Filling the Gap in Knowledge About Neonatal Drug Dosing Challenges in Nigerian NICUs

Neonatal intensive care units in Nigerian teaching hospitals administer complex pharmacotherapy to a population with rapidly changing pharmacokinetic parameters, yet systematically documented evidence on dosing challenges, error types, and pharmacist involvement is absent from the published literature for most Nigerian NICU settings. This study examined dosing challenges, error rates, and contributing factors across NICUs at four teaching hospitals in the South East, South West, and North Central zones. A prospective mixed-methods study was conducted over six months. Pharmacists conducted daily prescription reviews for all neonates admitted to the four NICUs, documenting prescribed medications, dosing decisions, and identified discrepancies against reference standards. Semi-structured interviews with 32 NICU nurses, neonatologists, and pharmacists explored systemic and human factors contributing to dosing challenges. A total of 580 neonates were included, with 4,620 medication orders reviewed. Dosing discrepancies were identified in 31.2 percent of orders, with the most common errors being incorrect dose calculation (42.3 percent of discrepancies), wrong frequency (27.8 percent), and suboptimal gestational age-based dosing (29.9 percent). Gentamicin, phenobarbital, and caffeine citrate accounted for 58.6 percent of all identified discrepancies. Pharmacist recommendations were accepted in 92.7 percent of cases. The study fills a significant evidence gap by providing the first multi-site NICU dosing challenge analysis from Nigerian teaching hospitals, demonstrating the critical need for dedicated neonatal clinical pharmacists.

Keywords: neonatal drug dosing, NICU pharmacotherapy, medication errors, Nigerian teaching hospitals, neonatal pharmacist