RESUMO
PURPOSE: Evidence is needed to guide NICU use of lansoprazole (Prevacid), ranitidine (Zantac), and metoclopramide (Reglan). As a step toward that goal, we conducted a historic cohort analysis of all patients who received any of these medications in 4 Intermountain Healthcare NICUs during the year 2006. SUBJECTS: Data were obtained from all patients admitted between January 1 and December 31, 2006, to any of 4 Intermountain Healthcare NICUs. DESIGN: This was a retrospective descriptive design. METHODS: Data were obtained from electronic pharmacy records and electronic medical records. The NICUs involved were blinded and included McKay-Dee Hospital Center, Ogden, Utah; LDS Hospital, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; and Dixie Regional Medical Center, St George, Utah. RESULTS: Although the demographics of the patients at the 4 centers were similar, significant differences were seen among the centers in drug use patterns. Lansoprazole use ranged from a high of 17% of patients in one center to a low of 7% of patients in another. Ranitidine use ranged from 9% in one center to 1% in another. Metoclopramide use ranged from 9% of patients in one center to <1% in another. CONCLUSIONS: The extreme variability among the centers in use patterns of these 3 medications suggests lack of an adequate evidence base to guide practice and indicates that case controlled studies or random controlled trials are needed to devise a consistent evidence-based approach.
Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Monitoramento de Medicamentos/estatística & dados numéricos , Refluxo Gastroesofágico/tratamento farmacológico , Prontuários Médicos/estatística & dados numéricos , Metoclopramida/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Ranitidina/uso terapêutico , Antiulcerosos/uso terapêutico , Fidelidade a Diretrizes , Hospitais Comunitários/organização & administração , Hospitais de Ensino/organização & administração , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Lansoprazol , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Utah/epidemiologiaRESUMO
OBJECTIVE: Darbepoetin is longer acting and more potent than recombinant erythropoietin (rEpo). In certain situations, preterm neonates might benefit from rEpo, and for such patients darbepoetin would require fewer doses at a lower cost. However, the proper dose and dosing interval have not been established. STUDY DESIGN: We performed a prospective trial in two level III Neonatal Intensive Care Units. Patients <32 weeks gestation at birth, with a birth weight (BW) <1500 g, were eligible for participation if they were >21-days-old and had a hemoglobin (Hgb) concentration
