Medication Related Problems Among Critically Ill Neonates Admitted at Kenyatta National Hospital a Prospective Cohort Study

Abstract

Background: Neonates are usually at a significant risk for adverse risk for adverse drug reactions since organs required to handle medicine are still under development. Neonates at the neonatal intensive care unit are usually very ill with multiple organ dysfunction. They may be on multiple medications which greatly increases the chances of adverse drug reactions. Objective: The main objective of the study was to characterize the medication related problems and their associated factors among the neonates admitted to the intensive care units of Kenyatta National Hospital. Methods: The study was carried out between April and June 2019 and it was a descriptive prospective cohort study. It entailed the prospective review of treatment sheets and patient files of neonatal patients who are critically ill and admitted at the Kenyatta National Hospital. Data collection commenced within 48 hours of admission. Data collection was done by reviewing patient files to extract details such as demographic characteristics and clinical data on medication related problems. Patient records were reviewed daily. Follow-up was done daily for two weeks. Descriptive data analysis was conducted. The relationships between predictor and outcome variables for medication related problems was computed using logistic regression to identify risk factors for Medication Related Problems. The level of significance was set at 0.05. Results: A total of 70 participants met the eligibility criteria and were enrolled into the study. The most common diagnosis was respiratory distress syndrome (64, (88.8%), which was followed by infections (81.1%). Benzyl penicillin (52, (19%), gentamicin (50, (18.2%) and ceftazidime 32(11.7%) were the most prescribed antibiotics. Aminophylline (21, (5.5%) was the most prescribed respiratory drug. Dosing errors were evaluated and they were most likely to have a negative impact on treatment outcomes. Gastrointestinal (OR 1.5 95% CI 1.038, 2.165; p=0.031) and congenital disorders (OR 1.368 95% CI 1.018, 1.837; p=0.037) were strong predictors of underdosing. There was statistical significant association between the use of aminophylline, ranitidine, phenytoin and overdosing. There was no statistical significant between dosing errors and anthropometric measures. Conclusion: Dosing errors are the most common MRP among critically ill neonates admitted in the neonatal intensive care unit. Specialist pharmaceutical care is needed to identify and manage MRPs.