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Children
Special Issues
Childhood Obesity—Perioperative Controversies and Considerations
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Childhood Obesity—Perioperative Controversies and Considerations

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Endocrinology & Diabetes".

Deadline for manuscript submissions: 5 December 2024 | Viewed by 4695

Special Issue Editors

Dr. Janelle Vaughns

E-Mail Website
Guest Editor
Division of Anesthesiology, Sedation & Perioperative Medicine and Division of Clinical Pharmacology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA
Interests: pediatric obesity; obesity pharmacokinetics in chidren; disparity clinical research in obese children; perioperative dosing of commonly used medications in obese children; child and adolescent bariatric anesthesia
Prof. Dr. Johannes Van Den Anker

E-Mail Website
Guest Editor
Division of Clinical Pharmacology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
Interests: developmental pharmacology; neonatal pharmacology; pediatric pharmacology; maternal-fetal pharmacology; fetal pharmacology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Children journal has afforded me and Dr. Johannes Van Den Anker, the great opportunity to be guest editors of a Special Issue dedicated to the topics of childhood obesity and perioperative controversies, including drug dosing and updates in pediatric/adolescent bariatric surgery. Please join me in making this Special Issue innovative and scientifically relevant by contributing your manuscript.

Dr. Janelle Vaughns
Prof. Dr. Johannes Van Den Anker
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • childhood obesity
  • drug dosing in obese pediatric and adolescent patients
  • obesity pharmacokinetics in children
  • disparity research in obese children and adolescents
  • pediatric and adolescent bariatric surgery
  • bariatric anesthesia

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Published Papers (2 papers)

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Review

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17 pages, 2311 KiB  
Review
Perioperative Acetaminophen Dosing in Obese Children
by Brian Joseph Anderson and Luis Ignacio Cortinez
Children 2023, 10(4), 625; https://doi.org/10.3390/children10040625 - 27 Mar 2023
Cited by 2 | Viewed by 2707
Abstract
Acetaminophen is a commonly used perioperative analgesic drug in children. The use of a preoperative loading dose achieves a target concentration of 10 mg/L associated with a target analgesic effect that is 2.6 pain units (visual analogue scale 1–10). Postoperative maintenance dosing is [...] Read more.
Acetaminophen is a commonly used perioperative analgesic drug in children. The use of a preoperative loading dose achieves a target concentration of 10 mg/L associated with a target analgesic effect that is 2.6 pain units (visual analogue scale 1–10). Postoperative maintenance dosing is used to keep this effect at a steady-state concentration. The loading dose in children is commonly prescribed per kilogram. That dose is consistent with the linear relationship between the volume of distribution and total body weight. Total body weight is made up of both fat and fat-free mass. The fat mass has little influence on the volume of distribution of acetaminophen but fat mass should be considered for maintenance dosing that is determined by clearance. The relationship between the pharmacokinetic parameter, clearance, and size is not linear. A number of size metrics (e.g., fat-free and normal fat mass, ideal body weight and lean body weight) have been proposed to scale clearance and all consequent dosing schedules recognize curvilinear relationships between clearance and size. This relationship can be described using allometric theory. Fat mass also has an indirect influence on clearance that is independent of its effects due to increased body mass. Normal fat mass, used in conjunction with allometry, has proven a useful size metric for acetaminophen; it is calculated using fat-free mass and a fraction (Ffat) of the additional mass contributing to total body weight. However, the Ffat for acetaminophen is large (Ffat = 0.82), pharmacokinetic and pharmacodynamic parameter variability high, and the concentration–response slope gentle at the target concentration. Consequently, total body weight with allometry is acceptable for the calculation of maintenance dose. The dose of acetaminophen is tempered by concerns about adverse effects, notably hepatotoxicity associated with use after 2–3 days at doses greater than 90 mg/kg/day. Full article
(This article belongs to the Special Issue Childhood Obesity—Perioperative Controversies and Considerations)
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Other

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9 pages, 612 KiB  
Opinion
Need for Representation of Pediatric Patients with Obesity in Clinical Trials
by Sherbet Samuels, Jayabharathi Vaidyanathan, Elimika Pfuma Fletcher, Anuradha Ramamoorthy, Rajanikanth Madabushi and Gilbert J. Burckart
Children 2023, 10(10), 1640; https://doi.org/10.3390/children10101640 - 30 Sep 2023
Cited by 1 | Viewed by 1134
Abstract
Clinical trials are an integral aspect of drug development. Tremendous progress has been made in ensuring drug products are effective and safe for use in the intended pediatric population, but there remains a paucity of information to guide drug dosages in pediatric patients [...] Read more.
Clinical trials are an integral aspect of drug development. Tremendous progress has been made in ensuring drug products are effective and safe for use in the intended pediatric population, but there remains a paucity of information to guide drug dosages in pediatric patients with obesity. This is concerning because obesity may influence the disposition of drug products. When pediatric patients with obesity are not enrolled in clinical trials, dosing options for use in this subpopulation may be suboptimal. Reliance on physiological-based dosing strategies that are not informed by evaluation of the pharmacokinetics of the drug product could lead to under- or over-dosing with ensuing therapeutic failure or toxicity consequences. Thus, representation of pediatric patients with obesity in clinical trials is crucial to understand the benefit-risk profile of drug products in this subpopulation. It is important to acknowledge that this is a challenging endeavor, but not one that is insurmountable. Collective efforts from multiple stakeholders including drug developers and regulators to enhance diversity in clinical trials can help fill critical gaps in knowledge related to the influence of obesity on drug disposition. Full article
(This article belongs to the Special Issue Childhood Obesity—Perioperative Controversies and Considerations)
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