Description

Extraction of targeted endocardial leads can lead to inadvertent damage or dislodgement of nontargeted leads, though the frequency of this has not been reported in pediatrics and congenital heart disease (CHD).The objective was to characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of argatroban in pediatric patients and derive dosing recommendations. An open-label multicenter trial was conducted in pediatric patients (n = 18 from birth to 16 years). A population modeling approach was used to characterize pharmacokinetics and pharmacodynamics of argatroban in pediatric patients. Simulations were performed to derive a dosing regimen for pediatric patients. The estimated clearance of argatroban in pediatric patients was 2-fold lower than that in healthy adults. Body weight was significant predictor of argatroban clearance.

The clearance in a typical 20-kg pediatric patient was 3.1 L/h. In 4 patients with elevated serum bilirubin levels, the estimated clearance was 0.6 L/h. Effect on activated plasma thromboplastin time (aPTT) was found to be concentration dependent. Simulations suggested that a starting dose of 0.75 μg/kg/min in pediatric patients was comparable in performance to 2.0 μg/kg/min approved in adults for attaining target aPTT and risk for bleeding. A dose increment step size of 0.25 μg/kg/min was suitable for titration. The PK/PD of argatroban was reasonably characterized in pediatrics. Plasma concentration—aPTT relationship was used to derive a safe starting dose and titration scheme for the first time in pediatric patients and was incorporated into the US prescribing information for argatroban. Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation.

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With Regards
Mersy
Journal Coordinator
Journal of Reproductive Endocrinology & Infertility