Adverse drug events in pediatric intensive care are common, but improvement strategies exist and are effective

Off label use is associated with adverse drug eventsPharmacotherapy is a powerful tool to improve outcome in children, but there is still an obvious need to reduce drug related problems through adverse drug event (ADE) prevention and management. 1 An ADE can hereby be defined as 'any harmful and unintended event resulting from the use of a drug intended for diagnosis or therapy'.Such an ADE definition is irrespective of the dose but more appropriate for children, since these patients still commonly receive off label drugs using doses extrapolated from adults.Besides the absence of labeling, (poly)pharmacy, inappropriate formulations, variability in dosing practices, difficulties to assess pharmacodynamics effects (e.g.sedation, pain), immaturity and organ dysfunction further raise the risk for ADEs in critically ill children.2,3 In pediatric and neonatal intensive care units (ICU), off label use of drugs is up to 80---90%, so significantly higher than the recently reported 30% in a primary pediatric care setting in Brazil.4 Unfortunately, these off label practices are associated by significant higher risks to develop ADE.Du et al. recently quantified this risk in

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