Clinical Characteristics, Medication Prescription Pattern, and Treatment Outcomes at the Neonatal Intensive Care Unit of a Tertiary Health-Care Facility in Ghana

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Abstract

Objective:

Neonates are more susceptible to infections, as well as medication toxicities. This study, therefore, sought to describe the clinical characteristics, medication prescription pattern, and treatment outcomes for neonates admitted to the neonatal intensive care unit (NICU) of a tertiary health-care facility in Ghana.

Methods:

A retrospective cross-sectional study was conducted to ascertain clinical records, conditions for admission, spectrum of medications prescribed, and treatment outcomes from neonatal patient folders.

Findings:

Of 667 folders reviewed (51.4% males and 48.6% female), 61.8% were preterm (mean gestational age: 34.2 ± 3.6 weeks), 64.6% had low birth weight (LBW) (mean birth weight: 2.1 ± 0.9 kg), 90.6% were delivered through spontaneous vaginal delivery, and 57.4% delivered at the tertiary health-care facility. Of the 667 neonates, 70%, 27.1%, and 2.9% were queried with one, two, or three medical conditions, respectively. Respiratory distress, preterm, and pyrexia were common single queried conditions (88.5%). LBW, hypothermia, and single queried medical conditions were associated ( P ≤ 0.0001) with preterm male neonates. The mean duration of stay of preterm neonates was 3.5 ± 3.2 days (term babies: 1–2 days [ P = 0.0085]). Of 1,565 medications prescribed to the 667 neonates, 67.5% were antibacterial, with gentamicin (53.0%) being the most prescribed. 98.4% of neonates were prescribed at least one medication (i.e., 67.5% were prescribed antibacterial medications, 14.6% supplements, 11.0% bronchodilators, and 7.0% antiseizure); mean medication combination 2.6 ± 0.8 per neonate. Majority (75.4%) of the cases reviewed had treatment success.

Conclusion:

Respiratory distress and preterm deliveries are predominant presenting conditions, with antibacterial medication, mainly gentamicin and ampicillin, on prescription. Treatment success is significantly high at the NICU.

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Most cited references 30

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What is polypharmacy? A systematic review of definitions

Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch-Ellett … (2017)

Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.

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National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis

Lucia Hug, Monica Alexander, Danzhen You … (2019)

Summary Background Reducing neonatal mortality is an essential part of the third Sustainable Development Goal (SDG), to end preventable child deaths. To achieve this aim will require an understanding of the levels of and trends in neonatal mortality. We therefore aimed to estimate the levels of and trends in neonatal mortality by use of a statistical model that can be used to assess progress in the SDG era. With these estimates of neonatal mortality between 1990 and 2017, we then aimed to assess how different targets for neonatal mortality could affect the burden of neonatal mortality from 2018 to 2030. Methods In this systematic analysis, we used nationally-representative empirical data related to neonatal mortality, including data from vital registration systems, sample registration systems, and household surveys, to estimate country-specific neonatal mortality rates (NMR; the probability of dying during the first 28 days of life) for all countries between 1990 (or the earliest year of available data) and 2017. For our analysis, we used all publicly available data on neonatal mortality from databases compiled annually by the UN Inter-agency Group for Child Mortality Estimation, which were extracted on or before July 31, 2018, for data relating to the period between 1950 and 2017. All nationally representative data were assessed. We used a Bayesian hierarchical penalised B-splines regression model, which allowed for data from different sources to be weighted differently, to account for variable biases and for the uncertainty in NMR to be assessed. The model simultaneously estimated a global association between NMR and under-5 mortality rate and country-specific and time-specific effects, which enabled us to identify countries with an NMR that was higher or lower than expected. Scenario-based projections were made at the county level by use of current levels of and trends in neonatal mortality and historic or annual rates of reduction that would be required to achieve national targets. The main outcome that we assessed was the levels of and trends in neonatal mortality and the global and regional NMRs from 1990 to 2017. Findings Between 1990 and 2017, the global NMR decreased by 51% (90% uncertainty interval [UI] 46–54), from 36·6 deaths per 1000 livebirths (35·5–37·8) in 1990, to 18·0 deaths per 1000 livebirths (17·0–19·9) in 2017. The estimated number of neonatal deaths during the same period decreased from 5·0 million (4·9 million–5·2 million) to 2·5 million (2·4 million–2·8 million). Annual NMRs vary widely across the world, but west and central Africa and south Asia had the highest NMRs in 2017. All regions have reported reductions in NMRs since 1990, and most regions accelerated progress in reducing neonatal mortality in 2000–17 versus 1990–2000. Between 2018 and 2030, we project that 27·8 million children will die in their first month of life if each country maintains its current rate of reduction in NMR. If each country achieves the SDG neonatal mortality target of 12 deaths per 1000 livebirths or fewer by 2030, we project 22·7 million cumulative neonatal deaths by 2030. More than 60 countries need to accelerate their progress to reach the neonatal mortality SDG target by 2030. Interpretation Although substantial progress has been made in reducing neonatal mortality since 1990, increased efforts to improve progress are still needed to achieve the SDG target by 2030. Accelerated improvements are most needed in the regions and countries with high NMR, particularly in sub-Saharan Africa and south Asia. Funding Bill & Melinda Gates Foundation, United States Agency for International Development.

