Drug Utilisation in Very Preterm Infants: Any Changes during the Past Decade?

Abstract

Background: Improved standards of perinatal care for preterm infants led to decreased hospital mortality rates during the past decade. However, studies investigating changes in drug utilisation in neonatal intensive care units (NICU) during this period are missing.

Objective: The aim of the present study therefore was to evaluate the most frequently used groups of drugs in preterm infants treated in NICUs and to analyse potential changes in drug utilisation over a period of ten years.

Methods: Drug utilisation patterns in 164 preterm infants born between 1989 and 1990 (group I; gestational age 27.2±1.2 weeks, birth weight 970±145 g) were compared to those in 113 preterm infants born between 2001 and 2004 (group II; gestational age 26.9±1.65 weeks, birth weight 930±253 g, mean and standard deviation each) with need for postnatal mechanical ventilation.

Results: Significant changes in drug utilisation patterns were observed for complete courses of antenatal corticosteroids (40 vs. 51.5%), diuretics (78 vs. 36.6%), surfactant (63.3 vs. 75%), methylxanthines (89.9 vs. 56.7%), sedatives/analgesics (82.4 vs. 91.5%) and catecholamines (38.3 vs. 52.4%) (group II vs. group I each). Postnatal corticosteroids were applied more often in group II (17.4 vs. 13.4%). However, duration of postnatal corticosteroid treatment has decreased (6d vs. 13d). The use of antibiotics remained unchanged (100 vs. 98.9%). Comparison of clinical outcome variables showed a decreased duration of mechanical ventilation and a significantly increased survival rate.

Conclusion: Drug utilisation patterns in preterms have changed considerably during the past decade. Improved standards of care and shorter duration of mechanical ventilation may be operative.

Zusammenfassung

Hintergrund: Verbesserte Standards bei der perinatalen Betreuung Frühgeborener führten zu einer höheren Überlebensrate in der letzten Dekade. Angaben zu Veränderungen im Arzneimitteleinsatz auf Neugeborenenintensivstationen innerhalb dieses Zeitraums fehlen jedoch weitgehend.

Ziel: Ziel dieser Studie war deshalb, die am häufigsten eingesetzten Arzneimittelgruppen bei intensivmedizinisch betreuten Frühgeborenen zu untersuchen und mögliche Änderungen im Arzneimitteleinsatz über einen Zeitraum von 10 Jahren zu erfassen.

Methoden: Der Arzneimitteleinsatz bei 164 beatmeten Frühgeborenen der Jahrgänge 1989 und 1990 (Gruppe I, Gestationsalter 27,2±1,2 Wochen, Geburtsgewicht 970±145 g) wurde verglichen mit dem Arzneimitteleinsatz bei 113 beatmeten Frühgeborenen der Jahrgänge 2001–2004 (Gruppe II, Gestationsalter 26,9±1,65 Wochen, Geburtsgewicht 930±253 g).

Ergebnisse: Es zeigten sich signifikante Veränderungen im Einsatz von vollständigen Zyklen antenataler Kortikosteroide (40 vs. 51,5%), Diuretika (78 vs. 36,6%), Surfactant (63,3 vs. 75%), Methylxanthinen (89,9 vs. 56,7%), Sedativa/Analgetika (82,4 vs. 91,5%) und Katecholaminen (38,3 vs. 52,4%) (jeweils Gruppe II vs. Gruppe I). Postnatale Kortikosteroide wurden in Gruppe II häufiger verabreicht (17,4 vs. 13,4%), jedoch über einen kürzeren Zeitraum (6 Tage vs. 13 Tage). Der Einsatz von Antibiotika blieb unverändert (100 vs. 98,9%). Ein Vergleich des klinischen Verlaufes zeigte einen Rückgang in der Dauer der maschinellen Beatmung sowie eine signifikant höhere Überlebensrate.

Schlussfolgerung: Der Arzneimitteleinsatz bei Frühgeborenen zeigt über einen Zeitraum von 10 Jahren deutliche Veränderungen, was unter anderem durch verbesserte Standards in der Versorgung und kürzere Beatmungszeiten bedingt sein könnte.

drug utilisation - preterm infants - morbidity - surfactant - antenatal and postnatal corticosteroids

Arzneimitteltherapie - Frühgeborene - Morbidität - Surfactant - ante- und postnatale Kortikosteroide

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