fetal stage, then reached low levels in adults [122][132]. |
||
Gene expression |
SULT1C1 |
Gene expression |
|||
OATP2B1 | 1. Low expression in fetal livers and undetectable in adult livers [ |
Quantitative proteomics |
|||
1. Similar levels in preterm newborns, full-term neonates, and adults |
SULT1E1 |
Western blot |
1. Expression peaked in the earliest gestation period [89][ | ||
Immunohistochemistry |
1. Higher expression in neonates and young infants than in adults [147][157]. | 99]. 2. Higher expression in fetal livers than in adults [122][132]. |
|||
Gene expression |
1. Detectable in fetuses at GW 10–14, slightly higher than in adults [122][132]. |
||||
Gene expression |
SULT2A1 |
Western blot |
1. Low expression in fetuses at GW 25, increased to approach adult levels in neonates [89][99]. |
||
GSTA1/2 |
Starch gel electrophoresis |
1. Undetectable in fetal livers before GW 30, and steadily increased to reach adult levels by PNA 1–2 years [124][134]. |
|||
Western blot |
1. Detectable at GW 8 and rapidly increased at GW 13 [125][135]. |
||||
GSTM |
Immunohistochemistry |
1. Detectable in fetal livers (GW 10–30) and then increased rapidly to adult levels by 42 weeks after birth [126][136]. 2. GSTM levels remained constant over pre- and postnatal period [127][137]. |
|||
Western blot |
1. Detectable at GW 8 and slightly decreased at GW 13 [125][135]. |
||||
GSTP1 |
Immunohistochemistry |
1. Expression peaked in early fetal stages at GW 10–22, then decreased in the second and third trimesters, remained detectable in neonates [126][136]. |
|||
Western blot |
1. Detectable in embryo livers at GW 8 and slightly increased at GW 13 [125][135]. |
||||
GSTZ1 |
Western blot |
1. Undetectable in fetal livers, increased with age until 7 years of age, remained stable between 7 and 74 years of age [128][138]. |
Abbreviations: ADH, alcohol or aldehyde dehydrogenases; AOX, aldehyde oxidase; CYP, cytochrome P450; EPHX, human cytosolic epoxide hydrolases; FMO, flavin-containing mono-oxygenase; GA, gestational age; GST, glutathione S-transferases; GW, gestational week; PNA, postnatal age; PON, paraoxonase; SULT, sulfotransferases; UGT, uridine 5′-diphospho-glucuronosyltransferase.
Abbreviations: ATP1A1, ATPase Na+/K+ transporting subunit alpha 1; BCRP, breast cancer resistance protein; BSEP, bile salt export pump; GLUT, glucose transporter; GW, gestational week; MATE, multidrug and toxin extrusion; MCT, Monocarboxylate transporter; MDR, multidrug resistance gene; MRP, multidrug resistance-associated protein; NTCP, sodium/taurocholate cotransporting polypeptide; OAT, organic anion transporter; OATP, organic anion transporting polypeptide; OCT, organic cation transporter; P-gp, P-glycoprotein; TM50, age at which half of the adult value is reached; URAT, uric acid transporter 1.