Research on medication use in the neonatal intensive care unit

ABSTRACT

Introduction: Research on medication use aims at assessing how much of current pharmacotherapy is rational. In neonates, this is hampered by extensive off-label drug use and limited knowledge.

Areas covered: We report on medication use research and have conducted a systematic review of observational studies on medication use to provide an updated overview on characteristics, objectives, methods, and patterns in hospitalized neonates. Moreover, a review on aspects of medication use for opioids, anti-epileptics, gastric acid-related disorders and respiratory stimulants with emphasis on trends and impact of interventions is presented, illustrating how research on medication use can contribute to improved neonatal pharmacotherapy and more focused research. Medication use reports describe patterns and provide signals on irrational use, benchmarking, or can guide research priorities. Moreover, this may generate information on how neonatal health topics and their pharmacotherapy are handled over time or across regions.

Expert opinion: Research on medicine utilization is relevant, since it will inform us on aspects like trends, variability, or about the impact and pattern of implementation of guidelines in neonates. Further progress necessitates to merge datasets on medication use with clinical characteristics, and perinatal drug use remains an area in need of additional research.

KEYWORDS:

• Drug utilization
• infant
• medication use
• neonatal clinical pharmacology
• newborn

Article highlights

• Research on medication use aims to assess to what extent pharmacotherapy is rational. In neonates, this is obviously hampered by extensive off-label prescriptions and the limited knowledge on neonatal pharmacotherapy.

• Despite these limitations, medication use reports can describe patterns and provide signals on irrational medication use, guidelines and benchmarking, or for research priorities. This may generate information on how a pharmacotherapy for a particular neonatal health topic is handled longitudinal (with time) or cross-sectional (across regions).

• A systematic review of observational studies on medication use provided an updated overview on characteristics, objectives, methods, and patterns of medication use studies in hospitalized neonates. This systematic search documented a relevant increase in research output, with a variety of topics, geographic regions, and therapeutic topics covered.

• An illustrative review on aspects of medication use for opioids, anti-epileptics, gastric acid-related disorders and methylxanthines/respiratory stimulants illustrate how this can contribute to improved neonatal pharmacotherapy.

• To further improve the impact of medication use research in neonates, we suggest international collaboration and to include more granularity in the datasets (indication, outcome), to broaden the topic to cover also perinatal medication use, and to consider–when applicable–not only the individual patient but also the population.

Acknowledgments

We thank Sabrina Gunput from the Medical Library Erasmus Medical Centre, Rotterdam, the Netherlands for her assistance in conducting the systematic search strategy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Karel Allegaert has been supported by the agency for innovation by Science and Technology in Flanders (IWT) through the SAFEPEDRUG project (IWT/SBO 130033).