Analysis of anti-hypotensive drug pattern use in the Neonatal Intensive Care Unit: A comparative study between the public and private sectors in Libya
Ali M. Giurnazi, Suad A.M. Almadah, Antisar A.M. Souysi, Abdalah E. Albocefe, Aml A. Shakuona, Haneen A. Hasan, Rayan M.A. Al-Madhoun
Abstract
Neonatal hypotension is a critical and frequent condition in the Neonatal Intensive Care Unit (NICU), often requiring pharmacologic intervention. Despite established treatment strategies, considerable variability exists in clinical practice across different healthcare settings. This study aimed to compare the neonatal characteristics, clinical practices, treatment indications, and outcomes of patients admitted to a public hospital and a private clinic in Libya. A cross-sectional comparative study was conducted from December 2024 to April 2025. Data were collected using a validated standardized questionnaire that included neonate demographics, clinical presentation, diagnostic assessment, drug use patterns, outcome, and adverse events. A total of 120 neonates were included in the study. Neonates admitted to the private NICU had significantly more favorable baseline characteristics compared to those in the public NICU. A lower measured blood pressure and higher significant use of echocardiography (p<0.001) were observed in the private NICU. Dopamine was the primary agent used in the public NICU (85.7%) while the private NICU relied on combination therapy, including dobutamine (p<0.001). Clinical response occurred more rapidly in the private NICU. Conversely, a higher rate of mortality was observed in the public NICU compared with the private NICU (p<0.001). The current findings suggest a significant disparity in diagnosis, drug selection, and outcome between public and private NICUs. Thus, establishing standardized protocols and increasing access to diagnostic tools, such as echocardiography, could enhance neonatal outcomes, particularly in resource-limited settings.
Keywords
References
- Kluckow M. Low systemic blood flow and pathophysiology of the preterm transitional circulation. Early Human Development. 2005; 81: 429-437. doi: 10.1016/j.earlhumdev.2005.03.006
- Dempsey EM, Al Hazzani F, Barrington KJ. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion. Archives in Disease of Childhood. Fetal and Neonatal Edition. 2009; 94(4): F241-F244. doi: 10.1136/adc.2007.124263
- Gill AW. Postnatal cardiovascular adaptation. Archives in Disease of Childhood. Fetal and Neonatal Edition. 2019; 104(2): F220-F224. doi: 10.1136/archdischild-2017-314453
- Burns ML, Stensvold HJ, Risnes K, Guthe HJ, Astrup H, Nordhov SM, et al. Inotropic therapy in newborns: a population-based national registry study. Pediatric Critical Care Medicine. 2016; 17(10): 948-956. doi: 10.1097/ PCC.0000000000000898
- Aldana-Aguirre JC, Deshpande P, Jain A, Weisz DE. Physiology of low blood pressure during the first day after birth among extremely preterm neonates. The Journal of Pediatrics. 2021; 236: 40-46.e3. doi: 10.1016/j.jpeds. 2021.05.026
- Ancel PY, Goffinet F, EPIPAGE-2 Writing Group, Kuhn P, Langer B, Matis J, et al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011. JAMA Pediatrics. 2015; 169(3): 230-238. doi: 10.1001/jamapediatrics.2014.3351
- Dempsey E, Rabe H. The use of cardiotonic drugs in neonates. Clinics in Perinatology. 2019; 46(2): 273-290. doi: 10.1016/j.clp.2019.02.010
- Bada HS, Korones SB, Perry EH, Arheart KL, Ray JD, Pourcyrous M, et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage. The Journal of Pediatrics. 1990; 117(4): 607-614. doi: 10.1016/s0022-3476(05)80700-0
- Sahni M, Jain SK. Role of the renin-angiotensin-aldosterone system in the management of neonatal heart failure. NeoReviews. 2015; 16: e575-e585. doi: 10.1542/neo.16-10-e575
- Price JF. Unique aspects of heart failure in the neonate. In: Shaddy RE, Ed., Heart failure in congenital heart disease: From fetus to adult. New York: Springer; 2010. 21-42. doi: 10.1007/978-1-84996-480-7-2
- Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus in the premature infant: Is it pathologic? Current Opinion in Pediatrics. 2004; 16(2): 146-151. doi: 10.1097/00008480-200404000-00005
- Hashad NS. Dosing in the neonatal intensive care unit. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2023; 3(3): 61-62. doi: 10.5281/zenodo.8393129
