Large differences in neonatal drug use between NICUs are common practice: time for consensus?

Area of Science:

• Neonatal pharmacology
• Clinical pharmacy
• Pediatric intensive care

Background:

• Limited evidence exists on drug use in newborns, leading to potential variations in prescription practices.
• Understanding current drug prescription patterns in neonatal intensive care units (NICUs) is crucial for improving patient care.

Purpose of the Study:

• To investigate and compare drug prescription differences among neonatal intensive care units (NICUs) in the Netherlands.
• To assess the on/off-label status of prescribed drugs in relation to neonatal age.

Main Methods:

• A multicenter study involving neonates admitted over 12 months to four NICUs.
• Drugs were classified using the Anatomical Therapeutic Chemical (ATC) system.
• Treatment protocols for pain, intubation, convulsions, and hypotension were compared.

Main Results:

• 1491 neonates and 10,895 prescriptions were analyzed; 23% of prescriptions were off-label for neonatal age.
• Anti-infective drugs were most common (3161 prescriptions), with 4% off-label.
• Nervous system drugs (2500 prescriptions, 31% off-label) and cardiovascular drugs showed significant inter-NICU prescribing variations.

Conclusions:

• Drug utilization in neonatal clinical practice exhibits wide variability.
• Drug classes with higher off-label use proportions, such as cardiovascular and nervous system drugs, displayed the greatest inter-NICU differences.
• Prioritizing drug research in neonates is essential for ensuring safe, appropriate medications and optimal treatment outcomes.