Dexamethasone Use to Reduce Mechanical Ventilation and Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit.

Background: Ventilator-dependent neonates are at risk of bronchopulmonary dysplasia (BPD), a chronic lung disease. Dexamethasone may be used to facilitate extubation and reduce the incidence of BPD.

Objectives: To determine the efficacy of dexamethasone in reducing the incidence of established BPD at 36 weeks postmenstrual age (PMA); to establish the rate of extubation success; to determine the factors affecting extubation success; and to describe complications associated with dexamethasone therapy.

Neonatal Abstinence Syndrome: A Review of Treatment in the Neonatal Intensive Care Unit.

Background: Neonatal abstinence syndrome (NAS) is a collection of symptoms that neonates may experience following antenatal exposure to substances that induce withdrawal. Optimal management remains unknown, and there is variation in management and outcomes.

Objectives: To describe the management, length of hospitalization, and adverse events in near-term and full-term neonates with NAS for whom treatment (pharmacotherapy and/or supportive care) was initiated in the neonatal intensive care unit (NICU).

Development of Gentamicin Resistance During Treatment of Ventilator-Associated Pneumonia in a Neonate.

A neonate born at 25 + 1/7 weeks developed ventilator-associated pneumonia at 29 + 3/7 weeks post-menstrual age with that was originally sensitive to gentamicin. After 3 days of treatment with gentamicin, the minimum inhibitory concentration (MIC) changed from less than 1 mg/L to more than 16 mg/L. It appears that suboptimal gentamicin dosing led to the development of gentamicin resistance.

Antimicrobial stewardship intervention to reduce unnecessary antibiotic doses in neonates.

The wording of the antibiotic duration orders for neonatal sepsis was changed as an antimicrobial stewardship initiative to reduce the administration of unnecessary antibiotic doses. The change in wording allowed the patient to stop receiving antibiotics after they received 48 hours of therapy if the health care team had not received notification of a positive culture. This initiative led to a decrease in the number of neonates that received extra unnecessary doses from 50% to 7.

Expanding the role of pharmacy technicians to facilitate a proactive pharmacist practice.

Purpose: This study describes a change in pharmacy practice to expand pharmacy technician roles to allow dispensing without a pharmacist check, thereby enhancing the pharmacist role in direct patient care.

Summary: In an effort to optimize patient care with limited resources, we set out to change our pharmacy practice model. We transferred duties that did not require clinical judgment in the dispensary from the pharmacist to the regulated technician.

Barriers and Strategies for Transition from Student to Successful Hospital Pharmacist.

Background: Many health care professionals experience a process of transition when entering the workforce. Various barriers have been documented in the literature, including a lack of confidence, challenging interactions with patients and colleagues, workload, increased responsibility, and a fear of making mistakes. Strategies to overcome these barriers, such as orientation and support programs, have been proposed.

Assessment of Empiric Vancomycin Regimen in the Neonatal Intensive Care Unit.

Background: Vancomycin is used to treat serious gram-positive infections in neonates. Currently, there is no consensus on the preferred empiric dosing regimen or target trough vancomycin levels for neonates. The current Fraser Health empiric dosing regimen, implemented in 2010, was designed to achieve target trough levels of 5 to 15 mg/L.

Levofloxacin Use in the Neonate: A Case Series.

We report 6 cases of intravenous levofloxacin use to treat multidrug-resistant nosocomial respiratory infections in neonates with a postmenstrual age ranging from 27 to 42 weeks. Because of a lack of neonatal-specific information for levofloxacin, the usual pediatric dosage (10 mg/kg per dose every 12 hours) was used in these patients. Clinical cure occurred in 5 of the 6 patients.

Respiratory Syncytial Virus Infection Rates with Limited Use of Palivizumab for Infants Born at 29 to 31+6/7 Weeks Gestational Age.

Background: Immunoprophylaxis with palivizumab can reduce respiratory syncytial virus (RSV) infections and hospitalizations. Criteria in British Columbia limit the use of palivizumab to infants born at 29 to 31+6/7 weeks gestational age, which differ from guidelines of the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society (CPS).

Objective: To determine whether the limited use of palivizumab affected the frequency of hospital visits by RSV-positive infants (termed "RSV-positive hospital visits") who received approval for palivizumab and those who met the AAP/CPS criteria but did not receive approval for palivizumab.

Tetracaine (ametop) compared to placebo for reducing pain associated with intramuscular injection of palivizumab (synagis).

Infants receive many painful immunizations before they are 2 years old. The purpose of this study was to evaluate if topical tetracaine reduces the pain of intramuscular palivizumab compared to placebo. There were two study injections, one with tetracaine and one with placebo.

Development of a simplified protocol for administration of 20% magnesium sulphate for prophylaxis and treatment of eclampsia.

Background: Magnesium sulphate is a high-risk medication that is used extensively for prophylaxis and treatment of eclampsia. To accommodate recommendations related to fluid restrictions and patient safety, a protocol was developed for the administration of 20% magnesium sulphate.

Objectives: To determine whether administration of 20% magnesium sulphate increased the risk of phlebitis relative to 2% to 8% magnesium sulphate solutions, to determine if the institution's protocol for administration of 20% magnesium sulphate reduced errors during administration, and to identify strategies to further reduce potential errors.

Assessment of gentamicin 7 mg/kg once daily for pediatric patients with febrile neutropenia: a pilot project.

Context: Use of once daily aminoglycosides continues to increase for the pediatric population, including oncology patients. Concerns have been identified and still need to be resolved including the optimal dose, frequency, and monitoring parameters.

Objective: We completed a study to determine if empiric use of gentamicin 7 mg/kg once daily in pediatric patients admitted with febrile neutropenia provided extrapolated peaks and drug-free intervals consistent with suggested preferred levels.

Effect of indomethacin on closure of ductus arteriosus in very-low-birthweight neonates.

Aim: To identify factors related to indomethacin non-responsiveness for patent ductus arteriosus (PDA) closure in very-low-birthweight (VLBW) neonates.

Methods: A chart review of 107 VLBW neonates with a clinical diagnosis of PDA who received indomethacin, admitted to a tertiary neonatal intensive care unit in Toronto, Canada, was conducted (study period November 2001 to October 2003). Positive responders were those with no clinical evidence of PDA for 72 h after indomethacin.