Review of drug utilization patterns in NICUs worldwide

Abstract

Summary What is known and objectives When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A‐PINCH (Anti‐infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high‐risk medicines list, and determining whether there are any differences in medicine use between countries. Method Quasi‐systematic literature review. Search strategy Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms. Results A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A‐PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off‐label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors. What is new and conclusion Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off‐label and unlicensed medicines.

Pattern of drug use among preterm neonates: results from an Italian neonatal intensive care unit

“…Our results on most used classes of drugs (antimicrobials, cardiovascular agents, analgesics and respiratory drugs) are in accordance to other studies investigating the profile of drug use in NICUs, performed in other Western Countries [5, 10–12]. …”

“…For instance, in the first postnatal period, neonatologists often have to manage respiratory distress syndrome, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and other infections [1]. At present, very little is known on the actual use of combination of drugs in neonatal intensive care settings and their safety; studies investigating drug use in the neonatal population usually focused on single active substances and their status in terms of unauthorized or off-label use [2–5]. The evidence gathered so far however highlighted increased susceptibility of babies to drug-related toxicity (especially, renal damage [2]).…”

Drug prescription pattern in European neonatal units

“…We demonstrated that drugs for alimentary tract were by far most commonly used mainly due to high prescription rate of vitamins and probiotics similarly shown in previous studies [1].…”

“…Medicines play a pivotal role in improving neonatal health and reducing mortality, and thus are widely used in neonatal units. A median of 3 to 11 drugs per neonate are given depending on the setting and gestational age (GA) [1,2]. Most drugs administered to neonates are either offlabel or unlicensed and the exposure of off-label/unlicensed drugs is the highest among preterms [1].…”

“…A median of 3 to 11 drugs per neonate are given depending on the setting and gestational age (GA) [1,2]. Most drugs administered to neonates are either offlabel or unlicensed and the exposure of off-label/unlicensed drugs is the highest among preterms [1]. The use of drugs depends on underlying conditions, which are often associated with GA, drugs availability in a country and presence of evidence-based guidelines.…”