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Purpose The objectives of our study were to determine drug use, type and incidence of all adverse event associated with drug or drug-related processes (Adverse Drug Events, ADE) among pediatric inpatients in relation to hospital unit and length of stay. Patients and Methods 600 pediatric (0–18 years) admissions at a Swedish university hospital during one year were included and stratified in blocks to 150 neonatal, surgical/orthopedic, medicine and emergency-medicine unit admissions, respectively. Adverse events were identified from medical records using a pediatric trigger tool. All triggers identifying an adverse event related to drugs and drug-related devices were included. Data on drug use were extracted from the hospital drug-data warehouse. Results In total, 17794 daily drug orders were administrated to 486 (81.0% exposed) admissions. Parental nutrition, potassium salts and morphine constituted half of all high-risk drugs prescribed. Two-thirds of intravenous irritating drug doses consisted of vancomycin, esomeprazole and meropenem. In 129 (21.5%) admissions, at least one ADE was identified, out of which 21 ADE were classified as more severe (National Coordinating Council Medication Error Reporting Prevention-Index, NCCMERP≥F). The ADE incidence was 47.4 (95% confidence interval: 39.4–57.3) per 1000 admission days and varied by unit category. In neonatal units, 56.9 (49.5–65.4) ADEs/1000 admission days were detected, in surgery/orthopedic 54.2 (40.3–72.8), in medicine 44.1 (33.1–58.7), and in emergency-medicine 14.3 (7.7–26.7) ADEs/1000 admission days were found. The most common types of ADEs were identified by triggers that were not directly aiming at drugs including insufficiently treated pain (incidence peaking already in the first days), skin, tissue or vascular harm (peaking at the end of the first week) and hospital-acquired infections (peaking in later admission days). Conclusion Adverse drug events are common in pediatric patients. The incidence of ADEs and type of ADE varies by hospital unit and length of hospital stay.

Key Points Question What strategies for surfactant treatment of newborn infants are used, and how are these strategies associated with outcomes? Findings In this cohort study of 5209 infants who received 7980 surfactant administrations, late surfactant treatment (>2 hours after birth) was provided for 39% of very preterm infants and associated with higher neonatal morbidity. Off-label use occurred in 19% of infants without any association to outcome, and treatment omissions were associated with lower survival. Meaning In this study, adherence to best practices for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes., This cohort study evaluates registered use, off-label use, and omissions of surfactant treatment by gestational age and associations with outcomes, mainly among very preterm infants (gestational age, Importance While surfactant therapy for respiratory distress syndrome (RDS) in preterm infants has been evaluated in clinical trials, less is known about how surfactant is used outside such a framework. Objective To evaluate registered use, off-label use, and omissions of surfactant treatment by gestational age (GA) and associations with outcomes, mainly among very preterm infants (GA