Evaluation of the practice of dose-rounding in paediatrics.

Objectives: To investigate the rounding of prescribed drug doses for paediatric administration.

Methods: A cross-sectional medication chart review was conducted at a UK paediatric hospital. Proposed administration dose volumes were calculated for prescribed doses using available manufactured liquids measured with oral and intravenous syringes.

Potential Drug-Drug Interactions Among Critically Ill Pediatric Patients in a Tertiary Pulmonary Center.

Patients in the pediatric intensive care unit (PICU) are at increased risk of potential drug-drug interactions (pDDIs) because of the complexity of pharmacotherapy. The current study aimed to assess the rate, pattern, risk factors, and management of pDDIs in the PICU of an academic pulmonary hospital. A prospective observational study was conducted for 6 months.

Accuracy of enteral syringes with commonly prescribed paediatric liquid medicines.

Objective: Oral syringes are the preferred method for delivering paediatric enteral drugs; however, little is known about factors affecting accuracy, particularly at volumes <5 mL. We investigated volumetric accuracy for enteral syringes, using commercially available liquid drug formulations with various physicochemical properties at clinically relevant volumes.

Design: In vitro experiment.

Standard concentration infusions in paediatric intensive care: the clinical approach.

Unlabelled: The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability.

Objective: To identify the most appropriate clinical concentrations required by our paediatric intensive care unit (PICU) population with regard to accuracy of delivery and overall fluid allowance.

Safe implementation of standard concentration infusions in paediatric intensive care.

Objective: To evaluate safety, following introduction of standard concentrations of morphine infusions in paediatric critical care.

Methods: Implementation: A multidisciplinary team was convened, and several workstreams designated, including derivation of concentrations, manufacturing, supply, prescribing, administration using smart pump technology, training and evaluation. Safety Evaluation: Retrieval of all existing data on medication errors linked to morphine use using our hospital incident reporting system and risk assessment of errors in relation to standard concentration implementation.

Levomepromazine for difficult sedation in pediatric intensive care.

Sedation and analgesia using opioids and benzodiazepines is frequently required in critically ill children to minimize pain and anxiety. In some patients, difficult sedation occurs when tolerance or unacceptable side effects limit the efficacy of conventional analgo-sedative treatment. We describe seven patients (age range 1 to 17 yr) where difficult sedation was successfully managed with enteral levomepromazine (LMZ).

Pediatric formulation issues identified in Paediatric Investigation Plans.

Since the European Paediatric Regulation was introduced in 2007, companies developing new medicinal products or new indications/routes of administration/pharmaceutical forms are obliged to present age-appropriate formulations for the pediatric population within a Paediatric Investigation Plan (PIP) to the European Medicines Agency. Our review highlights a number of discrepancies between what is proposed by applicants and what is considered acceptable by regulators, taking a sample of PIP applications assessed by a specialized Formulation Working Group (FWG) of the Paediatric Committee in 2009. This Working Group assessed 43% of the total number of validated PIP applications during that year.

Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit.

Objective: To investigate the accuracy of morphine infusions prepared for neonates in relation to the label strength and to identify the differences in deviation between infusions made in neonatal intensive care unit (NICU) and those dispensed ready-to-use from pharmacy.

Methods: Unused portions of morphine solution for infusion were collected over a 6-weeks period and used to determine the concentration of the drug by high-performance liquid chromatography (HPLC).

Results: A total of 19.

Pediatric clinical trials in Latin America and Guyana: present views of local practitioners and ways to embrace the future.

Background: Global pediatric research has recently received increased attention by health professionals, and research and government institutions. Since the approval of the FDA Pediatric Exclusivity Provision and the EU Paediatric Regulation, pharmaceutical companies have begun to look to developing/transitional countries for international pediatric research collaboration as a way of facilitating the recruitment of patients to clinical trials. Among countries identified as being 'developing/transitional' some were in the North, Central, and South American regions.

Extended-interval gentamicin: population pharmacokinetics in pediatric critical illness.

Objectives: Once-daily gentamicin therapy is becoming increasingly common in pediatric practice; however, little is known about pharmacokinetics in critical illness. Gentamicin exhibits concentration dependant killing; thus, peak serum concentrations at least eight times higher than minimum inhibition concentration of the target organism have been recommended. We wanted to derive pharmacokinetic parameters for gentamicin in critical illness and to evaluate whether a dose of 8 mg/kg provides an adequate peak serum concentration (>16 mg/L).

The infancy of an international paediatric pharmacy network.

There are several pharmacy and clinical pharmacology organizations in which pediatrics is one of many special interest groups and a few whose focus is entirely pediatric drug therapy. Recently the foundation for the establishment of an International Network of Paediatric Pharmacists has been laid. This paper describes that network.

'Poppy seeds' in stomach aspirates: is oral omeprazole extemporaneous dispersion bioavailable?

We report the appearance of 'poppy seed'-like structures found in the aspirated stomach contents and faeces of a 3-month-old infant receiving an omeprazole liquid via nasogastric tube, prepared by dispersing an omeprazole tablet (10 mg MUPS(R)) in water. Electron microscopy and mass spectroscopy indicated that these particles were hollow, dark purple coloured spheres comprising undissolved omeprazole and its degradation products. These observations suggest rapid degradation of omeprazole in the acid stomach contents, with compromised absorption of active drug.

Use of oral clonidine for sedation in ventilated paediatric intensive care patients.

Objectives: We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile.

Design: Prospective, cohort study over a 72-h period.