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Toxic additives in medication for preterm infants
A Whittaker1, A E Currie, M A Turner
1Department of Infection, Immunity & Inflammation, University of Leicester Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK. hp28@le.ac.uk
Insights
Preterm infants frequently receive medications containing potentially toxic excipients like ethanol and propylene glycol. Infants with chronic lung disease (CLD) faced higher exposure levels, necessitating strategies to reduce this toxic load.
Area of Science:
- Neonatal pharmacology
- Pediatric toxicology
- Clinical pharmacy
Background:
- Limited data exists on excipient exposure in preterm infants during clinical care.
- Excipients are inactive ingredients in medications, but can have physiological effects.
Purpose of the Study:
- To quantify excipient exposure in preterm infants at a single center.
- To assess the impact of chronic lung disease (CLD) on excipient exposure.
Main Methods:
- Retrospective analysis of drug charts for infants receiving oral liquid medications.
- Study included infants born <30 weeks gestation or <1500g at birth.
- Focused on infants managed at the Leicester Neonatal Service.
Main Results:
- Infants were exposed to over 20 excipients, including potentially neurotoxic ethanol and propylene glycol.
- Infants with CLD showed higher concentrations of these toxins.
- High sorbitol exposure exceeded adult recommended guidelines in some cases.
Conclusions:
- Preterm infants commonly encounter potentially toxic excipients in medications.
- Higher exposure levels were observed in infants with CLD.
- Urgent development of strategies to minimize excipient exposure in preterm infants is needed.
Background:
Little is known about exposure of preterm infants to excipients during routine clinical care.
Objective:
To document excipient exposure in vulnerable preterm babies in a single centre, taking into account chronic lung disease (CLD) as a marker of illness severity.
Design:
Excipient exposure after treatment with eight oral liquid medications was determined by retrospectively analysing the drug charts of infants admitted to a neonatal unit.
Setting:
The Leicester Neonatal Service.
Participants:
38 infants born between June 2005 and July 2006 who were less than 30 weeks' gestation and 1500 g in weight at birth and managed in Leicester to discharge.
Results:
The 38 infants represented 53% of the eligible target group; 7/38 infants had CLD. During their in-patient stay, infants were exposed to over 20 excipients including ethanol and propylene glycol, chemicals associated with neurotoxicity. Infants with CLD were exposed to higher concentrations of these toxins. Infants were also exposed to high concentrations of sorbitol, with some infants being exposed to concentrations in excess of recommended guidelines for maximum exposure in adults.
Conclusions:
Preterm infants are commonly exposed to excipients, some of which are potentially toxic. Strategies aimed at reducing excipient load in preterm infants are urgently required.
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