Medication error in an extremely low birth weight infant: paracetamol overdose.

Errors are part of human nature and are usually present in our actions. Medical errors occur quite often and can be serious. Medication errors are among the most frequent, especially in newborn infants because of the multiple steps that occur during the process of prescribing and administering drugs and because most drugs are not licensed for being used in newborn infants (off-label). The aim of this report is to describe a medication error in prescribing paracetamol for closing a patent ductus arteriosus in a preterm infant and to analyze its causes. A preterm female infant born at 27 weeks of gestational age with a birth weight of 750 g received paracetamol at 9 days old at a dose 20 times greater than required. The initial plasma level was 480 µg/mL. N-acetylcysteine was administered and her clinical outcome was satisfactory. Parents were notified of the event, which was recorded in the medical record and in the electronic error reporting system of the Hospital Italiano de Buenos Aires. We consider this report as an example that we are exposed to making mistakes and should maximize precautions to improve patient safety in neonatal units.

Medication error in an extremely low birth weight infant: paracetamol overdose / Medication error in an extremely low birth weight infant: paracetamol overdose.

Errors are part of human nature and are usually present in our actions. Medical errors occur quite often and can be serious. Medication errors are among the most frequent, especially in newborn infants because of the multiple steps that occur during the process of prescribing and administering drugs and because most drugs are not licensed for being used in newborn infants (off-label). The aim of this report is to describe a medication error in prescribing paracetamol for closing a patent ductus arteriosus in a preterm infant and to analyze its causes. A preterm female infant born at 27 weeks of gestational age with a birth weight of 750 g received paracetamol at 9 days old at a dose 20 times greater than required. The initial plasma level was 480 Ag/mL. N-acetylcysteine was administered and her clinical outcome was satisfactory. Parents were notified of the event, which was recorded in the medical record and in the electronic error reporting system of the Hospital Italiano de Buenos Aires. We consider this report as an example that we are exposed to making mistakes and should maximize precautions to improve patient safety in neonatal units.

Medication error in an extremely low birth weight infant: paracetamol overdose. / Medication error in an extremely low birth weight infant: paracetamol overdose.

Errors are part of human nature and are usually present in our actions. Medical errors occur quite often and can be serious. Medication errors are among the most frequent, especially in newborn infants because of the multiple steps that occur during the process of prescribing and administering drugs and because most drugs are not licensed for being used in newborn infants (off-label). The aim of this report is to describe a medication error in prescribing paracetamol for closing a patent ductus arteriosus in a preterm infant and to analyze its causes. A preterm female infant born at 27 weeks of gestational age with a birth weight of 750 g received paracetamol at 9 days old at a dose 20 times greater than required. The initial plasma level was 480 Ag/mL. N-acetylcysteine was administered and her clinical outcome was satisfactory. Parents were notified of the event, which was recorded in the medical record and in the electronic error reporting system of the Hospital Italiano de Buenos Aires. We consider this report as an example that we are exposed to making mistakes and should maximize precautions to improve patient safety in neonatal units.

[Cesarean delivery at term in low risk pregnancies: effects on neonatal morbidity]. / Nacimiento por cesárea al término en embarazos de bajo riesgo: efectos sobre la morbilidad neonatal.

INTRODUCTION: The rate of cesarean delivery (CD) has significantly increased over the last years, even in low risk pregnancies. Our objective was to compare the neonatal morbidity rate in low risk term infants delivered by vaginal or CD. DESIGN: Prospective observational and analytical cohort study. Main outcome measures. Incidence of any neonatal morbidity and respiratory morbidity. Population and methods. Infants < or = 37 weeks born at the Hospital Italiano de Buenos Aires between December 2004 and July 2006 were eligible. Exclusion criteria included: any maternal related disorder, acute or chronic fetal distress, breech presentation in primiparous women, multiple pregnancies, intrauterine growth restriction and newborns with major malformations. RESULTS: A total of 2021 infants were included, 1120 born vaginally and 901 by CD. Main indications for CD were failure to progress labor (46%) and previous CD (37%). Only 3% of CD was performed by maternal request. Any neonatal morbidity rate was 9% in infants born by CD and 6.6% in infants born vaginally (RR 1.36; 95%CI 1.01-1.8). Respiratory morbidity rate was 5.3% in infants born by CD and 3.1% in those born vaginally (RR 1.7; 95%CI 1.1-2.6). When stratified by gestational age, respiratory morbidity was higher only for infants < or =38 weeks (7.4% in CD vs. 2.1% in vaginal delivery; RR 3.5; 95%CI 1.5-8.1). Also, respiratory morbidity was higher in infants born < or =38 weeks by CD without labor vs. those with labor 10.5% and 3.9%, respectively (RR 1.35; 95%CI: 1.07-1.70). In a logistic regression analysis, CD and male sex were independently associated with higher respiratory morbidity. There were not significant differences in other morbidities. NICU admission was higher in infants born by CD (9.5% vs. 6.1%; RR 1.5; 95% CI: 1.1-2.1). Sixty-eight percent of the mothers from the CD group refereed having moderate to severe pain in the puerperium vs. 36% in the vaginal group (RR 1.9; 95% CI: 1.7-2.1). Exclusive breastfeeding at discharge was significantly lower in infants born by CD (90% vs. 96%; RR 0.94 95%CI 0.92-0.96). CONCLUSIONS: Low risk CD at term was associated with a higher neonatal morbidity, NICU admission and maternal pain in the puerperium. It also reduces exclusive breastfeeding rate at discharge.

