Abstract
Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.
Highlights
Prescribing drugs to newborn infants, those born preterm, is a challenge fraught with complexities including lack of evidence-based information about pharmacokinetics and pharmacodynamics of drugs, efficacy and side-effect profiles for some of the most frequently used drugs
20 July 2020 based on the following PICo: population, neonates, infants or newborn; interest, drug use or drug utilization; and context, neonatal intensive care or neonatal care
We found wide variation in the number of medications used per infant ranging from 1.7 drugs per infants reported by Bonati et al [75] to 11.1 per patient as reported by Neubert et al [43]
Summary
Prescribing drugs to newborn infants, those born preterm, is a challenge fraught with complexities including lack of evidence-based information about pharmacokinetics and pharmacodynamics of drugs, efficacy and side-effect profiles for some of the most frequently used drugs. Drug-utilization research provides an insight into the pattern of prescribing and is the essential first step towards rational drug use and evidence-based pharmacotherapy [1]. Physicians prescribe drugs not necessarily based on the available evidence and under influence from psychosocial and circumstantial aspects that impact their decisions [2]. Investigation into the trends and variability of drug use in the neonatal population can provide information that could guide effective strategies to improve prescribing practices and highlight areas for research. Observational studies describing patterns of drug use provide preliminary evidence to support this agenda.
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