Abstract
To evaluate the proportion of inappropriate digoxin level determinations in children at Children’s Hospital of Fudan University. A retrospective analysis of 291 digoxin level determinations in 210 inpatients was performed. Appropriateness criteria were based on existing criteria that were revised using local expert opinion. The main outcome measure was the proportion of digoxin levels assessed as inappropriate by these criteria. Of the 291 digoxin levels, 126 (43.3%) were considered inappropriate and the remaining 165 (56.7%), appropriate. For the majority of the inappropriate determinations timing of blood sampling was incorrect (74.6%); the remaining determinations were done without proper indication. Almost half the digoxin blood level monitoring was assessed as inappropriate, mainly because of incorrect timing of sampling. Interventions to ensure that appropriate indications and procedures for serum digoxin determination in children at the Children’s Hospital of Fudan University are urgently needed, moreover, special criteria need to be made for children in digoxin blood level monitoring. Key words: Digoxin, therapeutic drug monitoring, children, appropriateness.
Highlights
For drug therapy to be optimal for children it is important that they are not treated as miniature adults
Interventions to ensure that appropriate indications and procedures for serum digoxin determination in children at the Children’s Hospital of Fudan University are urgently needed, special criteria need to be made for children in digoxin blood level monitoring
The mean serum level observed in children aged less than one month was higher than in older children (1.29 ± 0.58 ) (Table 3), there was statistically significant differences in mean serum digoxin among less than 1 month group and other age groups (P < 0.01), the proportion of digoxin serum concentrations >2.0 ng/mL (17.7%) was significantly higher (p < 0.05) in patients less than one month of age and in patients being cared for in the ICU, cardiac surgery, newborn room than cardiology and other units (12.5, 10 and 18.2% vs. 1.8 and 0%; p < 0.01; Table 4)
Summary
For drug therapy to be optimal for children it is important that they are not treated as miniature adults. The pharmacokinetics of drugs in children can differ widely from adults due to physiological differences, including immaturity of enzyme systems and clearance mechanisms. Pharmacokinetics differs among children of different ages because many physiologic systems are immature in the first months after birth and change rapidly throughout childhood. These considerations mean that children are likely to benefit from therapeutic drug monitoring (TDM) for some drugs. The present retrospective study was performed to assess the proportion of digoxin level determinations in hospitalized children not fulfilling accepted criteria for appropriate digoxin level monitoring and to identify reasons for these inappropriate measurements
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