Medication safety in neonatal intensive care

Premature and VLBW neonates are vulnerable patients’ cohort with complex medical needs and requirement of advanced pharmacotherapy and medical care. When many infusions are prescribed, simultaneous administration is needed due to limited vascular access in sick and preterm neonates. Medication administration through a multi-infusion system is a complex process and there are many factors contributing to accurate drug delivery through that system. Research specifically targeting the subpopulation of premature very low birth weight neonates is needed to optimise safety of medication administration.

A systematic approach was undertaken throughout this thesis to address the issue of multi-infusion medication administration to premature ELBW and VLBW neonates. First, a literature search was done to summarise to-date knowledge in the area of IV infusion to neonates, highlighting the finding on drug delivery to VLBW neonates. Next, the laboratory work was planned to investigate the drug delivery rates through a multi-infusion system at low infusion rates. First, a model drug study was developed to gain insight into parameters affecting drug delivery rates. It was found that patient’s body weight and infusion connection point significantly impact drug delivery rate. The same methodology was used to investigate these findings with the use of critical medication used in the NICU – adrenaline and dopamine. These results confirmed finding of drug delivery rate with model drug. Further, to test that infusion system affects time to drug delivery, a retrospective cohort study in VLBW neonates receiving insulin was done. It revealed that the medication dose could be changed before the medication reaches patient’s bloodstream, as no clinical effect was observed when medication was flowing through infusion lines. The last study investigated often overlooked factor of vertical displacement. Investigation of vertical displacement of an infusion pump by 50 cm showed considerable alterations in drug delivery rate observed as bolus delivery and time with decreased drug delivery to the patient.