Medication follow-up in newborns with extremely low birth-weight

Abstract

Objective:The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.Methods:A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.Results:The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients’ pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were “untreated health problem” (40%, n=10) and “quantitative ineffectiveness” (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of “treatment day count correction” and “dose correction”, both with 21.6% (n=8), and “correction of dosage” (16.2%, n=6).Conclusion:The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.

Impacto da atuação do farmacêutico no âmbito hospitalar: uma revisão integrativa

“…(Wang et al, 2022) As ações de cuidado assistido requerem cautela também em pacientes neonatais. A atuação da assistência farmacêutica e farmácia clínica nestes pacientes foi observada por Loureiro et al (2019), através da descrição do acompanhamento medicamentoso em recém-nascidos de extremo baixo peso em uma unidade de terapia intensiva neonatal. Durante o período de estudo, 33 lactentes foram acompanhados por uma equipe multiprofissional, a qual incluía farmacêuticos clínicos.…”

“…A utilização de antimicrobianos foi vista como a principal classe medicamentosa mais envolvida nas falhas detectadas durante a prescrição, sendo assim, o farmacêutico foi responsável por planejar e reduzir efeitos negativos ao público neonatal, através da realização de atividades contínuas de avaliação de riscos associados à farmacoterapia. (Loureiro et al, 2019) Em sua publicação, Silva et al (2018)…”

Impact of pharmaceutical validation on prescribing errors in a neonatal intensive care unit. Randomised and controlled study

“…Although there are no references from Spain on the implementation of the pharmacist figure and its activities in NICUs, the role of pharmacists in these units has been described in some studies. For example, we might highlight a descriptive and exploratory study carried out by clinical pharmacists in Brazil assessed patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy, and follow-up of newborns’ clinical evolution ( 18 ). In a systematic review published in 2017, 30 studies analysed the role of pharmacists in NICU worldwide.…”

“…However, the daily cost of integrating a pharmacist into the unit for treatment validation is estimated to be approximately 106 euros, and it is not possible to calculate the costs avoided by preventing medication errors in our study. It is worth underlining that this was a randomised and controlled design, with a large sample of patients and a significant representation of both very preterm and very low-birth weight patients, for whom any medication error could have a relevant consequence not only in their clinical progress ( 18 ) but probably also in their neurodevelopment ( 20 ).…”