Frequently acquired drugs in neonatal intensive care and their physical compatibility

Aim Incompatibility of intravenous drugs is dangerous and therefore undesirable. The aim of this study was to identify the most commonly acquired intravenous drugs in five neonatal intensive care units and test these for compatibility. Methods The most frequently acquired drugs in five key hospitals in the South-Eastern district of Norway for 2019 and 2020 served as a proxy for the prevalence of use. Representatives were selected from the three most prevalent groups based on the Anatomical Therapeutic Chemical classification system. Co-administration of drug pairs was simulated using clinically relevant concentrations and infusion rates representing mixing ratios in the catheter. Particle formation was assessed by particle counting and size measurement, by visual examination using Tyndall beam, by turbidity and by measuring pH of mixed samples. Results The most frequently acquired drug groups were anti-infectives, neurological agents and cardiovascular drugs. Compatibility testing revealed that both ampicillin and benzylpenicillin were incompatible with morphine. Flecainide and fluconazole showed no signs of incompatibility with morphine. No information on these combinations in a neonatal-relevant setting is available. Conclusion We recommend to abstain from co-administering ampicillin and benzylpenicillin with morphine in neonatal intensive settings. Morphine co-administered with flecainide and fluconazole in neonatal patients were evaluated as safe.

Automated summary

The aim of this study was to identify the commonly acquired intravenous drugs in neonatal intensive care units and test their compatibility. The results showed that ampicillin and benzylpenicillin were incompatible with morphine, while flecainide and fluconazole showed no signs of incompatibility with morphine. Co-administration of ampicillin and benzylpenicillin with morphine should be avoided in neonatal intensive care settings, while the combination of morphine, flecainide, and fluconazole was evaluated as safe in neonatal patients.