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

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

doi:10.1055/s-0035-1564587

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2016; 33(04): 370-377
DOI: 10.1055/s-0035-1564587

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Autor*innen

Rashmi Gulati

¹Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
Mohamad T. Elabiad

¹Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
Ajay J. Talati

¹Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
Ramasubbareddy Dhanireddy

¹Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee

Abstract

Objective This study aims to study the association between trends in medication utilization and survival in very low-birth-weight (VLBW) infants over a 22-year period.

Study Design Medications received by VLBW infants were extracted retrospectively for the four periods 1990 to 1994, 1995 to 2000, 2001 to 2005, and 2006 to 2011 from our perinatal database and stratified by two birth weight groups: ≤ 1,000 g and 1,001 to 1,500 g.

Result A total of 5,529 VLBW infants were reviewed. The majority of them were African American (78%), with an increasing proportion over time. The median number of medications per patient in all VLBW infants remained similar over time, 9 (5, 15). A cardiovascular group of medications was most commonly used, with a significant increase in the use of dobutamine and indomethacin. A significant trend toward an increasing number of infants without any antibiotic exposure was also noted. Survival steadily and significantly increased from 83 to 87%.

Conclusion The trends of overall medication use remained the same in our neonatal intensive care unit (NICU) over the past 22 years. There was no association between medication utilization and survival. VLBW infants continue to receive a high number of medications in the NICU, including a variety of antibiotics.

Keywords

preterm - antibiotics - cardiovascular

Volltext

Referenzen

References
1 Aranda JV, Clarkson S, Collinge JM. Changing pattern of drug utilization in a neonatal intensive care unit. Am J Perinatol 1983; 1 (1) 28-30
2 Du W, Warrier I, Tutag Lehr V, Salari V, Ostrea E, Aranda JV. Changing patterns of drug utilization in a neonatal intensive care population. Am J Perinatol 2006; 23 (5) 279-285
3 Aranda JV, Cohen S, Neims AH. Drug utilization in a newborn intensive care unit. J Pediatr 1976; 89 (2) 315-317
4 Aranda JV, Collinge JM, Clarkson S. Epidemiologic aspects of drug utilization in a newborn intensive care unit. Semin Perinatol 1982; 6 (2) 148-154
5 Lindner U, Hilgendorff A, Frey G, Gortner L. Drug utilisation in very preterm infants: any changes during the past decade?. Klin Padiatr 2008; 220 (4) 238-242
6 Neubert A, Lukas K, Leis T, Dormann H, Brune K, Rascher W. Drug utilisation on a preterm and neonatal intensive care unit in Germany: a prospective, cohort-based analysis. Eur J Clin Pharmacol 2010; 66 (1) 87-95
7 Hsieh EM, Hornik CP, Clark RH, Laughon MM, Benjamin Jr DK, Smith PB ; Best Pharmaceuticals for Children Act—Pediatric Trials Network. Medication use in the neonatal intensive care unit. Am J Perinatol 2014; 31 (9) 811-821
8 Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics 2006; 117 (6) 1979-1987
9 Kumar P, Walker JK, Hurt KM, Bennett KM, Grosshans N, Fotis MA. Medication use in the neonatal intensive care unit: current patterns and off-label use of parenteral medications. J Pediatr 2008; 152 (3) 412-415
10 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371 (9608) 261-269
11 Allegaert K. Mechanism based medicine in infancy: complex interplay between developmental pharmacology and pharmacogenetics. Int J Clin Pharmacol 2011; 33 (3) 473-474
12 Allegaert K, Verbesselt R, Naulaers G , et al. Developmental pharmacology: neonates are not just small adults... Acta Clin Belg 2008; 63 (1) 16-24
13 Allegaert K, van de Velde M, van den Anker J. Neonatal clinical pharmacology. Paediatr Anaesth 2014; 24 (1) 30-38
14 Dell'Aera M, Gasbarro AR, Padovano M , et al. Unlicensed and off-label use of medicines at a neonatology clinic in Italy. Pharm World Sci 2007; 29 (4) 361-367
15 Cuzzolin L, Atzei A, Fanos V. Off-label and unlicensed prescribing for newborns and children in different settings: a review of the literature and a consideration about drug safety. Expert Opin Drug Saf 2006; 5 (5) 703-718
16 Glover DD, Amonkar M, Rybeck BF, Tracy TS. Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population. Am J Obstet Gynecol 2003; 188 (4) 1039-1045
17 Henry A, Crowther C. Patterns of medication use during and prior to pregnancy: the MAP study. Aust N Z J Obstet Gynaecol 2000; 40 (2) 165-172
18 Alexander GR, Kogan M, Bader D, Carlo W, Allen M, Mor J. US birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, hispanics, and blacks. Pediatrics 2003; 111 (1) e61-e66
19 Daniell AJ, Darlow BA. Audit of drug usage in a regional neonatal intensive care unit. Aust Paediatr J 1989; 25 (4) 207-210
20 Lesko SM, Epstein MF, Mitchell AA. Recent patterns of drug use in newborn intensive care. J Pediatr 1990; 116 (6) 985-990
21 Grohskopf LA, Huskins WC, Sinkowitz-Cochran RL, Levine GL, Goldmann DA, Jarvis WR ; Pediatric Prevention Network. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005; 24 (9) 766-773
22 Cotten CM, McDonald S, Stoll B, Goldberg RN, Poole K, Benjamin Jr DK ; National Institute for Child Health and Human Development Neonatal Research Network. The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants. Pediatrics 2006; 118 (2) 717-722
23 Benjamin Jr DK, Stoll BJ, Gantz MG , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics 2010; 126 (4) e865-e873
24 Yu Y, Du L, Yuan T , et al. Risk factors and clinical analysis for invasive fungal infection in neonatal intensive care unit patients. Am J Perinatol 2013; 30 (7) 589-594
25 Barr J, Brenner-Zada G, Heiman E , et al. Unlicensed and off-label medication use in a neonatal intensive care unit: a prospective study. Am J Perinatol 2002; 19 (2) 67-72
26 O'Donnell CP, Stone RJ, Morley CJ. Unlicensed and off-label drug use in an Australian neonatal intensive care unit. Pediatrics 2002; 110 (5) e52
27 Kieran EA, O'Callaghan N, O'Donnell CP. Unlicensed and off-label drug use in an Irish neonatal intensive care unit: a prospective cohort study. Acta Paediatr 2014; 103 (4) e139-e142
28 Laforgia N, Nuccio MM, Schettini F , et al. Off-label and unlicensed drug use among neonatal intensive care units in Southern Italy. Pediatr Int 2014; 56 (1) 57-59