Osmolality of Commonly Used Oral Medications in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal pharmacology
• Pediatric gastroenterology
• Clinical pharmacy

Background:

• Hyperosmolar oral products in neonates are linked to gastrointestinal complications.
• Recommendations suggest a maximum osmolality of 450 mOsm/kg for infant formulas and enteral nutrition.
• Intolerance to enteral nutrition with osmolality above 500 mOsm/kg has been reported in low birthweight infants.

Purpose of the Study:

• To determine the osmolality of commonly administered oral medications in neonatal intensive care units (NICUs).
• To provide essential osmolality data for neonatal medications, which is often unavailable.
• To inform clinical practice regarding the safe administration of oral medications to neonates.

Main Methods:

• Fifty-two oral medications, including solutions, suspensions, syrups, elixirs, and orally administered intravenous solutions, were selected.
• Osmolality measurements were performed in triplicate for each medication using freezing point depression.
• The study focused on medications frequently used in the NICU setting.

Main Results:

• A significant majority of medications tested had high osmolality.
• 86.1% (37 out of 43) of medications with measurable values exceeded 500 mOsm/kg.
• Only 14% (6 out of 43) of medications had an osmolality below 500 mOsm/kg.

Conclusions:

• This study provides crucial osmolality data for oral medications used in neonatal care.
• The findings indicate that most oral medications administered to neonates have an osmolality greater than 500 mOsm/kg.
• These results highlight a potential risk factor for gastrointestinal complications in neonates due to medication osmolality.