Neonatal ICU therapy: a literature review on pharmacotherapies

Abstract

INTRODUCTION: The neonatal period is an age group of vulnerability, which is subject to adverse effects related to conventional drug treatments and therapies, many drugs are empirically applied in the neonatal ICU (NICU), in off-label or non-licensed ways, currently the scientific basis on pediatric pharmacological assistance is scarce, constituting an unpredictable scenario of adverse and severe drug reactions. OBJECTIVE: To analyze the main pharmacological practices in the neonatal ICU, observing the possible effects on the newborn patient. METHODOLOGY: literature review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The search for articles was carried out in PubMed, SciELO and LILACS databases, applying descriptors from Descritores em Ciências da Saúde (DeCS) and Medical Subject Headings (MeSH). RESULTS: 415 articles were found and 26 were included in the study. It was noted that there is a high prevalence of overdoses and unnecessary prolongation of antibiotic therapy, adverse effects linked to bacterial resistance and alteration of the newborn’s (NB) microbiota may occur, generally these drugs were used in the scenario of neonatal sepsis and in an off-label way, vancomycin stood out as the most widely used antibiotic among the studies. The NB’s respiratory problems were pharmacologically treated with exogenous surfactant, propofol, hydrocortisone and milrinone, the clinical situations of use include Respiratory Distress Syndrome in Neonates and sedation for intubation. Painful procedures are common in the NICU, requiring pharmacological measures such as the use of analgesics and sedatives, including fentanyl, morphine, dipyrone, non-steroidal anti-inflammatory drugs and benzodiazepines, the safe application is also difficulty with these medications. Local anesthetics, such as lidocaine, are the most used for surgical pain, epidural anesthesia helps to reduce surgical stress, and topical anesthetics are useful for pain caused by skin barrier rupture. The group of drugs most used in an off-label way, according to the Anatomic Therapeutic Chemical (ATC) classification, were the group of anti-infectives for systemic use and drugs that act on the nervous system. CONCLUSION: the need for more scientific depth in the context of pharmacology at the NICU became extremely explicit during the study’s development, the lack of consensus for appropriate medical prescriptions leads to the need for greater care when prescribing for neonates, considering the inherent characteristics of the organism of these patients that alter the pharmacokinetics and pharmacodynamics of medications.