Perfil de uso de antimicrobianos em Unidades de Terapia Intensiva Neonatal: uma revisão de escopo

Abstract

Newborns are particularly susceptible to infections due to their immature immune systems, exacerbated by factors such as invasive procedures, length of hospital stay, and low birth weight. Consequently, studies investigating medication usage patterns in Neonatal Intensive Care Units suggest that systemic anti-infective agents constitute the most commonly used class of medications. The objective of this study is to describe the profile of antimicrobial use in Neonatal Intensive Care Units. This is a scoping review conducted according to the methodology proposed by the Joanna Briggs Institute (JBI). The protocol is registered on the Open Science Framework (OSF) platform (DOI 10.17605/OSF.IO/YB4AG). The following databases were included: LILACS; EMBASE; MEDLINE/PubMed; SciELO; Web of Science; and Scopus. To identify grey literature, digital repositories were consulted. Database searches were conducted in January 2024. The identified studies were uploaded to the Rayyan app, and duplicates were removed. The inclusion criteria were: availability in full text; containing data on consumption rates, most prescribed antimicrobials, most common indications, or off-label use of antimicrobials; being conducted in NICUs; and including only antimicrobial medications, except for studies addressing off-label use. The exclusion criteria were: being a study on the use of antimicrobials for specific indications and being a duplicate or overlapping study. Study selection and data extraction were conducted by two independent reviewers. The extracted data were presented in tabular form accompanied by a narrative description. A total of 4,029 articles were identified, of which 39 were included in the final review. Most of the studies were cohort or cross-sectional. No significant variation in gestational ages was observed. Regarding birth weight, values over 2,000 grams were more common in high-income countries. Neonatal sepsis was the main reason for prescribing antimicrobials. The most common method for measuring antimicrobial consumption was Days of Therapy (DOT). Among antimicrobials, antibacterials were the most studied. The classes of penicillins, cephalosporins, and glycopeptides were mentioned in all studies. Antimicrobials were used offlabel concerning dose, administration interval, indication, and age.