Trends in Medication Use in Very Low-Birth-Weight Infants in a Level 3 NICU over 2 Decades

Gulati, Rashmi; Elabiad, Mohamad T.; Talati, Ajay J.; Dhanireddy, Ramasubbareddy

doi:10.1055/s-0035-1564587

Cited by 6 publications

(12 citation statements)

References 23 publications

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“…The study periods varied from one month [26,55,67,68] to studies spanning over 22 years [33]. The median (interquartile range, IQR) duration of data collection in 79 studies was 6 (3-18) months.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Several studies (27 studies) [8,11,13,19,20,22,23,26,28,32,34,[37][38][39][42][43][44][45]50,59,63,[67][68][69]71,73,75] reported the maximum number of drugs received by at least one infant: Kumar et al [38] reported the highest drug burden with at least one infant receiving 62 individual drugs, while 8 other studies [13,20,22,23,28,32,43,50] reported that the maximum number of drug per infant was ≥30 in their population. The study periods varied from one month [26,55,67,68] to studies spanning over 22 years [33]. The median (interquartile range, IQR) duration of data collection in 79 studies was 6 (3-18) months.…”

Section: Number Of Drugs Per Infantmentioning

confidence: 99%

“…Four studies listed the pharmacological class of the drugs [10,19,39,47] while Kumar et al (2008) [26] classified the pharmacological groups based on the most frequent indication and the physiological effects of the drug (38). The remaining six studies did not state their classification method [14,21,33,61,75,77].…”

Section: Most Frequently Prescribed Pharmacological Groupsmentioning

confidence: 99%

“…Observational studies describing patterns of drug use provide preliminary evidence to support this agenda. Although evidence for of 33 medication use in neonates is limited, studies describing drug use are accumulating [3] and emerging evidence suggests wide variations in practices across the globe.…”

Section: Introductionmentioning

confidence: 99%

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Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

Al-Turkait

Szatkowski

Choonara

et al. 2020

IJERPH

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Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Number Of Drugs Per Infantmentioning

confidence: 99%

Section: Most Frequently Prescribed Pharmacological Groupsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

Al-Turkait

Szatkowski

Choonara

et al. 2020

IJERPH

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“…point for clinical trials on the most commonly used off-label medications, and to better identify infants at highest risk of medication over-prescribing and adverse drug events. While a majority of the published studies provide data on frequency of on-and off-label medication use in the NICU, 7 very few identify clinical and demographic predictors of receiving a higher number of medications. The objective of this study was to not only quantify medication utilization in very low birth weight (<1,500 g) preterm infants but to also identify risk factors associated with the highest quartile of medication exposure.…”

mentioning

confidence: 99%

Quantifying Medication Exposure in Very Low Birth Weight Neonates

Davis

Akinmboni

Mooney³

2019

Am J Perinatol

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Objective Very low birth weight (VLBW) infants are exposed to medications with insufficient evidence describing pharmacokinetics and safety. Objective was to quantify and identify risk factors associated with the highest quartile of medication exposure. Study Design Retrospective record review of VLBW infants admitted to a level-IV neonatal intensive care unit (NICU). We obtained baseline clinical and demographic characteristics, as well as data on all medications received during admission. Characteristics of patients within the upper quartile of medication use were compared with remaining patients. Results Identified 106 infants, mean birth weight (BW) = 961 g, gestational age = 27.3 weeks. Infants received a median = 20 medications (range, 4–72). Those in the top quartile of medication use received ≥30 medications while in the NICU and had higher odds of being male sex, lower BW, longer length of hospital stay (LOHS), and bronchopulmonary dysplasia. Sepsis did not affect medication exposure. Antibiotics, opiates, and reflux medications were among the top prescribed. Conclusion Infants are exposed to a large number of medications during NICU hospitalization, including potentially unnecessary antibiotics and reflux medications. Male sex, the presence of certain comorbidities such as necrotizing enterocolitis, and LOHS, are associated with higher exposure. Increased awareness of this issue may assist in decreasing medication exposure in VLBW populations.

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