Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.
T he documented cases of thromboembolic disease have risen greatly in the pediatric population, with venous thromboembolism increasing by 70%. 1 Although not completely understood, the growing number of cases is hypothesized to be the result of advances in the treatment of critically ill patients, including the increased use of indwelling catheters. 2-4 Neonates are particularly susceptible to thromboembolic complications. Neonates and adolescents constitute the largest groups of pediatric patients diagnosed with thromboembolic disease, with the rate of venous thromboembolism ranging from 75 to 94 cases per 10,000 hospital admissions, respectively. 1,5,6 The coagulation system is immature at birth, resulting in a unique balance between procoagulants and inhibitors. Healthy neonates are considered hemodynamically stable because most do not develop spontaneous thrombotic complications. 7 The coagulation system may become hypercoagulable in ill neonates with disease states such as respiratory distress, pulmonary hypertension, and sepsis. 3 Because most patients admitted
Bronchopulmonary dysplasia (BPD) is a chronic pulmonary disease commonly seen in preterm infants who require supplemental oxygen and/or assisted mechanical ventilation. BPD, a major cause of morbidity and mortality among premature infants, occurs in 5,000 to 10,000 premature infants in the United States each year. Despite numerous medical advances, no single intervention will prevent or treat BPD; hence, premature infants have an increased risk for developing significant sequelae that affect both cognitive and motor function. This article provides a brief overview of BPD and reviews the available literature regarding the safe and effective use of nebulized furosemide in the treatment of this disorder.
Risk assessment is key for optimal management of patients (pts) with pulmonary arterial hypertension (PAH). REVEAL Lite 2 (RL2) is a non-invasive risk assessment tool for PAH. In this post-hoc analysis of the GRIPHON study (NCT01106014), RL2 was applied to assess its prognostic and predictive value in PAH pts randomized to selexipag, a selective IP prostacyclin receptor agonist, or placebo.METHODS: RL2 was used to calculate risk score and pts were categorized into low, intermediate and high-risk strata at baseline (randomization) and post-baseline timepoints. Analyses were performed to examine associations between risk category and change in risk category with long-term outcome (time to first morbidity/mortality event; MM) and the treatment effect of selexipag on long-term outcome by risk category. Hazard ratios (HR) and concordance index (C-index) were calculated using Cox proportional hazard model. Change in risk category from baseline was compared between treatment arms by proportional odds model. RESULTS:At baseline: overall 41% pts were low, 26% intermediate and 33% high risk; proportions were similar between treatment arms. Risk category at baseline was predictive of time to first MM: with selexipag, HR were 2.09 for intermediate vs low and 5.38 for high vs low risk; with placebo, HR were 2.41 for intermediate vs low and 3.50 for high vs low risk. C-index values at baseline, 4, 6 and 12 months, respectively were 0.68, 0.74, 0.76 and 0.73 for selexipag and 0.65, 0.67, 0.66 and 0.70 for placebo. Change in risk category correlated with change in MM rate: improvement in risk category correlated with a reduction in MM rate (HR vs no change in risk 0.43, 0.39, 0.42 at 4, 6, and 12 months, respectively); while worsened risk category correlated with an increase in MM rate (HR vs no change in risk 2.82, 3.05, 3.77 at 4, 6 and 12 months, respectively). Selexipag was approximately twice as likely to improve pts' risk profile than placebo (odds ratio of improvement for selexipag/placebo: 2.0, 1.8, 1.9 at 4, 6, and 12 months, respectively; p<0.001 for all comparisons). Selexipag reduced the MM rate across all baseline risk categories: HR 0.57 (p¼0.0178) for low, 0.42 (p¼0.0001) for intermediate, and 0.71 (p¼0.0326) for high-risk pts, respectively compared with placebo.CONCLUSIONS: RL2 risk category and change in risk category are prognostic for long-term outcome. Selexipag treatment improved risk profile and long-term outcome compared with placebo; selexipag treatment effect on long-term outcome was strongest for pts at low and intermediate risk at baseline. CLINICAL IMPLICATIONS: RL2 risk assessment is prognostic of long-term outcome in pts with PAH and can detect response to treatment. Simple risk assessment tools may have utility for treatment monitoring and as an endpoint in PAH clinical trials.
s VOLUME 23 s J PHARM TECHNOL 203Piperacillin/tazobactam (Zosyn, Wyeth Pharmaceuticals, Collegeville, PA) is a parenteral β-lactam antibiotic commonly used in hospitals due to its broad-spectrum antimicrobial activity, which includes gram-positive, gramnegative, and anaerobic bacteria. 1 It is supplied as a powder for reconstitution in conventional vials, the ADD-Vantage system (Abbott Laboratories), and the Galaxy Bag (Baxter International, Inc.), which is a frozen, iso-osmotic, sterile, nonpyrogenic solution in single-dose plastic containers. 2 Use of the conventional vial requires reconstitution and therefore entails pharmacy technician labor costs associated with preparation time. Previous time-motion studies have been conducted with several antibiotics, including piperacillin/tazobactam, to assess the time and labor costs associated with the preparation and administration of various dosages as well as administration techniques. 3,4Piperacillin/tazobactam has now been reformulated 5 as a result of new United States Pharmacopeia (USP) guidelines on particulate standards (USP 788), which were tightened after initial approval of the drug. Reformulated piperacillin/tazobactam contains 2 new components, edetate disodium dehydrate (EDTA) and sodium citrate, and is now compatible with lactated Ringer's solution and certain aminoglycosides.The purpose of this study was to evaluate and compare the time required for pharmacy technicians to reconstitute the reformulated piperacillin/tazobactam solution with that of the original formulation. A formulation currently used in Europe that also contains EDTA and sodium citrate (Vial X, Tazocin) was added for comparison. These results were then used to determine labor costs associated with preparing the reformulation based on reconstitution time.Background: Piperacillin/tazobactam, an intravenous broad-spectrum antibiotic commonly used in the hospital setting, has recently been reformulated with edetate disodium dehydrate (EDTA) and sodium citrate due to new guidelines on particulate standards. This reformulation is now compatible with lactated Ringer's solution and certain aminoglycosides.
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