R. Uppal
A. Chhabra*
A. Narang*
From
the Department of Pharmacology and
Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Reprint requests: Dr. R. Uppal, Additional Professor, Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Manuscript received: March 7, 1997; Initial review completed: April 24, 1997;
Revision accepted: December 15,1997.
Scant information is available regarding the extent and pattern of drug use in perinatal period particularly the, Neonatal Intensive Care Unit (NICU). Iatrogenic problems are being increasingly recognized and information is becoming available on the handling of drugs in the newborn. Studies from Montreal, have shown that most newborns admitted to the NICU are exposed to a number of
drugs(1). This study evaluated the drug utilization patterns in a NICU of a tertiary care hospital in India in the hope that such information, would help in improving the quality of care provided.
Subject and Methods
The study was a prospective survey of 149 neonates, admitted to the NICU. Pretested forms were used to collect information from the hospital records of neonates
admitted to the NICU (over a period of six months). Data pertained to the gestational age, birth weight, admission and discharge, sex, diagnosis, outcome, drugs administered to mother (if the baby was delivered in our hospital or records available) and newborn. Drug
utilization in neonates was assessed by daily review. Fluids and electrolyte solutions, amino acids, glucose, oxygen, phototherapy and prophylactic ophthalmic treatment were not considered in data collection.
Results
One hundred and forty nine infants were admitted in NICU during the study period. The mean birth weight was 2250±96.8 g (range 1001-3500 g), the mean gestational age was 33±44.0 weeks, and the mean duration of stay in NICU was 17±16.4 days.
The baseline population was similar to that seen in other studies of drug use in
NICU(2,3). The commonest diagnostic categories were premature infants (n
= 117),
birth asphyxia (n = 54), respiratory distress (n = 37), jaundice (n = 42), small for date (n = 26), pneumonia (n = 23), polycythemia (n = 18), Rh
incompatibility (n = 10) and congenital heart disease (n
=
5).
Tables I & II show the most and less frequent drugs given to the
neonates. The median number of drugs received was 7. Three neonates were given
no drugs, 21 were given 1-2 drugs, 50 received 3-5 drugs, 62 received 6-10 drugs
and 10 neonates received more than 10 drugs concurrently. Antimicrobials were
administered to 105 of the 149 neonates; 12 were administered only 1 antimicrobial, 41 received
2,
33
received 3, 15 received 4 and 40 were
administered 5 concurrent antimicrobials. Specific drugs like aminophylline were used in less than 15% of the infants whereas phenytoin and indomethacin were used in less than 10%.
TABLE I
Most Frequently
Received
Drugs
in NICU.
Drug group
|
Drug |
Number |
Per cent
(n
=
149) |
Vitamins/Minerals |
|
Vitamin K |
136 |
91 |
|
Osteocalcium |
84 |
56 |
|
Multivitamins |
70 |
43 |
|
Ca gluconate |
72 |
42 |
|
Vitamin E |
65 |
40 |
CNS |
|
Phenobarbitone |
34 |
22 |
CVS |
|
Frusemide |
39 |
28 |
Antibiotics |
|
Amikacin |
93 |
62 |
|
Penicillin |
67 |
44 |
|
Cefotaxime |
57 |
38 |
TABLE II
Less Frequently Received Drugs in NICU.
Drugs received |
10-14% |
5-9% |
1% |
2-4% |
Antifungal lotion |
Antibiotic eye drops |
Iron preparation |
Naloxone |
Aminophylline |
Indomethacin
|
Diazepam |
Gentamicin |
Cloxacillin |
Immunoglobulin
|
ABDEC |
Hydrocortisone |
|
Sodiun bicarbonate |
Intraglobulin |
Trichlorphos |
|
Dopamine |
Pethidine |
|
|
Phenytoin |
Metronidazole |
|
|
Morphine |
Dexamethasone |
|
|
Ceftazidime |
Metoclopramide |
|
Discussion
This study had a small sample size but
gave us an overall pattern of drug use profile in a tertiary care NICU. This drug utilization study reflects the problems for which neonates were admitted to the neonatal intensive care unit; the largest number of neonates were in the premature category, birth asphyxia and respiratory distress. Drugs given to the mother can also
affect
the perinatal outcome and subsequent management in NICV.
In 68 out of 149 neonates, the mother had received no medication during labor.
There were 88 vaginal deliveries, 49 caesarean sections and 12 forceps. However,
no correlation could be established between the medication given to the mother
and neonatal complications like birth asphyxia and respiratory distress. The most commonly administered drugs to the mother were analgesics, anesthetics, antibiotics, oxytocics and tocolytics; this is similar to that observed in other studies(4).
The criteria adopted for audit were assessing the drug choice for the
individual neonates, its dosage form, dose calculation, dose
schedules, inter dose intervals and total duration of use. This
was considered appropriate for most antimicrobials and other
drugs. As most drugs, particularly (antimicrobials) were given as
life saving measures it was difficult to focus on their
irrationality. Though the number of drugs used in some neonates
were rather large, adverse drug reactions in such sick neonates were difficult to ascertain.
The intensity of drug therapy increased with clinical course and its complexity. The largest number of drugs per day were given in the first week in NICU, then intensity fell in the second week. The neonates therefore received a large number of drugs
concurrently, for a short duration only.
Drugs that are safe in adults may not be so for premature neonates. Although the sample size was small, focus on risks of adverse drug reactions and intensive monitoring of each neonate deserves attention. Such studies repeated at periods of time may show trends in drug usage and changes in preference therapies.
This report is intended to be a step in the broader evaluation of safety and efficacy of drug prescription in NICV.
Neonates are a very vulnerable group due to inmaturity of their body functions and great care needs to be taken to use the minimum number of drugs.
|