Nacimiento por cesárea al término en embarazos de bajo riesgo: efectos sobre la morbilidad neonatal / Cesarean delivery at term in low risk pregnancies: effects on neonatal morbidity

La tasa de cesárea aumentó marcadamente en años recientes. Nuestro objetivo fue comparar, en embarazos de bajo riesgo, la prevalencia de morbilidad en recién nacidos de término por vía vaginal y cesárea. Población y métodos. Estudios de cohorte prospectivo. Fueron elegibles los neonatos de 37 a 41 semanas, nacidos en el Hospital Italiano de Buenos Aies, desde diciembre 2004 a julio 2006. Criterios de exclusión: enfermedades maternas; compromiso fetal, presentación pelviana en primíparas, gemelares, restricción del crecimiento intrauterino y malformaciones mayores. Resultados. Se incluyeron 1120 nacidos por vía vaginal y 901 por cesárea. La morbilidad neonatal total fue 9 por ciento en cesáreas y 6,6 por ciento en partos vaginales (RR 1,36; IC 95 por ciento 1,01-1,8). La morbilidad respiratoria fue 5,3 por ciento en cesáreas y 3,1 por ciento en vaginal (RR 1,7; IC95 por ciento 1,1-2,6), y solo resulto mayor en los menor o igual 38 semanas (7,4 por ciento en cesáreas contra 2,1 por ciento en vaginal; RR 3,5; IC 95 por ciento 1,5 - 8,1). En el análisis de regresión logística, cesárea y sexo masculino se asociaron en forma independiente con mayor morbilidad respiratoria. El ingreso a cuidados intensivos fue mayor en nacidos por cesárea (9,5 por ciento contra 6,1 por ciento contra 6,1 por ciento; RR 1,5; RR 1,5; IC95 por ciento 1,1 -2,1. El 68 por ciento de madres con cesárea manifestaron dolor moderado intenso en el puerperio, contra 36 por ciento en parto vaginal (RR 1,9; IC95 por ciento 1,7-21). La lactancia exclusiva al alta fue menor en madres con cesárea (90 por ciento contra 96 por ciento; RR 0,94 IC95 por ciento 0,92-0,96 por ciento). Conclusiones. La cesárea se asoció con mayor morbilidad neonatal, ingreso a cuidados intensivos y dolor materno puerperal, y con disminución de lactancia exclusiva al alta.

Nacimiento por cesárea al término en embarazos de bajo riesgo: efectos sobre la morbilidad neonatal / Cesarean delivery at term in low risk pregnancies: effects on neonatal morbidity

La tasa de cesárea aumentó marcadamente en años recientes. Nuestro objetivo fue comparar, en embarazos de bajo riesgo, la prevalencia de morbilidad en recién nacidos de término por vía vaginal y cesárea. Población y métodos. Estudios de cohorte prospectivo. Fueron elegibles los neonatos de 37 a 41 semanas, nacidos en el Hospital Italiano de Buenos Aies, desde diciembre 2004 a julio 2006. Criterios de exclusión: enfermedades maternas; compromiso fetal, presentación pelviana en primíparas, gemelares, restricción del crecimiento intrauterino y malformaciones mayores. Resultados. Se incluyeron 1120 nacidos por vía vaginal y 901 por cesárea. La morbilidad neonatal total fue 9 por ciento en cesáreas y 6,6 por ciento en partos vaginales (RR 1,36; IC 95 por ciento 1,01-1,8). La morbilidad respiratoria fue 5,3 por ciento en cesáreas y 3,1 por ciento en vaginal (RR 1,7; IC95 por ciento 1,1-2,6), y solo resulto mayor en los menor o igual 38 semanas (7,4 por ciento en cesáreas contra 2,1 por ciento en vaginal; RR 3,5; IC 95 por ciento 1,5 - 8,1). En el análisis de regresión logística, cesárea y sexo masculino se asociaron en forma independiente con mayor morbilidad respiratoria. El ingreso a cuidados intensivos fue mayor en nacidos por cesárea (9,5 por ciento contra 6,1 por ciento contra 6,1 por ciento; RR 1,5; RR 1,5; IC95 por ciento 1,1 -2,1. El 68 por ciento de madres con cesárea manifestaron dolor moderado intenso en el puerperio, contra 36 por ciento en parto vaginal (RR 1,9; IC95 por ciento 1,7-21). La lactancia exclusiva al alta fue menor en madres con cesárea (90 por ciento contra 96 por ciento; RR 0,94 IC95 por ciento 0,92-0,96 por ciento). Conclusiones. La cesárea se asoció con mayor morbilidad neonatal, ingreso a cuidados intensivos y dolor materno puerperal, y con disminución de lactancia exclusiva al alta.(AU)