Medication follow-up in newborns with extremely low birth-weight
Objective: The medication follow-up in infants with extremely low birth-weight in a neonatal intensive care unit is described, identifying drug-related problems (DRP), drug-related negative outcomes, and the relationship between the occurrence of DRP and birth-weight of newborns and their impact on pharmacotherapy and length of hospital stay.
Methods: A descriptive and exploratory study was performed in which medication follow-up of a population of infants with extremely low birth-weight admitted to the neonatal intensive care unit of a government-run maternity hospital was carried out by clinical pharmacists. Monitoring comprised assessment of patients’ pharmacotherapy needs through visits to the neonatal unit, evaluation of prescriptions and information on medical records, identification of issues associated with pharmacotherapy and follow-up of the newborns’ clinical evolution to determine whether desired results were achieved.
Results: The subjects were 33 infants characterized by extremely low weight at birth. Analysis of patients' pharmacotherapy showed that 39.4% (n=13) of the neonates presented some type of DRP, totaling 37 DRPs and a mean of 2.8 problems/patient. Fourteen drugs were identified with the occurrence of DRP. Vancomycin and cefepime were the most prevalent, with 18.9% (n=7). Occurrence of DRPs and several clinical characteristics of newborns and their pharmacotherapy were compared. The most prevalent drug-related negative outcomes identified were "untreated health problem" (40%, n=10) and "quantitative ineffectiveness" (32%, n=8). Pharmaceutical interventions were performed for all problems associated with pharmacotherapy, with a prevalence of "treatment day count correction" and "dose correction", both with 21.6% (n=8), and "correction of dosage" (16.2%, n=6).
Conclusion: The research evidenced the role of the clinical pharmacist in the solution and prevention of drug-related problems, contributing with the multidisciplinary team to obtain a safe and effective pharmacotherapy. Further, current study confirmed that there is an association between the characteristics of the newborns under analysis (eg. birth-weight, pharmacotherapy) and the occurrence of drug-related problems.
Hernández ORM, Sánchez AR. The extreme weight newborn. Rev Cub Obstet Ginecol. 2010;36(2):32-41.
Carvalho CG, Ribeiro MR, Bonilha MM, Fernandes Jr M, Procianoy RS, Silveira RC. Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores. J Pediatr (Rio J). 2012;88(6):465-470. https://doi.org/10.2223/JPED.2231
Pallás CR, De-La-Cruz J, Del-Moral MT, Lora D, Malalana MA.Improving the Quality of Medical Prescriptions in Neonatal Units. Neonatology. 2008;93(4):251-256. https://doi.org/10.1159/000111530
World Health Organization. WHO model formulary for children 2010. Geneva: WHO; 2010.
Canadian Paediatric Society Statement.Enhanced roles for health professionals in newborn care. Paediatr Child Health. 2000;5(2):106-114.
Klopotowska JE, Kuiper R, Van KanHJ, De Pont AC, Dijkgraaf MG, Lie-A-Huen L, Vroom MB, Smorenburg SM. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study. Crit Care. 2010;14(5):R174. https://doi.org/10.1186/cc9278
Thompson R. Neofax 2011, 24 ed. New York, NY: PDR Network; 2011.
Comite De Consenso GIAF-UGR. Third Consensus of Granada on Drug Related Problems and Negative Outcomes associated with Medication. Ars Pharmac. 2007 48;1:5-17.
Farré Riba R, Clopés Estela A, Sala Esteban MF, Castro Cels I, Gámez Lechuca M. [Pharmaceutical interventions (part 1): methodology and assessment]. Farm Hosp. 2000;24(3):136-144.
Strand LM, Cipolle RJ, Morley PC. Pharmaceutical Care Practice: The patient centered approach to medication management, 3rd Ed. New York: McGraw-Hill; 2012.
WHO Collaborating Centre for Drug Statistics Methodology. Anatomical-Therapeutical-Chemical (ATC) Classification Index and Guidelines. World Health Organization, Geneva. Available at http://www.whocc.no/atc_ddd_index/ (accessed on Nov 20, 2014).
