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Stark A, Smith PB, Hornik CP, Zimmerman KO, Hornik CD, Pradeep S, Clark RH, Benjamin DK Jr, Laughon M, Greenberg RG. Medication Use in the Neonatal Intensive Care Unit and Changes from 2010-2018. J Pediatr. 2021 Sep 2:S0022-3476(21)00860-X.

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.

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