Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN.
Purdue University College of Pharmacy, Purdue University, West Lafayette, IN.
J Pediatr. 2023 Aug;259:113489. doi: 10.1016/j.jpeds.2023.113489. Epub 2023 May 17.
To evaluate the use of drugs with pharmacogenomic (PGx) guidelines from the Clinical Pharmacogenetics Implementation Consortium in early childhood.
A retrospective observational study of patients admitted to the neonatal intensive care (NICU) between 2005 and 2018 with at least 1 subsequent hospitalization at or after 5 years of age was performed to determine PGx drug exposure. Data regarding hospitalizations, drug exposures, gestational age, birth weight, and congenital anomalies and/or a primary genetic diagnosis were collected. Incidence of PGx drug and drug class exposures was determined and patient specific factors predictive of exposure were investigated.
During the study, 19 195 patients received NICU care and 4196 (22%) met study inclusion; 67% received 1-2, 28% 3-4, and 5% 5 or more PGx-drugs in early childhood. Preterm gestation, low birth weight (<2500 g), and the presence of any congenital anomalies and/or a primary genetic diagnosis were statistically significant predictors of Clinical Pharmacogenetics Implementation Consortium drug exposures (P < .01, P < .01, P < .01, respectively).
Preemptive PGx testing in patients in the NICU could have a significant impact on medical management during the NICU stay and throughout early childhood.
评估临床药物基因组学实施联盟（Clinical Pharmacogenetics Implementation Consortium，CPIC）指导下的药物在婴幼儿早期的使用情况。
对 2005 年至 2018 年间在新生儿重症监护病房（neonatal intensive care，NICU）住院且至少在 5 岁后有后续住院的患者进行回顾性观察性研究，以确定药物基因组学药物暴露情况。收集有关住院、药物暴露、胎龄、出生体重、先天性异常和/或原发性遗传诊断的数据。确定药物基因组学药物和药物类别暴露的发生率，并研究预测暴露的患者特定因素。
在研究期间，有 19195 名患者接受了 NICU 治疗，其中 4196 名（22%）符合研究纳入标准；67%的患者在婴幼儿期接受了 1-2 种 PGx 药物，28%的患者接受了 3-4 种，5%的患者接受了 5 种或更多 PGx 药物。早产、低出生体重（<2500g）、任何先天性异常和/或原发性遗传诊断是 CPIC 药物暴露的统计学显著预测因素（P<0.01、P<0.01、P<0.01，分别）。
在 NICU 患者中进行预防性药物基因组学检测可能会对 NICU 期间和整个婴幼儿期的医疗管理产生重大影响。
