Drug utilisation in neonatal units in England and Wales: a national cohort study

Al-Turkait, Asma; Szatkowski, Lisa; Choonara, Imti; Ojha, Shalini

Abstract

Purpose: To describe drug utilisation patterns in neonatal units. Methods: Retrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44weeks’ gestational age (GA) from 01 January 2010 to 31 December 2017. Results: The cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11–24) in extremely preterm, 7 (5–11) in very preterm, 3 (0–4) in moderate-to-late preterm, and 3 (0–3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32weeks’ GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline. Conclusion: Antibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units. Registration: ClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.

Citation

Al-Turkait, A., Szatkowski, L., Choonara, I., & Ojha, S. (2022). Drug utilisation in neonatal units in England and Wales: a national cohort study. European Journal of Clinical Pharmacology, 78(4), 669-677. https://doi.org/10.1007/s00228-021-03267-x

• Journal Article Type: Article
• Acceptance Date: Dec 15, 2021
• Online Publication Date: Jan 13, 2022
• Publication Date: Apr 1, 2022
• Deposit Date: Jan 17, 2022
• Publicly Available Date: Jan 17, 2022
• Journal: European Journal of Clinical Pharmacology
• Print ISSN: 0031-6970
• Electronic ISSN: 1432-1041
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 78
• Issue: 4
• Pages: 669-677
• DOI: https://doi.org/10.1007/s00228-021-03267-x
• Keywords: Drug utilisation, Rational prescribing, Antibiotics
• Public URL: https://nottingham-repository.worktribe.com/output/7274378
• Publisher URL: https://link.springer.com/article/10.1007/s00228-021-03267-x