Current pharmacotherapy in the newborn

Abstract

Several drugs are used in newborns in spite of the lack of specific clinical research in this particularly vulnerable population with particular needs. In the newborn, the individual response to a drug in terms of efficacy and safety is highly variable, and predicting drug dosing is complex since rapid physiological changes occurring during the perinatal and early postnatal periods affect the pharmacokinetic profile of many drugs. Neonatal disorders such as renal and hepatic diseases may also have significant implications for drug pharmacokinetics. Therefore, pharmacotherapy in the newborn brings difficulties in accurate drug delivery and carries a high risk of adverse drug reactions. In addition, the neonatal population, especially that treated in neonatal intensive care units, is highly exposed to the risk of medication errors, with potentially serious adverse events. This paper reviews some current issues related to neonatal pharmacotherapy that are of paramount importance for the clinician. In particular, the peculiar pharmacokinetics of drugs during the neonatal period and its clinical implications are discussed. The use of therapeutic drug monitoring to individualize drug dosage and to optimize pharmacotherapy is also described. Finally, the relevant issue of medication errors in neonatology is examined in order to highlight their main causes and key strategies in preventing these type of errors. In the future, pharmacometabolomics and other "omic" sciences could play an important role in designing personalized neonatal health care.

Medication safety in neonatal care: a review of medication errors among neonates

“…Among the 20 articles reviewed, the majority used a prospective chart review method to collect data and just over half of the studies were conducted in the USA (10 of 18) [Raju et al 1989; Vincer et al 1989; Kaushal et al 2001; Carroll et al 2003; Chappell and Newman, 2004; Cordero et al 2004; Gray and Goldmann, 2004; Gray et al 2006; Simpson et al 2004; Suresh et al 2004; Kunac and Reith, 2005; Van Den Anker, 2005; Ligi et al 2008; Pallas et al 2008; Campino et al 2009; Jain et al 2009; Stavroudis et al 2010; Antonucci and Porcella, 2012; Dabliz and Levine, 2012; Sorrentino and Alegiani, 2012]. A summary of the errors reported are presented in Table 2.…”

“…A summary of the errors reported are presented in Table 2. The prescribing phase was associated with the highest incidence of medication errors, comprising 14–74% of total error reports [Kaushal et al 2001; Cordero et al 2004; Gray and Goldmann, 2004; Simpson et al 2004; Suresh et al 2004; Pallas et al 2008; Campino et al 2009; Jain et al 2009; Stavroudis et al 2010; Antonucci and Porcella, 2012; Sorrentino and Alegiani, 2012]. The most frequently reported error within this phase involved incorrect dosing, with 42% of errors relating to overdoses or underdoses [Jain et al 2009].…”

“…The most frequently reported error within this phase involved incorrect dosing, with 42% of errors relating to overdoses or underdoses [Jain et al 2009]. Ten articles reported that dosing errors occurred because of miscalculation of doses and incorrect placement of decimal points or units of measurement [Kaushal et al 2001; Cordero et al 2004; Simpson et al 2004; Van Den Anker, 2005; Pallas et al 2008; Campino et al 2009; Jain et al 2009; Stavroudis et al 2010; Antonucci and Porcella, 2012; Dabliz and Levine, 2012]. One Indian-based study reported that as a result of a dosing error, an infant received a tenfold increase in the delivery of morphine [Jain et al 2009].…”

“…Errors in prescribing were attributed to lack of physician experience, high-intensity physician workloads as well as the lack of neonate-specific drug protocols or policies on the ward [Gray and Goldmann, 2004; Jain et al 2009]. This is an important issue within the NICU, as the majority of literature highlights that due to the lack of evidence-based information, physicians do not have a reliable source of information to refer to, leading to the prescribing of off-label and unlicensed medicines and subsequent erroneous prescribing decisions [Kaushal et al 2001; Suresh et al 2004; Kunac and Reith, 2005; Van Den Anker, 2005; Campino et al 2009; Stavroudis et al 2010; Antonucci and Porcella, 2012; Dabliz and Levine, 2012; Sorrentino and Alegiani, 2012]. Other common prescribing errors reported only within the neonatal population included: incorrect use of units (i.e.…”

“…Other common prescribing errors reported only within the neonatal population included: incorrect use of units (i.e. grams instead of milligrams) and wrong administration route [Kaushal et al 2001; Cordero et al 2004; Gray and Goldmann, 2004; Simpson et al 2004; Van Den Anker, 2005; Pallas et al 2008; Campino et al 2009; Jain et al 2009; Antonucci and Porcella, 2012; Dabliz and Levine, 2012].…”