DRUG-RELATED PROBLEMS IN CARDIAC NEONATES UNDER INTENSIVE CARE

ABSTRACT Objective: To determine the frequency and nature of the Drug Related Problems (DRP) in neonates with cardiac diseases admitted to an Intensive Care Unit. Methods: This prospective cross-sectional study was developed at the Neonatal Intensive Care Unit (NICU) of a teaching maternity hospital in Brazil from January 2014 to December 2016. All neonates diagnosed with any heart disease (congenital heart disease, cardiomyopathy, arrhythmias, etc.) and who were admitted to the NICU for more than 24 hours with at least one prescribed drug were included in the study. Demographic and clinical data were collected from the records of the institution’s clinical pharmacy service. DRP and their respective interventions were independently reviewed and classified by two pharmacists. DRP classification was performed through the Pharmaceutical Care Network Europe v6.2 system. Results: 122 neonates were included in the study. The frequency of neonates exposed to DRP was 76.4% (confidence interval of 95% [95%CI] 65.9–82.0), with a mean of 3.2±3.8 cases/patient. In total, 390 DRP were identified, of which 49.0% were related to “treatment effectiveness”, 46.7% to “adverse reactions” and 1.0% to “treatment costs”. The medicines most involved in DRP were Vancomycin (10.2%; n=46), Meropenem (8.0%; n=36) and Furosemide (7.1%; n=32). Pharmacists performed 331 interventions, of which 92.1% were accepted by physicians and nurses. Conclusions: The study showed that DRP are very frequent in patients with cardiac diseases hospitalized in the NICU, predominating problems related to the effectiveness and safety of the drug treatment.

摘要
研究目的：明确入住重症监护病房的心脏疾病新生儿所面临的药物相关问题（Drug Related Problems, DRP）的发生频率与类型。
研究方法：本前瞻性横断面研究于2014年1月至2016年12月期间，在巴西某教学型妇产医院的新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）开展。本研究纳入所有确诊存在各类心脏疾病（包括先天性心脏病、心肌病、心律失常等）、入住NICU时长超过24小时且至少使用1种处方药物的新生儿。研究人员从该院临床药学服务的病历记录中收集人口学与临床相关数据。两名药师独立对药物相关问题及其对应的干预措施进行审核与分类，药物相关问题的分类采用欧洲药学监护网络v6.2系统完成。
研究结果：本研究共纳入122例新生儿。发生药物相关问题的新生儿占比为76.4%（95%置信区间[95%CI] 65.9~82.0），每名患者平均涉及3.2±3.8个药物相关问题。共计识别出390例药物相关问题，其中49.0%与“治疗有效性”相关，46.7%与“不良反应”相关，1.0%与“治疗成本”相关。与药物相关问题关联度最高的药物依次为万古霉素（Vancomycin，10.2%；n=46）、美罗培南（Meropenem，8.0%；n=36）与呋塞米（Furosemide，7.1%；n=32）。药师共实施331项干预措施，其中92.1%获得医师与护士的采纳。
研究结论：本研究结果显示，入住NICU的心脏疾病新生儿中药物相关问题发生率极高，其中以药物治疗的有效性与安全性相关问题为主。