Neonatal Pharmacogenomics and Pharmacogenetics

Drug therapy is a mainstay in treatment of most diseases; however, there is a wide variation in drug response among individuals. This chapter focuses on the influence of genetics on pharmacokinetics (PK) processes (absorption, distribution, metabolism, and elimination) and pharmacodynamics (PD). This is followed by a more fulsome definition of pharmacogenetics (PGe) and pharmacogenomics (PGx). The chapter summarizes some of the foundational principles and concepts underlying genetic variations in drug responses, and from there reviews some of the current methodologies used in PGe and PGx research. It considers the current state of PGe and PGx related to neonates and identifies genes of specific interest to the neonatal prescriber. Finally, the chapter considers the current and future state of neonatal PGx and discusses the feasibility of routine genomic sequencing in NICUs, and the potential of combined physiologic and genetic models as a means of individualized pharmacotherapy for neonates.