Drug-Related Problems in Cardiac Neonates Under Intensive Care

Abstract

Objective: To determine the frequency and nature of the Drug Related Problems (DRP) in neonates with cardiac diseases admitted to an Intensive Care Unit. Methods: This prospective cross-sectional study was developed at the Neonatal Intensive Care Unit (NICU) of a teaching maternity hospital in Brazil from January 2014 to December 2016. All neonates diagnosed with any heart disease (congenital heart disease, cardiomyopathy, arrhythmias, etc.) and who were admitted to the NICU for more than 24 hours with at least one prescribed drug were included in the study. Demographic and clinical data were collected from the records of the institution’s clinical pharmacy service. DRP and their respective interventions were independently reviewed and classified by two pharmacists. DRP classification was performed through the Pharmaceutical Care Network Europe v6.2 system. Results: 122 neonates were included in the study. The frequency of neonates exposed to DRP was 76.4% (confidence interval of 95% [95%CI] 65.9–82.0), with a mean of 3.2±3.8 cases/patient. In total, 390 DRP were identified, of which 49.0% were related to “treatment effectiveness”, 46.7% to “adverse reactions” and 1.0% to “treatment costs”. The medicines most involved in DRP were Vancomycin (10.2%; n=46), Meropenem (8.0%; n=36) and Furosemide (7.1%; n=32). Pharmacists performed 331 interventions, of which 92.1% were accepted by physicians and nurses. Conclusions: The study showed that DRP are very frequent in patients with cardiac diseases hospitalized in the NICU, predominating problems related to the effectiveness and safety of the drug treatment.

Impact of Clinical Pharmacist-Led Interventions on Drug-Related Problems Among Pediatric Cardiology Patients: First Palestinian Experience

“… 18 A Brazilian study was performed in an educational hospital to evaluate the characteristics of DRPs in newborns with various heart diseases. 11 The study reflected that the main identified problem was “P1: Treatment effectiveness” (49.0%), followed by “P2: Treatment safety” (46.7%), and “P3: Others” (3.3%). Our results came in the same order as their DRPs, with a relatively similar percentage of the “P1 -Treatment effectiveness” (50.8%), but we also observed a lower percentage of the “P2 - Treatment safety” (30.4%) than the one obtained by the Brazilian study.…”

“…Pediatric patients receiving cardiovascular medications are at risk of different types of drug-related problems (DRPs). 3 , 11 Few studies have been published on the analysis of DRPs among hospitalized pediatric cardiology patients. Most publications, however, were conducted in the adult population.…”

“…In our study, also, a higher proportion (18.8%) of the problem classified as “P3 others” which included “P3.1 Unnecessary drug-treatment” (8.7%), and “Unclear problem/complaint” (10.1%) compared to those obtained by the Brazilian study. 11 The following explanations can be taken into account to discuss this high rate of the “P3 others” problem. The first refers to the methodology currently in use that highlighted the identification of this “P3 other” problem that paid less attention before and was not defined entirely by the “PCNE classification system”.…”

“… 8 The incidence of DRPs in pediatric patients ranges from 25.6 to 59.8%, 9 , 10 with reported incidences of up to 76.4% in children with cardiovascular diseases. 11 The cornerstone of a clinical pharmacist’s intervention is the discovery, identification, and resolution of DRPs. 12 Even optimization of pharmacotherapy by a clinical pharmacist can be assessed by the overall number of DRPs treated or averted and by the assessment of patient outcomes.…”

Perspectiva da terapia com alprostadil na cardiopatia congênita: foco no neonato

“…Alta hospitalar se deu tanto por melhora do quadro clínico após a terapia medicamentosa e realização dos exames, quanto por não constatação de cardiopatia congênita. O trabalho realizado por Nascimento et al (2020) Destaca-se que em alguns casos, quando se compara a relação disponibilizada pela Farmácia do Hospital e a evolução do RN, percebe-se que o medicamento não foi administrado em nenhum momento da internação, o que dificulta mensurar, de fato, o verdadeiro número de pacientes que fizeram uso do alprostadil, podendo-se configurar como uma limitação do estudo.…”