Medication Use in the Neonatal Intensive Care Unit and Changes from 2010 to 2018.

Medication Use in the Neonatal Intensive Care Unit and Changes from 2010 to 2018.
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DOI:
10.1016/j.jpeds.2021.08.075
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发表时间:
2022-01
影响因子:
5.1
通讯作者:
Greenberg, Rachel G.
Greenberg, Rachel G.
中科院分区:
医学2区
文献类型:
--
作者:
Stark, Ashley;Smith, P. Brian;Hornik, Christoph P.;Zimmerman, Kanecia O.;Hornik, Chi D.;Pradeep, Sidart;Clark, Reese H.;Benjamin, Daniel K., Jr.;Laughon, Matthew;Greenberg, Rachel G.

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提供美国NICU的最新药物处方模式,并检查处方模式随时间推移的趋势。我们对2010年至2018年期间在Pediatrix Medical Group管理的NICU接受治疗的799,016名婴儿进行了队列研究。我们使用了三种不同的方法来报告药物计数:暴露,疗程和使用天数。我们通过绝对变化和相对变化来定义给药频率的变化。我们检查了每种药物的FDA包装说明书,以确定药物是否标记用于婴儿,并使用Pubmed搜索药代动力学(PK)研究。最常用的处方药包括:氨苄青霉素、庆大霉素、柠檬酸咖啡因、poractant alpha、吗啡、万古霉素、呋塞米、芬太尼、咪达唑仑和对乙酰氨基酚。在用于极低出生体重婴儿(ELBW)的前50种药物中,只有20种(40%)是FDA标记用于婴儿的药物;在未标记用于婴儿的药物中,13/30(43%)至少有2项已发表的药代动力学(PK)研究。2010年至2018年使用相对增加最多的药物包括:右美托咪定、可乐定、罗库溴铵、左乙拉西坦、阿托品和二氮嗪。使用相对减少最多的药物包括:醋酸氨丁三醇(THAM)、泮库溴铵、水合氯醛、亚胺培南+西司他丁和阿米卡星。随着时间的推移,NICU的药物使用趋势发生了很大变化。必须确定NICU中药物使用的变化,以更好地为进一步的前瞻性研究提供信息。
To provide up-to-date medication prescribing patterns in United States NICUs and to examine trends in prescribing patterns over time. We performed a cohort study of 799,016 infants treated in NICUs managed by the Pediatrix Medical Group from 2010–2018. We used three different methods to report counts of medication: exposure, courses, and days of use. We defined the change in frequency of medication administration by absolute and relative change. We examined the FDA package insert for each medication to determine if a medication was labeled for use in infants and used Pubmed to search for pharmacokinetics (PK) studies. The most prescribed medications included: ampicillin, gentamicin, caffeine citrate, poractant alpha, morphine, vancomycin, furosemide, fentanyl, midazolam, and acetaminophen. Of the top 50 medications used in infants with extremely low birth weights (ELBW), only 20 (40%) are FDA labeled for use in infants; of those that are not labeled for use in infants, 13/30 (43%) had at least 2 published pharmacokinetic (PK) studies. Medications with the greatest relative increase in use from 2010 to 2018 included: dexmedetomidine, clonidine, rocuronium, levetiracetam, atropine, and diazoxide. Medications with the greatest relative decrease in use included: tromethamine (THAM) acetate, pancuronium, chloral hydrate, imipenem+cilastatin, and amikacin. Trends of medication use in the NICU change substantially over time. It is imperative to identify changes in medication usage in the NICU to better inform further prospective studies.
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