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Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies
Rosliana Rosli1, Ahmad Fauzi Dali1, Noorizan Abd Aziz1
1Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia.
Insights
Hospitalized neonates frequently receive multiple drugs, often anti-infectives like ampicillin and gentamicin. Current drug utilization studies show significant variability in methods and reporting, highlighting a need for standardized approaches.
Area of Science:
- Neonatal Pharmacology and Therapeutics
- Drug Utilization Research
- Systematic Review Methodology
Background:
- Neonates, particularly those hospitalized, receive extensive drug therapy despite limited safety and efficacy data.
- Information on drug consumption patterns in this vulnerable population is scarce, necessitating a comprehensive review.
Purpose of the Study:
- To systematically review and analyze published studies on drug utilization in hospitalized neonates.
- To identify common drug classes and specific agents prescribed to neonates.
- To assess the methodologies and reporting standards employed in existing drug utilization research.
Main Methods:
- A systematic literature review was conducted using Medline, CINAHL, Embase, and PubMed.
- Observational studies published up to August 2016, focusing on drug utilization in neonatal wards, were included.
- Data were assessed based on study design, objectives, and methods of reporting drug consumption.
Main Results:
- Twenty drug utilization studies were identified, with 12 covering all drug classes and eight focusing on antimicrobials.
- Anti-infectives (ampicillin, gentamicin) were the most commonly reported drugs, followed by cardiovascular, nervous system, and respiratory agents.
- Significant heterogeneity was observed in study designs, data sources, sample sizes, and reporting methods (e.g., volume of units vs. ATC/DDD system).
Conclusions:
- Hospitalized neonates are exposed to a wide array of medications, underscoring the need for careful drug management.
- Current drug utilization studies exhibit considerable variability in methodology and reporting, complicating comparisons and data synthesis.
- Further research is warranted to establish optimal methods for quantifying drug use prevalence in neonates.
Abstract:
Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.
