Abstract
PurposeTo describe drug utilisation patterns in neonatal units.MethodsRetrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44 weeks’ gestational age (GA) from 01 January 2010 to 31 December 2017.ResultsThe cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11–24) in extremely preterm, 7 (5–11) in very preterm, 3 (0–4) in moderate-to-late preterm, and 3 (0–3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32 weeks’ GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline.ConclusionAntibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units.RegistrationClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.
Highlights
Drug utilisation studies highlight aspects such as pattern, variability and trends in pharmacotherapy
All infants admitted to neonatal units in England and Wales from 01 January 2010 to 31 December 2017 whose data are recorded in the Neonatal Research Database (NNRD) were included
Records of 643,233 infants admitted to 187 neonatal units across England and Wales from 01 January 2010 to 31 December 2017 were retrieved from the NNRD
Summary
Drug utilisation studies highlight aspects such as pattern, variability and trends in pharmacotherapy They inform design and implementation of effective strategies for rational prescribing practices and inform research [1]. Large scale drug utilisation studies from the USA [4, 5] have described prescribing patterns and change over time from selected centres. No such studies have been conducted in the UK where the provision of neonatal care is almost exclusively within the National Health Service (NHS), providing a unique opportunity to evaluate drug use at a population level
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