The Effect of Standard Concentration Infusions on Medication Errors in Neonatal and Pediatric Healthcare Settings: A Systematic Review

Journal of Clinical Medicine, vol. 14, pp. 7965

Abstract

Background and Objectives: Neonates and children are at high risk of medication errors (ME) with intravenous (IV) infusion therapies, particularly when strategies such as the “rule of six” with individualized, weight-based concentrations are used. Standard concentrations (SCs) have been proposed to reduce variability, improve safety, and facilitate the use of electronic prescribing and smart infusion technologies. The impact of SCs for continuous IV infusions on ME rates in neonatal and pediatric settings was systematically evaluated. Methods: A systematic review was conducted in MEDLINE, Embase and CINAHL (database inception-August 2025) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies implementing SCs for neonatal or pediatric IV infusions and measuring outcomes referring to ME rates were included. The relative risk reduction/increase in MEs was calculated. Results: Five uncontrolled before-after studies published between 2005 and 2020 were included. The relative risk reductions ranged from 41.2% to 95.1% for overall ME and from 49.7% to 100% for selected error types. In two studies, the relative risk for two error types (paper-generated prescriptions, administration) increased after implementing SCs. Reviewed benefits included decreased calculation and preparation errors, reduced medication process times, improved workflow efficiency and high staff satisfaction. Conclusions: SCs may contribute to safer IV infusion practice in the neonatal and pediatric setting, especially combined with smart technologies and training. However, current evidence is limited and heterogeneous. Larger, prospective experimental studies are needed to confirm their long-term impact on pediatric ME rates.

Authors 9

1. Linda Wende Aachen

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany

2. Mark Schoberer Aachen Department of Pediatric and Adolescent Medicine Section of Neonatology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Section of Neonatology, Department of Pediatric and Adolescent Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany

3. Almuth Kaune

   Technische Universität Dresden · University Hospital Carl Gustav Carus

   Affiliation as printed

   Hospital Pharmacy, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany

4. Karen Birgit Kreutzer

   University Children's Hospital Tübingen

   Affiliation as printed

   Department of Neonatology, University Children’s Hospital Tübingen, 72076 Tübingen, Germany

5. Thorsten W Orlikowsky Aachen Department of Pediatric and Adolescent Medicine Section of Neonatology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Section of Neonatology, Department of Pediatric and Adolescent Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany

6. Nanna Christiansen

   Evelina London Children's Healthcare

   Affiliation as printed

   Pharmacy Department, Evelina London Children’s Hospital, London SE1 7EH, UK

   Pharmacy Department, Evelina London Children's Hospital, London SE1 7EH, UK

7. Per Nydert
   Affiliation as printed

   Pediatric Drug Therapy Group, Astrid Lindgren Children’s Hospital, 171 76 Stockholm, Sweden

   Pediatric Drug Therapy Group, Astrid Lindgren Children's Hospital, 171 76 Stockholm, Sweden

8. Sebastian Schubert

   Johannes Gutenberg University Mainz · University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Hospital Pharmacy, Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany

9. Albrecht Eisert corresponding Aachen Institute of Clinical Pharmacology

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Hospital Pharmacy, RWTH Aachen University Hospital, 52074 Aachen, Germany

   Institute of Clinical Pharmacology, RWTH Aachen University Hospital, 52074 Aachen, Germany