Nolt Valerie D, Kibler Alexandra Victoria, Wilkening G Lucy, Fabian Tanya J
University of Kentucky HealthCare, Lexington, KY, USA.
Penn State Milton S Hershey Medical Center, Pittsburgh, PA, USA.
Paediatr Drugs. 2017 Apr;19(2):139-146. doi: 10.1007/s40272-016-0209-x.
Second-generation antipsychotics (SGAs) are prescribed for a variety of indications and are strongly associated with adverse metabolic effects. Studies of pediatric outpatients have revealed several deficiencies in monitoring practices for adverse effects associated with SGAs.
Our objective was to characterize SGA prescribing and metabolic parameter monitoring (MPM) in an inpatient pediatric population.
Patients aged <18 years and discharged on SGA treatment between 1 November 2013 and 30 April 2014 from an inpatient psychiatric institution in Pittsburgh, PA, USA were included. Electronic medical records (EMRs) were reviewed for patient age and weight and for parameters used by the International Diabetes Federation (IDF) to define metabolic syndrome: waist circumference, fasting blood glucose, triglycerides, high-density lipoprotein, and blood pressure. The primary outcome was the percent of patients with completed MPM, defined as all parameters being available within the patient's EMR in any form, except estimates. Secondary outcomes included percent of patients with existing metabolic syndrome or obesity according to IDF criteria, average total daily dose of individual SGAs, and frequency of individual SGA utilization. Data were analyzed utilizing univariate descriptive statistics.
A total of 243 patients met inclusion criteria and were included in the analysis. For the primary outcome, 13.2% (n = 32) of patients had completed MPM for all parameters. Blood pressure was the most frequently documented parameter (n = 241; 99.2%), whereas waist circumference was the least (n = 67; 28%). Risperidone was the most commonly prescribed SGA (n = 99; 41%; average daily dose 1.92 mg).
Compared with outpatient studies, rates of documented MPM for certain parameters (i.e., fasting blood glucose, lipids) is higher for pediatric inpatients treated with SGAs. However, several monitoring deficiencies are still noted.
第二代抗精神病药物（SGA）被用于多种适应症，且与不良代谢效应密切相关。儿科门诊患者的研究显示，在监测与SGA相关的不良反应方面存在若干不足。
我们的目的是描述住院儿科患者中SGA的处方情况和代谢参数监测（MPM）。
纳入2013年11月1日至2014年4月30日期间在美国宾夕法尼亚州匹兹堡市一家住院精神病机构接受SGA治疗并出院的18岁以下患者。查阅电子病历（EMR）以获取患者年龄、体重以及国际糖尿病联盟（IDF）用于定义代谢综合征的参数：腰围、空腹血糖、甘油三酯、高密度脂蛋白和血压。主要结局是完成MPM的患者百分比，定义为患者EMR中以任何形式（估计值除外）可获取所有参数。次要结局包括根据IDF标准患有现有代谢综合征或肥胖症的患者百分比、个体SGA的平均每日总剂量以及个体SGA的使用频率。利用单变量描述性统计分析数据。
共有243名患者符合纳入标准并纳入分析。对于主要结局，13.2%（n = 32）的患者完成了所有参数的MPM。血压是记录最频繁的参数（n = 241；99.2%），而腰围记录最少（n = 67；28%）。利培酮是最常用的SGA（n = 99；41%；平均每日剂量1.92 mg）。
与门诊研究相比，接受SGA治疗的儿科住院患者某些参数（即空腹血糖、血脂）的MPM记录率更高。然而，仍存在一些监测不足。