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ACOG Committee Opinion No 579: Definition of term pregnancy.

(2013)

In the past, the period from 3 weeks before until 2 weeks after the estimated date of delivery was considered "term," with the expectation that neonatal outcomes from deliveries in this interval were uniform and good. Increasingly, however, research has shown that neonatal outcomes, especially respiratory morbidity, vary depending on the timing of delivery within this 5-week gestational age range. To address this lack of uniformity, a work group was convened in late 2012, which recommended that the label "term" be replaced with the designations early term (37 0/7 weeks of gestation through 38 6/7 weeks of gestation), full term (39 0/7 weeks of gestation through 40 6/7 weeks of gestation), late term (41 0/7 weeks of gestation through 41 6/7 weeks of gestation), and postterm (42 0/7 weeks of gestation and beyond) to more accurately describe deliveries occurring at or beyond 37 0/7 weeks of gestation. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse and encourage the uniform use of the work group's recommended new gestational age designations by all clinicians, researchers, and public health officials to facilitate data reporting, delivery of quality health care, and clinical research.

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Author and article information

Journal

Journal ID (nlm-ta): J Res Pharm Pract

Journal ID (iso-abbrev): J Res Pharm Pract

Journal ID (publisher-id): JRPP

Title: Journal of Research in Pharmacy Practice

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 2319-9644

ISSN (Electronic): 2279-042X

Publication date Collection: Jan-Mar 2021

Publication date (Electronic): 13 May 2021

Volume: 10

Issue: 1

Pages: 30-37

Affiliations

[1 ]Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

[2 ]Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana

[3 ]Department of Pharmacy, University for Development Studies, Tamale, Ghana

[4 ]Department of Physiology and Biophysics, University for Development Studies, Tamale, Ghana

[5 ]Department of Biomedical Laboratory Sciences, University for Development Studies, Tamale, Ghana

Author notes

Address for correspondence: Prof. George Asumeng Koffuor, E-mail: gkoffuor@ 123456yahoo.com

Article

Publisher ID: JRPP-10-30

DOI: 10.4103/jrpp.JRPP_20_118

PMC ID: 8259601

PubMed ID: 34295850

SO-VID: 0a916218-b280-49e8-be38-1b5700be941e

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 20 October 2020

Date accepted : 12 February 2021

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Clinical Characteristics, Medication Prescription Pattern, and Treatment Outcomes at the Neonatal Intensive Care Unit of a Tertiary Health-Care Facility in Ghana

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Related collections

Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 30

What is polypharmacy? A systematic review of definitions

National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis

ACOG Committee Opinion No 579: Definition of term pregnancy.

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