**Core Concept**
Lidocaine elimination in newborns differs from adults due to immature hepatic and renal functions. Newborns have a lower capacity for lidocaine metabolism and excretion, leading to prolonged drug elimination half-lives.

**Why the Correct Answer is Right**
Lidocaine is primarily metabolized by the liver through the cytochrome P450 enzyme system, specifically CYP1A2 and CYP3A4. In newborns, these enzymes are not fully developed, resulting in delayed lidocaine metabolism. Additionally, newborns have a lower glomerular filtration rate (GFR) and less efficient renal tubular secretion, further prolonging lidocaine elimination. This reduced clearance can lead to increased lidocaine concentrations and potentially toxic effects in newborns.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the primary mechanism of lidocaine elimination in newborns. While lidocaine does undergo some glucuronidation, this is not the primary reason for delayed elimination in newborns.
**Option B:** This option is incorrect because it implies that lidocaine is primarily excreted unchanged in the urine, which is not accurate. Lidocaine undergoes significant hepatic metabolism before excretion.
**Option C:** This option is incorrect because it does not specify the underlying mechanism of delayed lidocaine elimination in newborns. While lidocaine elimination may be affected by various factors, the correct answer focuses on the immature hepatic and renal functions.

**Clinical Pearl / High-Yield Fact**
When administering lidocaine to newborns, it is essential to consider their immature pharmacokinetics, including delayed metabolism and excretion. This can lead to increased lidocaine concentrations and potentially toxic effects, such as seizures or cardiac arrhythmias.

**Correct Answer: D.**