Pattern of Drug Utilisation in Neonatal Intensive Care Unit in a Tertiary Care Hospital

Background: Every year millions of babies are born and a large proportion of them are admitted to the neonatal ward for various indications. Neonates particularly preterm and very preterm neonates are the most vulnerable population. There is paucity of information to guide rational prescribing in children and newborns.Objectives: The objective of this study was to determine the patterns of drug use in newborns in tertiary care NICU, VIMS, Bellary, Southern India.Materials and Methods: Data from 100 Case records of newborns admitted in NICU from Jan 2013 - June 2013 was collected. Information regarding gender, gestational age, birthweight, length of hospital stay, survival status at discharge, and details of all drugs used was collected in the prestructured proforma and subjected to statstical analysis.Results: Among 100 study subjects 57% were females and 43% were males. Only 51% of them completed term. Majority of them were admitted with Perinatal asphyxia complicated by HIE (48%). The most common drugs used were Ceftriaxone(75%) and Amikacin(75%), Phenobarbitone sodium(39%), VitaminK(19%) and Aminophylline(11%).73% of newborns were recovered. The relation between gestational age, birth weight, indications and the type of drugs used was found to be statistically significant.Conclusion: Ceftriaxone and Amikacin are most commonly used drugs. Appropriate care was given to all the neonates to improve the outcome.

IJBR (2014) 05 (09) www.ssjournals.com Among them 57% were females and 43% were males. 51% of them completed term and 32% were in hospital for more than 7 days. Aro und 48% of them were admitted with Perinatal asphyxia complicated by HIE, 20% MAS and 8% of them suffered from septicaemia.
The most common drugs used were Ceftriaxone (75%) and Amikacin (75%), Phenobarbitone sodium (39%), Vitamin -K (19%) and Aminophylline (11%).The most commonly used antibiotics are shown in Fig 2 and other drugs used are shown in Table1.   Among the total newborns 73% of newborns were recovered and discharged, 18% went against medical advice and 9% were referred to higher centers as shown fig 4.

Fig 4: Shows out come
The relation between gestational age, birth weight, indications and the type of drugs used was found to be statistically significant. The relation between gender and outcome come was found to be statistically significant. The factors gender, gestational age is found to have significant association with outcome as shown in table 2, 3 & 4.

Discussion
Advances in medical technology have resulted in improved survival rates in both preterm and term infants including high-risk, low birth weight infants 6 .There is general appreciation that neonates especially preterm have high drug utilization rates ,Syste m evaluation is needed to see the trend of medication use ,define the group that are high risk for adverse events 7 . Among the 100 neonates admitted male: female ratio was 1:1.3 most of them (57%) were admitted within 24hrs of the birth which was consistent with other studies 8,9 . Which may be explained by fact many of them could be reffered from outside. Most of them 48% admitted with diagnosis of perinatal asphyxia, second most common cause MAS(20%) and followed by se pticemia 8% which was in contradiction to studies done in Nepal where jaundice being the commonest cause followed by sepsis and perinatal asphyxia. This could be at tributed to the poor intranatal and perinatal care or due to the delay in the transit to the hospital of mothers during labour time which causes the fetal distress and majority of them are exposed to perinatal asphyxia. Another study in Nigeria showed sepsis being the commonest cause .But re sults consistent with study done in Pakistan showed asphyxia being common cause followed by jaundice, prematurity and sepsis 3 .The most common drugs used in our study were Ceftriaxone(75%) and Amikacin (75%) compared to study done in Michigan showed most common antibiotic used was Ampicillin and cefotaxime 10 .This could be related to the availability of the drug in the centre ,but still the rationale of using antibiotic at such high rate compared to the diagnosis need to be established which may be a precautionary measure to prevent septicaemia. Among 100 newborns 73% of them recovered and discharged, 18% of them went against medical advice and 9% were referred. Compared to study in Nepal where 76.9% of them discharged after improvement, 6.5 % left against medical advice and 1.62% referred to higher centre, Indicates the better neonatal care with predominant antibiotic treatment with other modes and also explains the need of better intranatal and perinatal care which would avoid many neonates suffering from perinatal asphyxia.

Conclusion
Out of 100 newborn cases admitted and treated in NICU of VIMS, majority of cases were females and admitted on the day of birth with the complaints of Perinatal Asphyxia, MAS, Septicaemia etc. They were treated with standard treatment, 73% cases recovered and di scharged only 9% of the cases were referred to the higher centers and 18% went against medical advice. In our study the relation between gestational age, birth weight, indicatio ns and the type of drugs used was found to be statistically significant. This indicates the drug usage and the neonatal care is provided efficiently inspite many of them being due to improper intranatal management and delay in seeking treatment.