Analysis of anti-hypotensive drug pattern use in the Neonatal Intensive Care Unit: A comparative study between the public and private sectors in Libya

Neonatal hypotension is a critical and frequent condition in the Neonatal Intensive Care Unit (NICU), often requiring pharmacologic intervention. Despite established treatment strategies, considerable variability exists in clinical practice across different healthcare settings. This study aimed to compare the neonatal characteristics, clinical practices, treatment indications, and outcomes of patients admitted to a public hospital and a private clinic in Libya. A cross-sectional comparative study was conducted from December 2024 to April 2025. Data were collected using a validated standardized questionnaire that included neonate demographics, clinical presentation, diagnostic assessment, drug use patterns, outcome, and adverse events. A total of 120 neonates were included in the study. Neonates admitted to the private NICU had significantly more favorable baseline characteristics compared to those in the public NICU. A lower measured blood pressure and higher significant use of echocardiography (p<0.001) were observed in the private NICU. Dopamine was the primary agent used in the public NICU (85.7%) while the private NICU relied on combination therapy, including dobutamine (p<0.001). Clinical response occurred more rapidly in the private NICU. Conversely, a higher rate of mortality was observed in the public NICU compared with the private NICU (p<0.001). The current findings suggest a significant disparity in diagnosis, drug selection, and outcome between public and private NICUs. Thus, establishing standardized protocols and increasing access to diagnostic tools, such as echocardiography, could enhance neonatal outcomes, particularly in resource-limited settings.