OBJECTIVES: The majority of drugs used in sick newborns receiving intensive care are unlicensed and off-label, exposing infants to greater risk of adverse drug reactions (ADRs). Our aim was to study the compatibility of co-infusions for a selected group of drugs and nutrition solutions as part of our quality assurance programme in the neonatal intensive care unit. METHODS: The authors reviewed drug studies in the literature. Documented compatibility or the lack thereof was the main end point for the 1042 co-infusions investigated. The results of searches were reviewed against predetermined criteria for co-infusion of 13 intensive care drugs with 66 other drugs and two nutrition solutions and albumin. RESULTS: 33/820 (4%) co-infusions were documented as compatible without any restrictions. 212/820 (26%) drug co-infusions were compatible, but 196 of the 212 (93%) had restrictions on infusion fluid, concentration or contact time. 608/820 (74%) drug co-infusions in neonates have either been shown to be incompatible or have not been tested. Among those not tested, 163/486 (34%) entailed major differences in pH level which could cause co-infusion instability. CONCLUSION: There is a lack of data on compatibility for the majority of drugs used for co-infusions in neonates. Caregivers therefore need to pay special attention to infusion lines when drugs are co-administered. Our results suggest that further studies on drug compatibility are needed to reduce possible ADRs and toxicity, and avoid precipitation and occlusion of infusion lines in critically ill neonates.
OBJECTIVES: The majority of drugs used in sick newborns receiving intensive care are unlicensed and off-label, exposing infants to greater risk of adverse drug reactions (ADRs). Our aim was to study the compatibility of co-infusions for a selected group of drugs and nutrition solutions as part of our quality assurance programme in the neonatal intensive care unit. METHODS: The authors reviewed drug studies in the literature. Documented compatibility or the lack thereof was the main end point for the 1042 co-infusions investigated. The results of searches were reviewed against predetermined criteria for co-infusion of 13 intensive care drugs with 66 other drugs and two nutrition solutions and albumin. RESULTS: 33/820 (4%) co-infusions were documented as compatible without any restrictions. 212/820 (26%) drug co-infusions were compatible, but 196 of the 212 (93%) had restrictions on infusion fluid, concentration or contact time. 608/820 (74%) drug co-infusions in neonates have either been shown to be incompatible or have not been tested. Among those not tested, 163/486 (34%) entailed major differences in pH level which could cause co-infusion instability. CONCLUSION: There is a lack of data on compatibility for the majority of drugs used for co-infusions in neonates. Caregivers therefore need to pay special attention to infusion lines when drugs are co-administered. Our results suggest that further studies on drug compatibility are needed to reduce possible ADRs and toxicity, and avoid precipitation and occlusion of infusion lines in critically ill neonates.