Tratamiento de los recién nacidos de muy bajo peso al nacer. ¿Se basa en la evidencia?

¿Tienen los recién nacidos las mismas oportunidades farmacoterapéuticas que los adultos?

INTRODUCTION

The use of drugs in pediatrics, specially in neonates, poses two main problems: the legal conditions for their use in this population and the lack of commercial formulations suitable for pediatric dosing.

PATIENTS AND METHODS

We reviewed the drug prescriptions of all patients admitted to our neonatal intensive care unit over 46 days, chosen at random between September and November 2005.

RESULTS

A total of 2,558 drug prescriptions were issued, corresponding to 62 different drugs. Overall, 5.2 % of prescriptions were for drugs not authorized for use in pediatric patients. In neonates, this percentage increased to 8.4 %. A total of 22.6 % of the drugs were not authorized for use in neonates. Formulations prepared by the hospital pharmacists were required in 17.2 % of drug prescriptions.

CONCLUSIONS

In the last few years, information on drugs in pediatric patients has increased. However, continued efforts are required in this field so that drugs with proven clinical efficacy in pediatric patients become authorized for use in this population. Because of the lack of suitable commercial formulations for use in pediatric patients, preparation of formulations by the hospital pharmacist and the use of drug dilutions at the bedside are mandatory, both of which are a source of possible preparation and administration errors.

Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries?

Background

The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country

Methods

The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence

Results

Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics

Conclusions

Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleading