Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Data Collection Tools
2.3. NRAMs Identification
2.4. Statistical Analysis
3. Results
3.1. Population Characteristics
3.2. Drug-Related Problems (DRPs)
3.3. Types of NRAM
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviation
NRAMs | negative results associated with medications |
NRAM | Negative result associated with medication |
PN | parenteral nutrition |
DRPs | drug-related problems |
NB | newborns |
PNB | preterm newborns |
CEN | complementary enteral nutrition |
EN | enteral nutrition |
GA | gestational age |
BW | birth weight |
APGAR | appearance, pulse, grimace, activity, respiration. |
CEISH-PUCE | Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador |
VLBW | very low birth weight |
NICU | neonatal intensive care unit |
TN | term newborn |
LPN (T) | late preterm newborn |
MPN (M) | moderate preterm newborn |
SPN (Sev) | severe preterm newborn |
EPN (Ext) | extremely preterm newborn |
ABW | adequate birth weight |
LBW | low birth weight |
ExLBW | extremely low birth weight |
DB | direct bilirubin |
BT | total bilirubin |
ALT | alanine aminotransferase |
GA | gestational age |
ES | evolution sheet |
VGI | volume of glucose infusion |
EUN | elevated urea nitrogen |
IVH | intraventricular hemorrhage |
NPO | nothing by mouth |
MCT | medium chain triglycerides |
SIRS | systemic inflammatory response syndrome |
FDA | Food and Drug Administration |
SFT | follow-up service |
ESPGHAN | European Society for Pediatric Gastroenterology Hepatology and Nutrition |
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Description | Average ± SD | Min–Max. | N | % |
---|---|---|---|---|
Gender | ||||
Male | - | - | 40 | 51 |
Female | - | - | 38 | 49 |
Type of birth | ||||
Cesarean | - | - | 69 | 88 |
Normal | - | - | 9 | 12 |
Weight | ||||
Birth weight | 1.640 ± 0.644 | 0.670–3.845 | ||
Adequate birth weight (ABW) | 2.955 ± 0.468 | 2.506–3.845 | 10 | 13 |
Low birth weight (LBW) | 1.774 ± 0.232 | 1.520–2.440 | 31 | 40 |
Very low birth weight (VLBW) | 1.294 ± 0.165 | 1.00–1.480 | 27 | 34 |
Extremely low birth weight (ExLBW) | 0.832 ± 0.100 | 0.670–0.960 | 10 | 13 |
Age | ||||
Gestational age | 33.000 ± 3.100 | 25.520–40.401 | ||
Term newborn (TN) | 37.812 ± 1.250 | 36.421–40.401 | 10 | 13 |
Late preterm newborn LPN (L) | 34.100 ± 0.921 | 33.100–36.405 | 34 | 44 |
Moderate preterm newborn MPN (M) | 31.901 ± 0.805 | 30.212–33.001 | 19 | 24 |
Severe preterm newborn SPN (Sev) | 29.305 ± 0.412 | 29.005–30.002 | 8 | 10 |
Extremely preterm newborn EPN (Ext) | 26.704 ± 0.912 | 25.013–28.025 | 7 | 9 |
Score APGAR | ||||
Minute 1 | 7.001 ± 1.805 | 1.001–10.002 | ||
(a) 7–10 | 7.950 ± 0.651 | 7.002–8.012 | 59 | 76 |
(b) 4–6 | 4.932 ± 0.832 | 4.043–6.023 | 14 | 18 |
(c) NV-3 | 1.753 ± 0.961 | NV–3.0 | 5 | 6 |
Minute 5 | 9.001 ± 1.305 | 1.001–10.015 | ||
(a) 7–10 | 8.812 ± 0.412 | 7.023–10.012 | 72 | 92 |
(b) 4–6 | 6.005 ± 0.000 | 6.001 | 3 | 4 |
(c) NV-3 | 2.012 ± 1.405 | NV–3.001 | 3 | 4 |
Nutritional therapy | ||||
Time of nutritional therapy administered (days) | 12.001 ± 7.705 | 1.001–30.049 | ||
(a) >28 | 23.601 ± 1.323 | 31.001 | 1 | 1 |
(b) 21–28 | 24.701 ± 2.105 | 22.013–28.011 | 10 | 13 |
(c) 14–21 | 18.071 ± 1.701 | 15.001–21.002 | 14 | 18 |
(d) 7–14 | 10.962 ± 1.932 | 8.000–14.005 | 25 | 32 |
(e) 1–7 | 3.961 ± 2.105 | 1.000–7.015 | 28 | 36 |
Mix type | 920 | 100 | ||
2 in 1 | - | - | 43 | 5 |
2 in 1 + lipids apart | - | - | 418 | 45 |
3 in 1 | - | - | 459 | 50 |
Drugs | ||||
Number of drugs administered during nutritional therapy (drugs/day) | 5.001 ± 2.122 | 1.501–10.561 | - | - |
Mortality | ||||
Yes | - | - | 17 | 22 |
No | 61 | 78 |
DRPs | n | % Validation | % Total |
Administrative Validation | 250 | 100 | 3.57 |
Error or absence in the patient data | 64 | 25.60 | |
Evidence of amendment | 29 | 11.62 | |
Typing error of the components in the prescription Typing error in the calories declared in the evolution sheet | 47 | 18.82 | |
Typing error in the rate of micronutrients declared in the evolution sheet | 38 | 15.20 | |
Typing error in the total volume to prepare the PN and/or the infusion rate declared in the progress sheet | 19 | 7.62 | |
Typing error in the dextrose rate declared in the evolution sheet | 18 | 7.21 | |
Typing error in the lipid rate declared in the evolution sheet | 15 | 6.00 | |
Typing error in the declared amino acid ratio in the evolution sheet | 13 | 5.21 | |
Duplication of prescription sheets | 3 | 1.23 | |
Wrong prescription for the patient | 3 | 1.22 | |
Omission of the prescription | 1 | 0.42 | |
Physicochemical validation | 5512 | 100 | 78.81 |
Calculation error of caloric intake and/or declared value in the clinical history | 920 | 16.69 | |
Necessary vitamins not available | 920 | 16.69 | |
Phosphorus required not available | 920 | 16.69 | |
Filters 1.2 µ not available | 877 | 15.91 | |
Filters 0.22 µ not available | 461 | 8.36 | |
Amino acid rate > necessary | 347 | 6.30 | |
Lipid rate > to necessary | 327 | 5.93 | |
Calorie rate < to necessary | 321 | 5.82 | |
Electrolyte rate > that required (summed as mEq/kg/day of chlorine) | 204 | 3.70 | |
Carbohydrate rate > necessary | 108 | 1.96 | |
Lipid rate < to necessary | 70 | 1.27 | |
Calorie rate > the necessary | 18 | 0.33 | |
Carbohydrate rate < to necessary | 17 | 0.31 | |
Fluid rate > to necessary | 2 | 0.04 | |
Clinic Validation | 1232 | 100 | 17.62 |
Toxicity risk associated with packaging material. | 348 | 28.25 | |
Kcal/gN ratio < (100–130) | 169 | 13.72 | |
Phosphorus analysis not available | 129 | 10.47 | |
Magnesium analysis not available | 129 | 10.47 | |
BUN test not performed | 129 | 10.47 | |
Lipid infusion rate <recommended (0.35 mL/kg/h) | 93 | 7.55 | |
Kcal/gN ratio < (150–200) | 88 | 7.14 | |
Lipid infusion rate > recommended (0.51 mL/kg/h) | 26 | 2.11 | |
PN-drug incompatibility (dopamine and/or dobutamine) | 26 | 2.11 | |
