Abstract
<title>Abstract</title> <p> <bold>Objective</bold> To characterize prescribing practices and predictors of neuroactive medication exposure in NICU patients. <bold>Study Design</bold> This was a retrospective cohort study of 16 968 infants receiving care in five NICUs over six years. We summarized infant exposure to opioids, sedatives, or psychotropics, and evaluated factors that predicted medication exposure and drug exposure patterns over time. <bold>Result</bold> Of the 17 159 infants admitted to a NICU, 3 032 (18%) were exposed to at least one drug of interest. Lower gestational age (aOR 0.82 per week, 95% CI 0.81–0.83) and White race (aOR 1.28, 95% CI 1.18–1.39) were associated with exposure (both p < 0.001). The rates of dexmedetomidine, ketamine, clonidine, and fentanyl exposure increased over time. Lorazepam, midazolam, and pentobarbital rates decreased. <bold>Conclusion</bold> Neuroactive medication use has changed over time. Exposure is most common in premature infants, underscoring the urgent need for clinical trials to establish their safety and efficacy. </p>