Prevalence of Potential Drug-Drug Interactions in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study

Abstract

Hospitalized  neonates  in neonatal  intensive  care  unit  (NICU)  are  usually  exposed  to great  number  of drugs  and they  are susceptible to adverse outcomes due to their immature functioning organs and reasons like inappropriate  dosing or choice of medicines. We aimed  to assess  the prevalence  and characteristics  of potential  drug-  drug  interactions  (pDDIs)  in the NICU.  In this prospective observational study, case sheets of neonates who were in the NICU for more than 24 hours and were administered with at least two drugs were analysed for pDDIs by using Lexicomp database. All pDDIs were classified according to their severity, reliability, risk level and their underlying mechanisms. Potential predictors and potential outcomes of pDDIs were also evaluated. We found that 66.2% of neonates were exposed  to at least  one pDDI.  Total of 902  pDDIs  comprising  of 70 distinct  pDDIs  were  identified  of which  88% were  moderate  in severity. 11.8% and 0.2% of them were major and minor respectively. Most of pDDIs belonged to category C (61.4%) and category D (30%) of risk level. Majority of interactions  had pharmacodynamic  mechanism  (65.7%) and fair scientific evidences (68.6%). The most common potential adverse drug events included increased sympathomimetic effects, nephrotoxicity and alteration of serum concentration of drugs. Systemic  anti-infective  were  involved  in majority  of interactions.  pDDIs  were more  prevalent  in neonates  with  gestational  age of <32 weeks,  >11 days of hospital stay and those who received >11 concomitant drugs. Identification of pDDIs and monitoring the neonates for potential adverse outcomes is mandatory especially in high risk conditions to avoid or minimize the actual harm.