ALT analysis not available | 23 | 1.87 | |
AST analysis not available | 23 | 1.87 | |
Direct bilirubin analysis not available | 23 | 1.87 | |
Alkaline phosphatase test not available | 23 | 1.87 | |
PN-drug interaction | 3 | 0.24 |
Classification of NRAM Granada 2007 (%) | Criteria | NRAM | n | % | DRPs | p-Value | RR (CI 95%) |
---|---|---|---|---|---|---|---|
NEED (16) | (I): Untreated health problem | Alkaline phosphatase elevation | 7 | 11 | Phosphorus needed not available | ˂0.001 | 0.4 (0.141–0.648) |
Lactic acidosis | 3 | 5 | Necessary vitamins not available | 0.001 | 0.2 (0.073–0.681) | ||
EFFECTIVITY (11) | (IV): Ineffective quantitative | Hypoalbuminemia | 5 | 8 | Relation Kcal/gN < (100–130) | 0.570 | 1.4 (0.537–3.396) |
Hypoglycemia | 2 | 3 | Carbohydrate rate < necessary | 0.127 | 4.5 (0.768–26.405) | ||
SECURITY (72) | (VI): Insecurity quantitative | Cholestasis | 12 | 20 | Lipid level > to necessary | 0.001 | 3.2 (1.720–6.109) |
Hyperchloremia | 9 | 15 | Electrolyte rate > that required (summed as mEq/kg/day of chlorine) | 0.845 | 1.0 (0.548–2.005) | ||
Elevated liver enzymes | 7 | 11 | Lipid level > to necessary | 0.165 | 1.9 (0.855–4.183) | ||
Metabolic acidosis | 6 | 10 | Amino acid rate > necessary | 0.432 | 1.4 (0.605–3.227) | ||
Hyperglucemia | 7 | 11 | Carbohydrate rate > necessary | 0.024 | 2.8 (1.203–6.430) | ||
Hypertriglyceridemia | 2 | 3 | Lipid level > to necessary | 0.083 | 6.8 (0.969–47.067) | ||
Hypercalcemia | 1 | 2 | Calcium level > necessary | 0.340 | 3.4 (0.311–36.684) |
Factors | Alkaline Phosphatase Elevation | Lactic Acidosis | Cholestasis | Hyperglycemia |
---|---|---|---|---|
Birth weight | 0.393 | 0.197 | 0.442 | 0.075 |
Gestational age (GA) | ||||
PNB | 0.967 | 0.188 | 0.780 | 0.031 * |
TN | 0.519 | 0.700 | 0.029 * | 0.764 |
APGARassessment | ||||
Apgar 1′ | 0.464 | 0.183 | 0.788 | 0.696 |
Apgar 5′ | 0.776 | 0.030 * | 0.724 | 0.629 |
Time of nutritional therapy administered (days) | ||||
<14 days | 0.882 | 0.785 | 0.785 | 0.427 |
>14 days | 0.037 * | 0.337 | 0.966 | 0.056 |
Number of drugs administered during nutritional therapy (drug/day) | 0.014 * | 0.214 | 0.457 | 0.766 |
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Vega Díaz, E.N.; Miranda Barros, A.A.; Castelo Reyna, M.A.; Tenelanda López, D.; Tubon, I. Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy. Pediatr. Rep. 2023, 15, 360-372. https://doi.org/10.3390/pediatric15020032
Vega Díaz EN, Miranda Barros AA, Castelo Reyna MA, Tenelanda López D, Tubon I. Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy. Pediatric Reports. 2023; 15(2):360-372. https://doi.org/10.3390/pediatric15020032
Chicago/Turabian StyleVega Díaz, Evelin Nataly, Aida Adriana Miranda Barros, Monica Alexandra Castelo Reyna, Dennys Tenelanda López, and Irvin Tubon. 2023. "Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy" Pediatric Reports 15, no. 2: 360-372. https://doi.org/10.3390/pediatric15020032