DRUG-RELATED PROBLEMS IN CARDIAC NEONATES UNDER INTENSIVE CARE.

Amanda Roseane Farias Do Nascimento,Marco Edoardo Tavares Dos Santos,Tatiana Xavier Da Costa,Rand Randall Martins,Ramon Weyler Duarte Leopoldino

doi:10.1590/1984-0462/2020/38/2018134

Amanda Roseane Farias Do Nascimento, Marco Edoardo Tavares Dos Santos + Show 3 more

Open Access

https://doi.org/10.1590/1984-0462/2020/38/2018134

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Abstract

ABSTRACTObjective:To determine the frequency and nature of the Drug Related Problems (DRP) in neonates with cardiac diseases admitted to an Intensive Care Unit.Methods:This prospective cross-sectional study was developed at the Neonatal Intensive Care Unit (NICU) of a teaching maternity hospital in Brazil from January 2014 to December 2016. All neonates diagnosed with any heart disease (congenital heart disease, cardiomyopathy, arrhythmias, etc.) and who were admitted to the NICU for more than 24 hours with at least one prescribed drug were included in the study. Demographic and clinical data were collected from the records of the institution’s clinical pharmacy service. DRP and their respective interventions were independently reviewed and classified by two pharmacists. DRP classification was performed through the Pharmaceutical Care Network Europe v6.2 system.Results:122 neonates were included in the study. The frequency of neonates exposed to DRP was 76.4% (confidence interval of 95% [95%CI] 65.9–82.0), with a mean of 3.2±3.8 cases/patient. In total, 390 DRP were identified, of which 49.0% were related to “treatment effectiveness”, 46.7% to “adverse reactions” and 1.0% to “treatment costs”. The medicines most involved in DRP were Vancomycin (10.2%; n=46), Meropenem (8.0%; n=36) and Furosemide (7.1%; n=32). Pharmacists performed 331 interventions, of which 92.1% were accepted by physicians and nurses.Conclusions:The study showed that DRP are very frequent in patients with cardiac diseases hospitalized in the NICU, predominating problems related to the effectiveness and safety of the drug treatment.

Highlights

Due to the complexity of drug treatments, critically ill patients are prone to drug-related problems (DRPs).[1]
According to the Pharmaceutical Care Network Europe (PCNE), DRP is any event that interferes with a patient’s pharmacotherapy and, leads to or possible leads to undesirable clinical outcomes.[2]
All neonates diagnosed with heart disease admitted to the Neonatal Intensive Care Unit (NICU) between January 2014 and December 2016 for more than 24 hours and on at least one prescribed drug were included in the study

Summary

INTRODUCTION

Due to the complexity of drug treatments, critically ill patients are prone to drug-related problems (DRPs).[1]. Physiological immaturity, weight changes and off-label drug use contribute to the occurrence of DRPs.[4,5] The pharmacokinetic and pharmacodynamic peculiarities of neonates are associated with the rapid maturation of organs and systems over time, and the varying degrees of interindividual maturation. Such characteristics may lead to the sudden reach of sub or supra-therapeutic doses and make medication monitoring difficult.[5,6] Due to the increased need for dose calculations, weight changes in pediatric patients may impact drug safety.[7] Another important factor is the widespread use of off-label medicines.

METHOD

RESULTS

DISCUSSION