title: Review of drug utilization patterns in NICUs worldwide.
abstract: OBJECTIVE
  When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care. Specific objectives include the following: identifying the most commonly used medicines, comparing these to the A-PINCH (Anti-infectives, Potassium and other electrolytes, Insulin, Narcotics and sedatives, Chemotherapy agents, Heparin and other anticoagulants), high-risk medicines list, and determining whether there are any differences in medicine use between countries.
  
  
  METHODS
  Quasi-systematic literature review.
  
  
  METHODS
  Google Scholar, MEDLINE/PubMed, Scopus and EMBASE were searched utilizing selected MeSH terms.
  
  
  RESULTS
  A total of 19 articles from 12 countries were reviewed. Medication use between countries was very similar with no discernible differences in types of medicines prescribed. The most commonly used medicines included gentamicin, ampicillin, caffeine, furosemide and vitamin K. The median number of medicines prescribed per patient ranged from 3 to 11, and an inverse relationship was identified between gestational age and the number of medications that were prescribed. Nine of the 20 most commonly used medicines were listed as A-PINCH medicines, and included antibiotics, fentanyl, morphine and heparin. Inappropriate prescribing, as well as the high use of off-label/unlicensed medicines, was highlighted as areas of practice that require consideration to improve medication safety and minimize the potential risk for medication errors.
  
  
  CONCLUSIONS
  Overall, the types of medicines used in NICUs worldwide are similar, with consistent reports on the common use of antibiotics, caffeine and vitamins. However, it cannot be definitively stated that the findings of the review accurately depict current practice in NICUs, due to the limited amount of published literature available. There are several areas of concern that warrant further investigation to improve rational use of medicines in the neonatal populations, including high use of antibiotics and off-label and unlicensed medicines.
authors: Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia. Natalia.Krzyzaniak@student.uts.edu.au.
authors: N
authors: http://orcid.org/0000-0001-5668-7292
authors: N
authors: Krzyżaniak
authors: Pharmacology Department, Medical University of Gdansk, Gdańsk, Poland.
authors: I
authors: I
authors: Pawłowska
authors: Graduate School of Health (Pharmacy), University of Technology Sydney, Broadway, NSW, Australia.
authors: B
authors: B
authors: Bajorek
mesh_terms: D004348:Drug Labeling / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
keywords: NICU; drug utilization; neonate; prescription patterns