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Drug utilisation in preterm and term neonates
1Department of Paediatrics, Medical University of Lübeck, Federal Republic of Germany.
Insights
Drug use is high in newborns, especially preterm infants requiring mechanical ventilation. Antibiotics, parenteral nutrition, and blood products are frequently administered due to variable infection symptoms and respiratory issues.
Area of Science:
- Neonatal pharmacology
- Clinical pharmacy
- Pediatric intensive care
Background:
- Drug utilization in neonates is critical due to physiological immaturity.
- Understanding prescribing patterns is essential for optimizing neonatal care.
- Previous studies have provided insights into neonatal drug use.
Purpose of the Study:
- To analyze drug utilization patterns in term and preterm neonates.
- To identify factors associated with increased drug exposure in vulnerable infants.
- To provide an overview of common treatments in neonatal intensive care.
Main Methods:
- Prospective investigation across 4 clinical studies.
- Inclusion of 3880 neonates with varying gestational ages.
- Data collection on drug administration, including antibiotics, parenteral nutrition, and blood products.
Main Results:
- High prevalence of antibiotic use (69% to 100%), particularly in preterm neonates needing ventilation.
- Frequent administration of parenteral nutrition (84-100%) and blood products (91-100%).
- Increased drug usage (mean 17 drugs) in very preterm infants with complications.
Conclusions:
- Antibiotic use is high due to non-specific infection signs and respiratory complications.
- Neonatal intensive care units (NICUs) see significant drug administration.
- Further research on dexamethasone for bronchopulmonary dysplasia is ongoing.
Abstract:
Drug utilisation in term and preterm neonates (i.e. less than 28 days of age) has been investigated prospectively in 4 clinical studies during the past 10 years. 3880 neonates with a mean gestational age of 34.5 weeks (corresponding birthweight 2280g) were enrolled in these studies. An overview indicates a high prevalence of antibiotic treatment throughout the studies, ranging from 69% to virtually 100%. The highest prevalence was observed in studies enrolling only preterm neonates (gestational age less than 30 weeks) with need for mechanical ventilation. A further high prevalence of parenteral nutrition (84 to 100%), transfusion of blood products (91 to 100%) and vitamin use (16 to 78%) was described. Higher degrees of immaturity and rates of complications were associated with an increased drug usage up to a mean of 17 different drugs in very preterm (i.e. less than or equal to 30 weeks gestation) neonates with severe respiratory disorders and related complications. The high prevalence of antibiotic usage may be explained by the fact that clinical symptoms of neonatal bacterial infections are usually variable, and laboratory tests initially are not highly specific. Respiratory disorders in neonates are often associated with or caused by infections. Nosocomial infections in neonatal intensive care units further prompt administration of antimicrobial agents. Six prospective controlled clinical trials during the past 10 years have investigated treatment with dexamethasone of bronchopulmonary dysplasia, a chronic lung disease secondary to mechanical ventilation of surfactant-deficient lungs in very preterm neonates.(ABSTRACT TRUNCATED AT 250 WORDS)