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Original article

Vol. 151 No. 2526 (2021)

NeoCheck: a prescription-screening tool to optimise pharmacotherapy for hospitalised neonates

Cite this as:
Swiss Med Wkly. 2021;151:w20519



To develop a screening tool to optimise neonatal drug prescription, which is often based on low-quality evidence.


Neonatal pharmacotherapy recommendations were identified by literature review and synthesised into NeoCheck tool statements. In a two-round modified Delphi process, experts from Swiss neonatal intensive care units (NICUs) rated their agreement with individual statements using a five-point Likert scale (5 = totally agree). Statements with >65% scores ≥4 in round 1 and >75% scores ≥4 in round 2 were selected.


We identified 1375 clinical guidelines via literature review. After synthesis, 158 statements were submitted to 23 experts (1 clinical pharmacist, 22 neonatologists; 65% with >10 years neonatology practice) from 10 Swiss NICUs. Nineteen items did not reach the agreement threshold and were eliminated in the second Delphi round. The final NeoCheck tool comprises 141 statements in 11 medical domains concerning 49 neonatal diseases. Most (79%) statements concern all neonates, 13% concern preterm (<37 weeks gestational age) infants and 3% concern very preterm (<32 weeks gestational age) infants


NeoCheck is the first prescription-screening tool developed to optimise neonatal pharmacotherapy. In a future prospective study, its effect on NICU prescription optimisation and the quality of care will be assessed.


  1. Cuzzolin L, Agostino R. Off-label and unlicensed drug treatments in Neonatal Intensive Care Units: an Italian multicentre study. Eur J Clin Pharmacol. 2016;72(1):117–23.
  2. de Souza AS, Jr, Dos Santos DB, Rey LC, Medeiros MG, Vieira MG, Coelho HLL. Off-label use and harmful potential of drugs in a NICU in Brazil: A descriptive study. BMC Pediatr. 2016;16(1):13.
  3. Riou S, Plaisant F, Maucort Boulch D, Kassai B, Claris O, Nguyen KA. Unlicensed and off-label drug use: a prospective study in French NICU. Acta Paediatr. 2015;104(5):e228–31.
  4. Magalhães J, Rodrigues AT, Roque F, Figueiras A, Falcão A, Herdeiro MT. Use of off-label and unlicenced drugs in hospitalised paediatric patients: a systematic review. Eur J Clin Pharmacol. 2015;71(1):1–13.
  5. Di Paolo ER, Stoetter H, Cotting J, Frey P, Gehri M, Beck-Popovic M, et al. Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly. 2006;136(13-14):218–22.
  6. Joseph PD, Craig JC, Caldwell PHY. Clinical trials in children. Br J Clin Pharmacol. 2015;79(3):357–69.
  7. Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf. 2016;7(3):102–19.
  8. Lenclen R. Les erreurs de prescriptions en néonatologie: incidence, types d’ erreurs, détection et prévention [Medication errors in neonatology: a review]. Arch Pediatr. 2007;14(Suppl 1):S71–7.
  9. Machado APC, Tomich CSF, Osme SF, Ferreira DM de LM, Mendonça MAO, Pinto RMC, et al. Prescribing errors in a Brazilian neonatal intensive care unit. Cad Saude Publica. 2015;31(12):2610–20.
  10. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285(16):2114–20.
  11. Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89(6):845–54.
  12. Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016;41(2):158–69.
  13. Desnoyer A, Blanc AL, Pourcher V, Besson M, Fonzo-Christe C, Desmeules J, et al. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. BMJ Open. 2017;7(7):e016070.
  14. Berthe-Aucejo A, Nguyen PKH, Angoulvant F, Bellettre X, Albaret P, Weil T, et al. Retrospective study of irrational prescribing in French paediatric hospital: prevalence of inappropriate prescription detected by Pediatrics: Omission of Prescription and Inappropriate prescription (POPI) in the emergency unit and in the ambulatory setting. BMJ Open. 2019;9(3):e019186.
  15. Blanc AL, Guignard B, Desnoyer A, Grosgurin O, Marti C, Samer C, et al. Prevention of potentially inappropriate medication in internal medicine patients: A prospective study using the electronic application PIM-Check. J Clin Pharm Ther. 2018;43(6):860–6.
  16. Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013–9.
  17. Gommela TL, Cunningham MD, Eyal F. Neonatology: management, procedures, on-call problems, diseases and drugs. 6th edition. New York: McGraw-Hill; 2009.
  18. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323(7308):334–6. doi:.
  19. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.
  20. Prot-Labarthe S, Vercheval C, Angoulvant F, Brion F, Bourdon O. « POPI; pédiatrie : omissions et prescriptions inappropriées ». Outil d’identification des prescriptions inappropriées chez l’enfant [POPI: a tool to identify potentially inappropriate prescribing practices for children]. Arch Pediatr. 2011;18(11):1231–2.
  21. Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6(6):e20476.
  22. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Chinese J Evidence-Based Med. 2009;9(1):8–11.
  23. Uhlig K, Balk EM, Lau J. Grading evidence-based guidelines--what are the issues? Am J Kidney Dis. 2008;52(2):211–5.
  24. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

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