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Adverse drug reactions in children leading to hospital admission
A A Mitchell1, P G Lacouture, J E Sheehan
1Slone Epidemiology Unit, University School of Public Health, MA 02146.
Insights
Adverse drug reactions cause a small fraction of pediatric hospital admissions, with higher rates in children with cancer. This study provides a baseline for pediatric drug safety surveillance.
Area of Science:
- Pediatric Pharmacology
- Drug Safety Surveillance
- Hospital Admissions
Background:
- Understanding the incidence and causes of pediatric hospital admissions due to adverse drug reactions (ADRs) is crucial for improving child safety.
- This study systematically monitored pediatric admissions across various hospital settings to quantify ADR-related admissions.
Observation:
- A total of 10,297 pediatric patients were monitored across teaching and community hospitals.
- ADR-prompted admissions varied significantly by patient group: 0.2% in neonatal intensive care, 22% in pediatric oncology, and 2% in general pediatric wards.
- Two pediatric deaths (0.03%) were attributed to ADRs.
Findings:
- The proportion of ADR-prompted admissions increased from infancy to age five and remained stable thereafter.
- Commonly implicated drugs included phenobarbital, aspirin, phenytoin, ampicillin/amoxicillin, theophylline/aminophylline, trimethoprim-sulfamethoxazole, and diphtheria-pertussis-tetanus vaccine.
- ADR admission rates were similar in teaching (2.1%) and community (1.8%) hospitals.
Implications:
- Pediatric ADRs represent a small but significant cause of hospital admissions compared to adults.
- These findings establish a benchmark for pediatric drug safety and inform targeted surveillance strategies.
- Further research into pediatric drug safety is warranted to minimize ADRs and improve patient outcomes.
Abstract:
To provide information regarding pediatric hospital admissions prompted by adverse drug reactions, data were reviewed from an intensive drug surveillance program in which 10,297 patients admitted to diverse pediatric wards at four teaching and three community hospitals were systematically monitored. Among 3,026 neonatal intensive care unit admissions, 0.2% were prompted by adverse drug reactions; among 725 children with cancer, 22% of admissions were prompted by adverse drug reactions. Among 6,546 children with other conditions monitored on general medical and specialty wards at two teaching hospitals and on general pediatric wards at three community hospitals, 2% (131) of admissions were prompted by adverse drug reactions. Two patients (0.03%) died because of their reactions. The proportion of admissions prompted by drug reactions increased between infancy and 5 years of age and tended to be relatively stable thereafter. The drugs most commonly implicated in the admissions were phenobarbital, aspirin, phenytoin, ampicillin/amoxicillin, theophylline/aminophylline, trimethoprim-sulfamethoxazole, and diphtheria-pertussis-tetanus vaccine. Similar proportions of admissions were prompted by adverse drug reactions in teaching hospitals (2.1%) and in community hospitals (1.8%), and the drug groups implicated in these admissions were generally similar in the two settings. In contrast to adult populations, children with adverse drug reactions account for a small proportion of hospital admissions. Findings from this large, systematic study of pediatric admissions to teaching and community hospitals may serve as a baseline to which other pediatric facilities can compare their experience.