Objective: To provide up-to-date medication prescribing patterns in United States NICUs and to examine trends in prescribing patterns over time.
Study design: We performed a cohort study of 799,016 infants treated in NICUs managed by the Pediatrix Medical Group from 2010-2018. We used three different methods to report counts of medication: exposure, courses, and days of use. We defined the change in frequency of medication administration by absolute and relative change. We examined the FDA package insert for each medication to determine if a medication was labeled for use in infants and used Pubmed to search for pharmacokinetics (PK) studies.
Results: The most prescribed medications included: ampicillin, gentamicin, caffeine citrate, poractant alpha, morphine, vancomycin, furosemide, fentanyl, midazolam, and acetaminophen. Of the top 50 medications used in infants with extremely low birth weights (ELBW), only 20 (40%) are FDA labeled for use in infants; of those that are not labeled for use in infants, 13/30 (43%) had at least 2 published pharmacokinetic (PK) studies. Medications with the greatest relative increase in use from 2010 to 2018 included: dexmedetomidine, clonidine, rocuronium, levetiracetam, atropine, and diazoxide. Medications with the greatest relative decrease in use included: tromethamine (THAM) acetate, pancuronium, chloral hydrate, imipenem+cilastatin, and amikacin.
Conclusion: Trends of medication use in the NICU change substantially over time. It is imperative to identify changes in medication usage in the NICU to better inform further prospective studies.