Análise dos problemas relacionados a medicamentos em Terapia Intensiva Neonatal

Abstract

Introduction: Drug Related Problem (DRP) is any event related to pharmacotherapy that actually or potentially interferes with the desirable clinical outcome. DRPs are very common in intensive care, however, little is known about DRPs in Neonatal Intensive Care Units (NICU). Objective: To analyze the DRPs in the NICU according to frequency, type, cause and corresponding pharmaceutical conducts. Methods: A prospective observational study was conducted in the NICU of a teaching hospital in Brazil from January 2014 to November 2016, based on the records of the clinical pharmacy service, excluding neonates with length of stay< 24 hours and with no prescribed drugs. DRPs were classified according to the Pharmaceutical Care Network Europe system and assessed for safety-relevance. Logistic regression analysis was applied to identify factors and drugs associated with DRPs. Results: Six hundred neonates were included in the study with mean gestational age of 31.9±4.1 weeks and birth weight of 1,779.4±885,3 g. The incidence of DRPs was 6.8 cases/1,00 patient-days (95%CI 6.2 – 7.3). Sub-optimal effect (52.8%) and dose selection (39.7%) were the most common problem and cause, respectively. Most of the pharmaceutical interventions were performed at the prescription level, with over 90% being accepted by the NICU team. Number of medications (OR 1.19; 95%CI 1.09 – 1.30), number of clinical problems (OR 1.17; 95%CI 1.01 – 1.37), length of stay (OR 1.05; 95%CI 1.02 – 1.07) and vaginal delivery (OR 1.61; IC95% 1.04-2.50) were associated with DRPs. Medicines with increased risk for DRP were alprostadil, amikacin, aminophylline, amphotericin B, ciprofloxacin, fluconazole, gentamicin, meropenem, phenobarbital and vancomycin. These drugs represent only one-third of all prescribed drugs. Conclusions: DRPs are very common in NICU, predominating problems of sub-optimal treatment, mainly due to inappropriate dose choice.