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Quantifying Medication Exposure in Very Low Birth Weight Neonates

Natalie L Davis1, Temitope O Akinmboni1, Sandra M Mooney2

  • 1Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland.

American Journal of Perinatology
|November 5, 2019
PubMed

Insights

Very low birth weight (VLBW) infants in the NICU receive numerous medications, with over 30 drugs associated with higher risks. Male sex, lower birth weight, and longer hospital stays correlate with increased medication exposure in these vulnerable infants.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Pediatric Critical Care

Background:

  • Very low birth weight (VLBW) infants face significant medication exposure during neonatal intensive care unit (NICU) stays.
  • There is a lack of comprehensive pharmacokinetic and safety data for many medications used in VLBW infants.
  • Understanding medication exposure is crucial for optimizing care and minimizing potential harm.

Purpose of the Study:

  • To quantify medication exposure in VLBW infants.
  • To identify risk factors associated with the highest quartile of medication exposure.
  • To inform strategies for reducing medication burden in this population.

Main Methods:

  • Retrospective review of clinical and demographic data for VLBW infants admitted to a level-IV NICU.
  • Analysis of all medications administered during the hospital admission.
  • Comparison of characteristics between infants in the highest quartile of medication use and the remaining infants.

Main Results:

  • A cohort of 106 VLBW infants (mean birth weight 961g, gestational age 27.3 weeks) was analyzed.
  • Infants received a median of 20 medications (range 4-72).
  • Infants in the top quartile (≥30 medications) had higher odds of being male, having lower birth weight, longer length of hospital stay (LOHS), and developing bronchopulmonary dysplasia. Sepsis was not a significant factor.

Conclusions:

  • VLBW infants experience substantial medication exposure in the NICU, including potentially unnecessary antibiotics and reflux medications.
  • Male sex, certain comorbidities (e.g., necrotizing enterocolitis), and prolonged LOHS are linked to increased medication exposure.
  • Raising awareness and implementing targeted interventions can help reduce medication exposure in VLBW infants.
Abstract

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