- Alouzi NA, Hashad NS, Yamane MA. Drug utilization pattern in the NICU: A World Health Organization-Anatomical Therapeutic Chemical Classification-based cross-sectional study. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(3): 75-82. doi: 10.5281/zenodo.16970145
- Evans K. Cardiovascular transition of the extremely premature infant and challenges to maintain hemodynamic stability. The Journal of Perinatal and Neonatal Nursing. 2016; 30(1): 68-72. doi: 10.1097/JPN.0000000000000156
- Fernandez EF, Watterberg KL. Relative adrenal insufficiency in the preterm and term infant. Journal of Perinatology. 2009; 29(Suppl 2): S44-S49. doi: 10.1038/jp.2009.24
- Wu TW, Azhibekov T, Seri I. Transitional hemodynamics in preterm neonates: Clinical relevance. Pediatrics and Neonatology. 2016; 57(1): 7-18. doi: 10.1016/j.pedneo.2015.07.002
- Korte C, Styne D, Merritt AT, Mayes D, Wertz A, Helbock HJ. Adrenocorticoid function in the very low birth weight infant. The Journal of Pediatrics. 1996; 128(2): 257-263. doi: 10.1016/s0022-3476(96)70404-3
- Agakidou E, Chatziioannidis I, Kontou A, Stathopoulou T, Chotas W, Sarafidis K. Pharmacologic management of neonatal hypotension: when, why, and which medication. Children (Basel). 2024; 11(4): 490. doi: 10.3390/children 11040490
- Donabedian A. Evaluating the quality of medical care. 1966. The Milbank Quarterly. 2005; 83(4): 691-729. doi: 10.1111/j.1468-0009.2005.00397.x
- Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM, WHO working group on caesarean section. WHO statement on caesarean section rates. BJOG: An International Journal of Obstetrics and Gynecology. 2016; 123(5): 667-670. doi: 10.1111/1471-0528.13526
- Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born Too Soon: The global epidemiology of 15 million preterm births. Reproductive Health. 2013; 10(Suppl 1): S2. doi: 10.1186/1742-4755-10-S1-S2
- Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: A systematic analysis. The Lancet. 2023; 402(10409): 1261-1271. doi: 10.1016/S0140-6736(23)00878-4. Erratum in: The Lancet. 2024; 403(10427): 618. doi: 10.1016/ S0140 -6736(24)00267-8
- Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000-19: An updated systematic analysis with implications for the sustainable development goals. Lancet Child and Adolescent Health. 2022; 6(2): 106-115. doi: 10.1016/S2352-4642(21)00311-4
- Brun P, Groisman B, Bidondo MP, Barbero P, Trotta M, Liascovich R. Prevalence of congenital anomalies and prenatal diagnosis by birth institution (public vs. non-public): Indicators of inequality in access to elective termination of pregnancy for fetal anomalies. Journal of Community Genetics. 2024; 15(4): 413-422. doi: 10.1007/s 12687-024-00714-x
- Dilli D, Soylu H, Tekin N. Neonatal hemodynamics and management of hypotension in newborns. Turkish Archives of Pediatrics. 2018; 53(Suppl 1): S65-S75. doi: 10.5152/TurkPediatriArs.2018.01801
- McNamara PJ, Jain A, El-Khuffash A, Giesinger R, Weisz D, Freud L, et al. Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the Neonatal Intensive Care Unit: An update from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2024; 37(2): 171-215. doi: 10.1016/j.echo.2023.11.016
- Greenough A, Emery EF. Randomized trial comparing dopamine and dobutamine in preterm infants. European Journal of Pediatrics. 1993; 152(11): 925-927. doi: 10.1007/BF01957532
- Subhedar NV, Shaw NJ. Dopamine versus dobutamine for hypotensive preterm infants. The Cochrane Database of Systematic Reviews. 2003; 2003(3): doi: 10.1002/14651858
- Sarafidis K, Verykouki E, Nikopoulos S, Apostolidou-Kiouti F, Diakonidis T, Agakidou E, Kontou A, Haidich AB. Systematic review and meta-analysis of cardiovascular medications in neonatal hypotension. Biomedicine Hub. 2022; 7(2): 70-79. doi: 10.1159/000525133
- Rios DR, Moffett BS, Kaiser JR. Trends in pharmacotherapy for neonatal hypotension. The Journal of Pediatrics. 2014; 165(4): 697-701.e1. doi: 10.1016/j.jpeds.2014.06.009
- Dwivedi K, Prakash S, Parveen K, Shaikh S. Survival outcome of neonates admitted at government and private neonatal intensive care units of Allahabad, India. International Journal of Community Medicine and Public Health. 2017; 4(7): 2389-2394. doi: 10.18203/2394-6040.ijcmph20172829
Submitted date:
10/20/2025
Reviewed date:
01/04/2026
Accepted date:
01/10/2026
Publication date:
01/07/2026
