From assumption to assurance: Real-time flow monitoring in neonatal infusions

In neonatal intensive care, infusion pumps display programmed flow rather than directly confirming drug delivery at the patient-end. At the low infusion rates used in neonatal practice, studies have shown that factors such as compliance, hydrostatic pressure, start-up delay, and partial occlusion can influence actual drug delivery. Although these phenomena are well described, continuous bedside confirmation of patient-end flow isn't available in routine practice.

This editorial discusses the clinical implications of this hidden gap and explores the potential role of real-time flow monitoring.

We review the mechanisms contributing to flow variability, discuss why conventional pumps cannot verify patient-end drug delivery, and propose a phased pathway for evaluating emerging flow-monitoring technologies. We emphasize that current evidence is based on engineering and early translational studies and that clinical benefit remains to be demonstrated.

Improving visibility of patient-end drug delivery may represent future directions for neonatal infusion safety and warrants clinical evaluation.