Medication Use in the Neonatal Intensive Care Unit and Changes from 2010 to 2018.

Journal Article (Journal Article)


To provide up-to-date medication prescribing patterns in US neonatal intensive care units (NICUs) and to examine trends in prescribing patterns over time.

Study design

We performed a cohort study of 799 016 infants treated in NICUs managed by the Pediatrix Medical Group from 2010 to 2018. We used 3 different methods to report counts of medication: exposure, courses, and days of use. We defined the change in frequency of medication administration by absolute change and relative change. We examined the Food and Drug Administration (FDA) package insert for each medication to determine whether a medication was labeled for use in infants and used PubMed to search for pharmacokinetics (PK) studies.


The most frequently prescribed medications included ampicillin, gentamicin, caffeine citrate, poractant alfa, morphine, vancomycin, furosemide, fentanyl, midazolam, and acetaminophen. Of the top 50 medications used in infants with extremely low birth weight, only 20 (40%) are FDA-labeled for use in infants; of the 30 that are not labeled for use in infants, 13 (43%) had at least 2 published PK studies. The medications with the greatest relative increase in use from 2010 to 2018 included dexmedetomidine, clonidine, rocuronium, levetiracetam, atropine, and diazoxide. The medications with the greatest relative decrease in use included tromethamine acetate, pancuronium, chloral hydrate, imipenem + cilastatin, and amikacin.


Trends of medication use in the NICU change substantially over time. It is imperative to identify changes in medication use in the NICU to better inform further prospective studies.

Full Text

Duke Authors

Cited Authors

  • Stark, A; Smith, PB; Hornik, CP; Zimmerman, KO; Hornik, CD; Pradeep, S; Clark, RH; Benjamin, DK; Laughon, M; Greenberg, RG

Published Date

  • January 2022

Published In

Volume / Issue

  • 240 /

Start / End Page

  • 66 - 71.e4

PubMed ID

  • 34481808

Pubmed Central ID

  • PMC9394450

Electronic International Standard Serial Number (EISSN)

  • 1097-6833

International Standard Serial Number (ISSN)

  • 0022-3476

Digital Object Identifier (DOI)

  • 10.1016/j.jpeds.2021.08.075


  • eng