Excretion

Renal blood flow, glomerular filtration rate, and tubular function are reduced in both preterm and term neonates. Therefore, newborns, especially those less than 34 weeks' gestation, require less frequent dosing intervals for many drugs. Aminoglycosides are administered every 8 hours in older children, every 12 hours in new-borns, and every 24 hours in extremely premature infants. The glomerular filtration rate of the term newborn is approximately 50% less than the adult level but reaches adult values by 1 year of age. Renal blood flow approaches adult values between ages 5 and 12 months. Tubular secretory functions mature at a slower rate than does glomerular filtration. Renal excretion of organic anions, such as penicillin, furosemide, and indomethacin, is very low in the newborn. Tubular secretion and reabsorption reach adult levels by 7 months of age. Renal elimination of drugs appears to play a greater role than does metabolism in newborns. Over the first year of life the infant develops a more adult-type excretory pattern.

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