Lohmann Gandini-Billinghurst P, Rodriguez Espinoza M, Webb Linares, V,Rospiglioso López, ML. [Mortality among newborns with extreme low body weight at birth from the neonatology unit at the Hospital Nacional Cayetano Heredia]. Rev Med Hered. 2006;17(3):141-147
Cunha M, Bettencourt A, Almeida A, Mimoso G, Soares P, Tomé, T. The extreme low birth weigtht newborn: Assessement at 2-3 years. Portuguese very low birth weight network, results from 2005 and 2006]. Acta Pediatr Port. 2013 44(1):1-8.
Mesquita M, Lacarrubba J, Galván L, Barreto N, Buena J, Adler E.Recién Nacidos de extremo bajo peso de nacimiento. Limites de viabilidad, reanimación en Sala de Partos y Cuidados Intensivos Neonatales. Pediatría (Asunción). 2010;37(2):127-135.
Lemons JA, Bauer GH, Oh W, Koroner SB, Papile, LA, Stoll S. Very low birth weight outcome of the National Institute of Child Health and Human Development, Neonatal Research Network: January 1995 Through December 1996. Pediatrics. 2001;107(1):E1. https://doi.org/10.1542/peds.107.1.e1
Lima EV, Oliveira DMP, Draque CM, Mori H, Pinto FLS, Saraiva MA, Guinsburg R, Almeida MFB, Mello FB, Amaro ER. [Survival of very low birth weight infants in level III private maternity hospital]. Rev Paul Pediatr. 2006;24(2):155-162.
Ramos HAC, Cuman RKN. [Risk factors for prematurity: document search]. Esc Anna Nery. 2009;13(2):297-304.
Figueiredo CP, Norton RC, Lamounier JA, Leão E. Late hemorragic disease of the newborn: case report. J Pediatr. 1998;74(1):67-70.
Almeida CB, Medeiros RMK, SèCCS, Santos IMN, Menezes SO, Gianini NOM. The use of exogenous surfactant at neonatal units at Rio de Janeiro City. Rev Soc Bras Enferm Ped. 2007;7(2):67-73.
López Martínez R, Cabañas Poy MJ, Oliveras Arenas M, Clemente Bautista S. [Drug use in a neonatal ICU: a prospective study]. Farm Hosp. 2005;29(1):26-29.
Neubert A, Lukas K, Leis T, Dormann H, Brune K, Rascher W. Drug utilization on a preterm and neonatal intensive care unit in Germany: a prospective, cohort-based analysis. Eur J Clin Pharmacol. 2010;66(1):87-95. https://doi.org/10.1007/s00228-009-0722-8
Carlson CA. Antibiotics and pharmacotherapeutics in the neonate. Newborn Infant Nurs Rev. 2010;10(4):203-208. https://doi.org/10.1053/j.nainr.2010.09.009
Silva CSMR, Vendramim P. Problemas relacionados a medicamentos em Unidade de Cuidados Intensivos Neonatal. Rev Acred. 2012;2(3):136-147.
Martinez BB, Ferreira, NC. [Assessment of medication regimen complexity among diabetics]. Rev Méd Minas Gerais. 2012;22(2):133-138.
Fernández-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Pérez-Sanz C, Duran-García E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97(6):564-568. https://doi.org/10.1136/archdischild-2011-301239
Drovandi A, Robertson K, Tucker M, Robinson N, Perks S, Kairuz T. A systematic review of clinical pharmacist interventions in paediatric hospital patients. Eur J Pediatr. 2018 Aug;177(8):1139-1148. https://doi.org/10.1007/s00431-018-3187-x
Cançado RD, Lobo C, Friedrich JR. [Treatment of iron deficiency anemia with oral iron]. Rev Bras Hematol Hemoter. 2010;32(Supl. 2):114-120. http://doi.org/10.1590/S1516-84842010005000062
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.