Girardi A, Galletti S, Raschi E, Koci A, Poluzzi E, Faldella G, De Ponti F
Department of Medical and Surgical Sciences, University of Bologna 40138, Bologna, Italy.
Present Address: Department of Medical and Surgical Sciences, University of Bologna, via Irnerio 48 40126, Bologna, Italy.
Ital J Pediatr. 2017 Apr 17;43(1):37. doi: 10.1186/s13052-017-0354-z.
Drug use in preterm neonates admitted to Neonatal Intensive Care Unit (NICU) has been investigated, so far, in terms of unauthorized or off-label use; very little is known on the use of combinations of different active substances, which is frequently required in this population (prophylaxis of infections, treatment of concomitant diseases). The aim of this study was to describe the most common patterns of drug use in an Italian NICU, focusing on those with nephrotoxic potential.
Medical records of preterm neonates (<37 weeks of gestational age) weighing less than 1,500 g at birth and admitted to an Italian NICU were scrutinized in a 3-year retrospective investigation. Analysis included drug exposure, duration of therapies, co-administration of drugs with potential renal side effects; also daily protein supplement was calculated from parenteral nutrition.
A cohort of 159 preterm neonates was selected; 68 were born weighing less than 1,000 g (extremely low birth weight infants, ELBW, Group A), 91 weighed between 1,000 and 1,500 g at birth (Group B). Compared to Group B, neonates of Group A were more likely to receive pharmacological treatments: the most used drugs were antibiotics (especially ampicillin and amikacin, p = .07 and p < .001, respectively), antifungals (especially fluconazole, p < .001), and diuretics (especially furosemide, p < .001). Analysis of co-administration of drugs with potential nephrotoxicity showed ampicillin and amikacin as the most reported combination (94.1% of Group A and 31.9% of Group B), the combination of furosemide with antibacterials (ampicillin or amikacin) was also frequently reported, with average period of combination shorter than 2 days.
ELBW infants were exposed to a higher number of drugs compared to other neonates and were more likely to receive associations of drugs with nephrotoxic potential (e.g. furosemide and amikacin), though only for short cycles. Further studies should evaluate the safety profile (especially potential renal side effects) related to most commonly used combinations.
迄今为止，对入住新生儿重症监护病房（NICU）的早产儿用药情况的研究主要集中在未经授权或超说明书用药方面；对于经常需要在该人群中使用的不同活性物质组合（感染预防、合并疾病治疗）的用药情况知之甚少。本研究的目的是描述意大利一家NICU中最常见的用药模式，重点关注具有肾毒性潜力的药物。
在一项为期3年的回顾性调查中，仔细审查了出生时体重小于1500g、胎龄小于37周且入住意大利一家NICU的早产儿的病历。分析内容包括药物暴露情况、治疗持续时间、具有潜在肾脏副作用的药物联合使用情况；还从肠外营养中计算每日蛋白质补充量。
选取了159名早产儿队列；其中68名出生时体重小于1000g（极低出生体重儿，ELBW，A组），91名出生时体重在1000至1500g之间（B组）。与B组相比，A组新生儿更有可能接受药物治疗：最常用的药物是抗生素（尤其是氨苄西林和阿米卡星，p分别为0.07和<0.001）、抗真菌药（尤其是氟康唑，p<0.001）和利尿剂（尤其是呋塞米，p<0.001）。对具有潜在肾毒性的药物联合使用情况的分析表明，氨苄西林和阿米卡星是报告最多的联合用药组合（A组为94.1%，B组为31.9%），呋塞米与抗菌药物（氨苄西林或阿米卡星）的联合使用情况也经常被报告，联合使用的平均时间短于2天。
与其他新生儿相比，ELBW婴儿接触的药物数量更多，并且更有可能接受具有肾毒性潜力的药物联合治疗（如呋塞米和阿米卡星），尽管只是短期疗程。进一步的研究应评估与最常用联合用药相关的安全性（尤其是潜在的肾脏副作用）。
