Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies

Abstract

Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

“…In children, drug use collectively is much more common than is usually appreciated; our work among a cohort of a million Canadian children demonstrated that children receive on average 4 prescriptions a year, confirmed by subsequent studies including a recent study revealing that American children receive on average 3.5 prescriptions a year . Within this population are 2 distinct groups; most children receive no or 1 prescription a year, but children with complex and often chronic problems—approximately 20% of children—receive 70% of all prescription drugs . Thus it is not surprising that, in the latter group of children, ADRs would be expected to be both common and important problems .…”

“…Far and away the largest amount of literature in this area is dominated by studies in adult medicine. Pharmacotherapy in adults is distinctly different from that in children in both the type and amount of medications used . One of the single best predictors for drug use in adults is age; the older the patient, the more medications she/he is likely to take, with more than 90% of people over age 65 being on at least 1 medication .…”

“…Pharmacotherapy in adults is distinctly different from that in children in both the type and amount of medications used. [12][13][14][15][16][17][18][19] One of the single best predictors for drug use in adults is age; the older the patient, the more medications she/he is likely to take, with more than 90% of people over age 65 being on at least 1 medication. 12 In children, drug use collectively is much more common than is usually appreciated; our work among a cohort of a million Canadian children demonstrated that children receive on average 4 prescriptions a year, confirmed by subsequent studies including a recent study revealing that American children receive on average 3.5 prescriptions a year.…”

“…13,18 Within this population are 2 distinct groups; most children receive no or 1 prescription a year, but children with complex and often chronic problemsapproximately 20% of children-receive 70% of all prescription drugs. [13][14][15][16][17][18][19] Thus it is not surprising that, in the latter group of children, ADRs would be expected to be both common and important problems. 8 For the majority of children, there is a low risk for an ADR for the simple fact that they rarely take medication, and when they do, short courses of monotherapy are most common.…”

Wheezing and infantile colic are associated with neonatal antibiotic treatment

“…Broad‐spectrum antibiotics (AB) is the most frequently prescribed drug type in neonates . Besides obvious beneficial short‐term effects, there is mounting evidence of negative long‐term side effects of antibiotics.…”