Use of dornase alfa in pediatric patients without cystic fibrosis.

OBJECTIVES: Literature regarding clinical benefits of dornase alfa (DNase) in pediatric patients without cystic fibrosis is lacking. In December 2020, the study institution implemented restrictions to limit DNase use in this patient population. The primary objective was adherence to DNase ordering restrictions. Secondary objectives included length of stay, respiratory function, and use of inhaled mucolytic agents.

METHODS: This single-center retrospective chart review included patients less than 18 years of age who received DNase one year prior to through one year after order restriction implementation. Data collected included patient demographics and respiratory clinical parameters. Dosing regimens for DNase, n-acetylcysteine and hypertonic saline were collected, as well as changes in length of stay (LOS) and adherence to ordering restrictions.

RESULTS: Of 101 orders placed after implementation of ordering restrictions, 16 (36%) met all ordering criteria. Hospital and intensive care unit (ICU) LOS after implementation of restrictions were not significantly different (p=0.767 and p=0.219 respectively). There was no significant change in patients' mean oxygenation index (p=0.252) or FiO2% (p=0.113) 24 hours after DA administration.

CONCLUSION: Respiratory function did not significantly change after DNase administration. Implementing restrictions on DNase did not impact ICU or hospital LOS. Adherence to DNase ordering restrictions could be improved.