ABSTRACT
This chapter describes the indications, acceptance, and increasing use of neonatal therapeutic drug monitoring (TDM). Neonatal TDM is useful but complicated. In order to maximize the effectiveness of neonatal TDM, a number of practical problems must be recognized and solved. Neonatal therapy involves diagnostic uncertainty. Antibiotics are often started before a diagnosis is confirmed, because the risk of waiting for confirmation of sepsis far exceeds the risk of unnecessary treatment. The signs, especially neurological or subjective signs, of efficacy or toxicity are also often difficult or impossible to detect or measure in the newborn. Proper TDM interpretation requires accurate dosing information, which is especially difficult to obtain in neonates. Contamination is also a major problem if venous samples are obtained from parenteral infusion sites.
