Compatibility of drug infusions in the NICU

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.