(Vienna, November 17, 2023) Around seven percent of children in Austria are born prematurely, i.e. before the 37th week of pregnancy (week of pregnancy). The earlier a child is born, the more immature the functions of their organs are and the greater the risk of becoming ill or suffering permanent disabilities. For children born extremely immature (birth before the 28th week of pregnancy), it is often a matter of life and death and they require optimal medical and pharmaceutical treatment, 24 hours a day. This demanding task is carried out at the AKH Vienna University Hospital by an interdisciplinary team in which doctors, nurses and pharmacists contribute their knowledge.
In the neonatal intensive care units at Vienna General Hospital and MedUni Vienna, children born so early are treated that they sometimes weigh less than 500 grams and are barely the size of an adult’s hand. Just a few years ago, many of these patients would have had no chance of survival. Through modern therapeutic approaches and interdisciplinary collaboration, the survival limit for extremely immature premature babies has now been reduced to 22 to 23 weeks of pregnancy. In Vienna, well over 80 percent of all extremely premature babies survive in the intensive care units for premature babies managed by Angelika Berger at MedUni Vienna and the Vienna General Hospital, and well over 80 percent also have favorable neurological development. . “Such successes are only possible through excellent professional cooperation and the great personal commitment of doctors, hospital pharmacists and nursing staff”, says Angelika Berger.
Daily individual infusion sets for each premature baby from the hospital pharmacy
The effort required to provide the best possible care to young patients is great – and not just directly in intensive care units, where around three specialists are needed per premature baby at any time of the day or night. In the hospital pharmacy at the Vienna General Hospital, run by Martina Anditsch, pharmacists and pharmaceutical assistants manually prepare all planned infusions for the next 24 hours every day with the help of automated pump systems – individually for each patient. An infusion “set” includes up to 15 perfusors (syringes for infusion pumps) or more for each premature baby, plus a variety of tubes (“lines”), bars, and connectors.
An important component of these individually adapted “kits” is parenteral nutrition. The still underdeveloped body of the premature baby is supplied with amino acids, fat, glucose as well as important vitamins, minerals and trace elements through infusions through the blood vessel system. This approach aims to compensate as much as possible for the natural supply of nutrients in the uterus. Depending on the laboratory values, the composition is continually adjusted by doctors (e.g. adding more sodium if the values are low) and additionally checked by pharmacists. The “sets” also contain infusions with which medication can be administered continuously for 24 hours (“bypasses”) and short infusions for administering certain medications over shorter periods of time (e.g. antibiotics or analgesics).
Last year, employees in the intravenous (iv = intravenous) services department of the pharmacy at Vienna’s AKH University Hospital prepared and assembled more than 6,000 of these “sets” for small patients. In addition to the two neonatal intensive care units, the IV service also provides individual infusions for the neonatal intermediate care ward as well as for newborns and children in other selected wards of the University Clinic for Pediatrics and Adolescent Medicine at MedUni Vienna and the Vienna General Hospital. The service is constantly expanding.
The highest hygiene standards are required in the preparation and assembly of infusions
Strict hygiene guidelines are particularly challenging when creating and assembling these “sets”, as the immune system is still seriously underdeveloped, especially in extremely premature babies, and has difficulty defending itself against pathogens. Therefore, perfusors are filled individually for each patient by hospital pharmacy staff in special clean rooms and transported to the wards in a sterile, welded form. There, the perfusors are assembled in their respective “sets” under aseptic conditions on a bench called laminar air flow and taken to the infusion pumps, which are located next to the incubators for small patients.
As medicine specialists, iv service pharmacists provide advice to doctors and nurses on clinical pharmaceutical issues. For example, they develop lists from which it is clear at any time in the wards which active ingredients are compatible with others, in which concentrations the active ingredients remain stable for at least a day at room temperature (that’s how long an infusion set is connected to the patient), which active ingredients must be protected from light and in what proportion certain dilutions must be made. Training the nursing team in aseptic work is also part of its activities. The department also performs important logistical tasks such as ordering, checking and distributing necessary medicines and medical devices to the wards.
Pharmacy at AKH Vienna University Hospital will soon be the largest hospital pharmacy in Europe
The Service IV department currently has six pharmacists and ten pharmaceutical-sales assistants (PKAs). In total, more than 200 people work in the hospital pharmacy at AKH University Hospital Vienna. Together, they ensure that thousands of patients on the various wards always reliably receive the correct medicines, diagnostics, medical devices and special nutritional products and that the safety of drug therapy is guaranteed at all times.
Every day, pharmacy employees distribute around 15,000 packages of medicines to the wards of the AKH Vienna University Hospital. The hospital pharmacy is currently being expanded during ongoing operations and transformed into the largest hospital pharmacy in all of Europe. Around 200,000 packs of medicines could be stored on site for patients in the future.
Video: State-of-the-art patient-centered medicine at the CCP of MedUni Vienna & Vienna General Hospital – case of premature twins