Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Nutrition, University of North Carolina Nutrition Research Institute, University of North Carolina Chapel Hill, Kannapolis, North Carolina.
Am J Perinatol. 2021 Mar;38(4):383-391. doi: 10.1055/s-0039-1697669. Epub 2019 Nov 4.
Very low birth weight (VLBW) infants are exposed to medications with insufficient evidence describing pharmacokinetics and safety. Objective was to quantify and identify risk factors associated with the highest quartile of medication exposure.
Retrospective record review of VLBW infants admitted to a level-IV neonatal intensive care unit (NICU). We obtained baseline clinical and demographic characteristics, as well as data on all medications received during admission. Characteristics of patients within the upper quartile of medication use were compared with remaining patients.
Identified 106 infants, mean birth weight (BW) = 961 g, gestational age = 27.3 weeks. Infants received a median = 20 medications (range, 4-72). Those in the top quartile of medication use received ≥30 medications while in the NICU and had higher odds of being male sex, lower BW, longer length of hospital stay (LOHS), and bronchopulmonary dysplasia. Sepsis did not affect medication exposure. Antibiotics, opiates, and reflux medications were among the top prescribed.
Infants are exposed to a large number of medications during NICU hospitalization, including potentially unnecessary antibiotics and reflux medications. Male sex, the presence of certain comorbidities such as necrotizing enterocolitis, and LOHS, are associated with higher exposure. Increased awareness of this issue may assist in decreasing medication exposure in VLBW populations.
极低出生体重（VLBW）婴儿接触到的药物，其药代动力学和安全性的证据不足。目的是量化并确定与药物暴露量最高四分位数相关的风险因素。
对入住四级新生儿重症监护病房（NICU）的 VLBW 婴儿进行回顾性病历回顾。我们获得了基本的临床和人口统计学特征，以及婴儿在住院期间接受的所有药物的数据。将用药量最高四分位数患者的特征与其余患者进行比较。
确定了 106 名婴儿，平均出生体重（BW）=961g，胎龄=27.3 周。婴儿接受中位数=20 种药物（范围，4-72）。在 NICU 中使用≥30 种药物的患者中，男性、BW 较低、住院时间（LOHS）较长和支气管肺发育不良的可能性更高。败血症并未影响药物暴露。抗生素、阿片类药物和反流药物是最常开的药物。
婴儿在 NICU 住院期间接受了大量药物治疗，包括可能不必要的抗生素和反流药物。男性、存在某些并发症（如坏死性小肠结肠炎）和 LOHS 与更高的暴露量相关。提高对这个问题的认识可能有助于减少 VLBW 人群的药物暴露。
