From the Research
Ondansetron can be used in neonates for the management of nausea and vomiting, though it should be used cautiously, with a recommended dose of 0.07 mg/kg given orally or 0.04 mg/kg given intravenously, as suggested by the most recent study 1.
Key Considerations
- The dose and administration route should be carefully selected based on the individual neonate's needs and medical history.
- Treatment duration should be limited to the shortest period necessary to control symptoms.
- When administering ondansetron to neonates, careful monitoring is essential due to their immature organ systems.
- Potential side effects include QT interval prolongation, which can lead to cardiac arrhythmias, so cardiac monitoring may be necessary, especially in premature infants or those with congenital heart conditions.
Mechanism of Action
- Ondansetron works by blocking serotonin 5-HT3 receptors in the chemoreceptor trigger zone and gastrointestinal tract, thereby reducing the vomiting reflex.
Alternative Options
- While generally effective, alternative antiemetics like metoclopramide may be considered if ondansetron is contraindicated or ineffective, though these alternatives also carry their own risks in the neonatal population, as noted in studies such as 2 and 3.
Evidence Summary
- The most recent and highest quality study, 1, provides guidance on the pharmacokinetics of ondansetron in pregnant women and neonates, supporting its use in neonates for the prevention of neonatal abstinence syndrome.
- Other studies, such as 2 and 3, demonstrate the efficacy of ondansetron in children for the management of nausea and vomiting, but may not be directly applicable to neonates due to differences in dosage and administration.