新生儿重症监护中的药物相互作用：一项前瞻性队列研究。

Drug-drug interactions in neonatal intensive care: A prospective cohort study.

机构信息

Postgraduate Program in Pharmaceutical Sciences, Pharmacy Department, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Multiprofessional Health Residency Program, Maternidade Escola Januário Cicco, Centro de Ciências da Saúde, Universidade Federal do Rio Grande Norte, Natal, RN, Brazil.

Postgraduate Program in Pharmaceutical Sciences, Pharmacy Department, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil; Pharmacy Department, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.

出版信息

Pediatr Neonatol. 2021 Mar;62(2):151-157. doi: 10.1016/j.pedneo.2020.10.006. Epub 2020 Oct 23.

DOI:10.1016/j.pedneo.2020.10.006

PMID:33158761

Abstract

BACKGROUND

To characterize the prevalence and profile of drug-drug interactions (DDIs), the drugs most related to major DDIs and risk factors of their prescription in a neonatal intensive care unit (NICU).

METHODS

Neonates admitted to a NICU who had at least one medication prescribed and a hospital stay >24 h were included in a prospective cohort study (August 2017 to July 2018). All medications prescribed during the hospitalization were collected from all neonates (n = 220), with the screening for DDIs. Prevalence and type of DDIs was identified. Network analysis was used to identify the drugs more implicated with DDIs. Logistic regression was used for the analysis of risk factors (p < 0.05).

RESULTS

Over 70% of neonates were exposed to DDIs and 29% were exposed to major DDIs. The network analysis identified furosemide, fentanyl, aminophylline and fluconazole as most implicated with DDI, fentanyl was especially associated with major DDIs. The number of drugs (OR 1.60, p < 0.01), caesarean delivery (OR 2.68, p < 0.05), gestational age (OR 1.03, p < 0.01) and APGAR score (OR 0.78, p < 0.01) were identified as risk factors for exposure to DDI.

CONCLUSION

Neonates in intensive care have a high exposure to DDIs and the occurrence of major DDIs is related specifically to the prescription of fentanyl. The number of prescribed drugs, gestational age, cesarean delivery and low APGAR score in the first minute were identified as risk factors for DDIs in NICU.

摘要

背景

为了描述药物-药物相互作用（DDI）的流行程度和特征、与主要 DDI 最相关的药物以及新生儿重症监护病房（NICU）中这些药物处方的危险因素。

方法

本前瞻性队列研究纳入了 2017 年 8 月至 2018 年 7 月期间在 NICU 住院且至少接受一种药物治疗且住院时间>24 小时的新生儿。对所有新生儿（n=220）采集住院期间开具的所有药物，对其进行 DDI 筛查。确定 DDI 的发生率和类型。采用网络分析确定与 DDI 关系更密切的药物。采用逻辑回归分析危险因素（p<0.05）。

结果

超过 70%的新生儿存在 DDI，29%的新生儿存在主要 DDI。网络分析发现呋塞米、芬太尼、氨茶碱和氟康唑与 DDI 关系最密切，芬太尼尤其与主要 DDI 相关。药物种类（OR 1.60，p<0.01）、剖宫产（OR 2.68，p<0.05）、胎龄（OR 1.03，p<0.01）和 APGAR 评分（OR 0.78，p<0.01）是发生 DDI 的危险因素。