title: Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies.
abstract: Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n= 7), the United States (n= 6), India (n= 5), Brazil (n= 1), and Iran (n= 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia.
authors.forename: Rosliana
authors.initials: R
authors.lastname: Rosli
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia.
authors.forename: Ahmad Fauzi
authors.initials: AF
authors.lastname: Dali
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Malaysia.
authors.forename: Noorizan
authors.initials: N
authors.lastname: Abd Aziz
authors.affiliation: Department of Environmental Health, Faculty of Health Sciences, Universiti Teknologi MARA Bertam, Malaysia.
authors.forename: Amir Heberd
authors.initials: AH
authors.lastname: Abdullah
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARASelangor, Malaysia; Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of TasmaniaHobart, Australia.
authors.forename: Long Chiau
authors.initials: LC
authors.lastname: Ming
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARASelangor, Malaysia; School of Pharmacy, KPJ Healthcare University CollegeNilai, Negeri Sembilan, Malaysia.
authors.forename: Mohamed Mansor
authors.initials: MM
authors.lastname: Manan
keywords: daily defined dosage; drug dosage calculations; drug utilization review; health services administration; hospital central supply