Neonatal sepsis is common and is a major cause of morbidity and mortality. 
Vancomycin is the preferred treatment of several neonatal staphylococcal 
infections. The aim of this study was to review published data on vancomycin 
pharmacokinetics in neonates and to provide a critical analysis of the 
literature. A bibliographic search was performed using PubMed and Embase, and 
articles with a publication date of August 2011 or earlier were included in the 
analysis. Vancomycin pharmacokinetic estimates, which are different in neonates 
compared with adults, also exhibit extensive inter-neonatal variability. In 
neonates, several vancomycin dosing schedules have been proposed, mainly based 
on age (i.e., postmenstrual and postnatal), body weight or serum creatinine 
level. Other covariates [e.g., extracorporeal membrane oxygenation (ECMO), 
indomethacin or ibuprofen, and growth restriction] of vancomycin 
pharmacokinetics have been reported in neonates. Finally, vancomycin penetrates 
cerebrospinal fluid (range = 7-42%). Renal function drives vancomycin 
pharmacokinetics. Because either age or weight is the most relevant covariate of 
renal maturation, these covariates should be considered first in neonatal 
vancomycin dosing guidelines and further adjusted by renal dysfunction 
indicators (e.g., ECMO and ibuprofen/indomethacin). In addition to the 
prospective validation of available dosing guidelines, future studies should 
focus on the relevance of therapeutic drug monitoring and on the value of 
continuous vancomycin administration in neonates.