{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:13:25Z","timestamp":1793445205601,"version":"4.5.0"},"reference-count":166,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union-NextGenerationEU","award":["BG-RRP-2.004-0004-C01"],"award-info":[{"award-number":["BG-RRP-2.004-0004-C01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Off-label prescribing is widespread among pediatricians, and it is unlikely that this trend will soon be bound by a uniform legal framework. This is necessitated by the fact that there are four variables: the patient\u2019s health condition, the physician\u2019s experience and knowledge, the legislative measures (laws, directives, guidelines, and recommendations), and finally, the pharmaceutical industry. There is considerable concern worldwide about the use of off-label medicines in children. We may call it an enormous global problem that is much talked about and written about; however, we should not forget that the goal around which everyone should unite is the patient\u2019s life. For healthcare providers, the most important thing will always be the health and preservation of the patient\u2019s life, particularly when it comes to children with life-threatening conditions in neonatal and pediatric intensive care units (NICU and PICU). The study aimed to examine the prevalence of off-label drug use in pediatrics. Literature research was conducted, and we included studies from 2012 to 2022 that evaluated off-label drug prevalence in various pediatric patient populations.<\/jats:p>","DOI":"10.3390\/pharmaceutics15122652","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T10:24:13Z","timestamp":1700562253000},"page":"2652","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Off-Label Prescribing in Pediatric Population\u2014Literature Review for 2012\u20132022"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-1054","authenticated-orcid":false,"given":"Valentina","family":"Petkova","sequence":"first","affiliation":[{"name":"Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1499-0733","authenticated-orcid":false,"given":"Dilyana","family":"Georgieva","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7744-0384","authenticated-orcid":false,"given":"Milen","family":"Dimitrov","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Nikolova","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rusz, C.-M., \u0150sz, B.-E., J\u00eetc\u0103, G., Miklos, A., B\u0103tr\u00eenu, M.-G., and Imre, S. (2021). Off-Label Medication: From a Simple Concept to Complex Practical Aspects. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910447"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1007\/s00228-014-1729-3","article-title":"Strategy to address innovative off-label medication use in China: Grading management","volume":"70","author":"Wu","year":"2014","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1111\/ped.14015","article-title":"Trends in the off-label use of \u03b2-blockers in pediatric patients","volume":"61","author":"Kaley","year":"2019","journal-title":"Pediatr. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1111\/bcp.13394","article-title":"Unlicensed and off-label uses of medicines: Definitions and clarification of terminology","volume":"83","author":"Aronson","year":"2017","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.pharmthera.2017.02.018","article-title":"Optimising the use of medicines to reduce acute kidney injury in children and babies","volume":"174","author":"Oni","year":"2017","journal-title":"Pharmacol. Ther."},{"key":"ref_6","first-page":"776","article-title":"Off-Label Medication use in Children, More Common than We Think: A Systematic Review of the Literature","volume":"111","author":"Allen","year":"2018","journal-title":"J. Okla. State Med. Assoc."},{"key":"ref_7","first-page":"426","article-title":"Evidence-based evaluation on off-label drug use policies in 15 countries. Chin","volume":"12","author":"Zhang","year":"2012","journal-title":"J. Evid.-Based Med."},{"key":"ref_8","first-page":"387","article-title":"The ethics of clinical trials","volume":"8","author":"Nardini","year":"2014","journal-title":"Ecancermedicalscience"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5694\/mja13.00184","article-title":"Off-label prescribing","volume":"200","author":"Seale","year":"2014","journal-title":"Med. J. Aust."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"121501","DOI":"10.1016\/j.ijpharm.2022.121501","article-title":"Paediatric specific dosage forms: Patient and formulation considerations","volume":"616","author":"Khan","year":"2022","journal-title":"Int. J. Pharm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"878","DOI":"10.2174\/138945012800675759","article-title":"Off-label drug use in paediatrics: A world-wide problem","volume":"13","author":"Lenk","year":"2012","journal-title":"Curr. Drug Targets"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s43441-022-00398-w","article-title":"Accelerating Pediatric Drug Development: A 2022 Special Issue of Therapeutic Innovation & Regulatory Science","volume":"56","author":"McCune","year":"2022","journal-title":"Ther. Innov. Regul. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Klassen, T.P., Hartling, L., Craig, J.C., and Offringa, M. (2008). Children Are Not Just Small Adults: The Urgent Need for High-Quality Trial Evidence in Children. PLOS Med., 5.","DOI":"10.1371\/journal.pmed.0050172"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1542\/peds.2007-2849","article-title":"Child Versus Adult Research: The Gap in High-Quality Study Design","volume":"122","author":"Silverstein","year":"2008","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/17843286.2018.1473094","article-title":"Neonates are not just little children and need more finesse in dosing of antibiotics","volume":"74","author":"Allegaert","year":"2019","journal-title":"Acta Clin. Belg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/bcp.12267","article-title":"Paediatric pharmacokinetics: Key considerations","volume":"79","author":"Batchelor","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/pr.2014.143","article-title":"Dosing in neonates: Special considerations in physiology and trial design","volume":"77","author":"Ku","year":"2015","journal-title":"Pediatr. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1002\/jcph.744","article-title":"Exposure Matching for Extrapolation of Efficacy in Pediatric Drug Development","volume":"56","author":"Mulugeta","year":"2016","journal-title":"J. Clin. Pharmacol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5643","DOI":"10.2174\/1381612821666150901105555","article-title":"New Ways of Detecting ADRs in Neonates and Children","volume":"21","author":"Jimenez","year":"2015","journal-title":"Curr. Pharm. Des."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/j.1365-2125.2005.02445.x","article-title":"How children\u2019s responses to drugs differ from adults","volume":"59","author":"Stephenson","year":"2005","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.prrv.2004.11.008","article-title":"Development of medicines for children in Europe: Ethical implications","volume":"6","author":"Raymond","year":"2005","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"208","DOI":"10.18773\/austprescr.2016.071","article-title":"Paediatric pharmacokinetics and drug doses","volume":"39","year":"2016","journal-title":"Aust. Prescr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/j.clinthera.2008.11.019","article-title":"The economics of pediatric formulation development for off-patent drugs","volume":"30","author":"Milne","year":"2008","journal-title":"Clin. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ogbonna, J.D.N., Cunha, E., Attama, A.A., Ofokansi, K.C., Ferreira, H., Pinto, S., Gomes, J., Marx, M.G., Peres, A.M., and Lobo, J.M.S. (2022). Overcoming Challenges in Pediatric Formulation with a Patient-Centric Design Approach: A Proof-of-Concept Study on the Design of an Oral Solution of a Bitter Drug. Pharmaceuticals, 15.","DOI":"10.3390\/ph15111331"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/j.1365-2125.2005.02410.x","article-title":"Formulation of medicines for children","volume":"59","author":"Nunn","year":"2005","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1007\/s11096-022-01478-5","article-title":"Development and evaluation of an assessment of the age-appropriateness\/inappropriateness of formulations used in children","volume":"44","author":"Duncan","year":"2022","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/bcp.12268","article-title":"Formulations for children: Problems and solutions","volume":"79","author":"Batchelor","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.ijpharm.2016.07.054","article-title":"Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children\u2019s Acceptability of Oral Formulations (CALF) Study","volume":"514","author":"Ranmal","year":"2016","journal-title":"Int. J. Pharm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s00431-014-2272-z","article-title":"Toxic excipients in medications for neonates in Brazil","volume":"173","author":"Souza","year":"2014","journal-title":"Eur. J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.phrs.2011.01.006","article-title":"Paediatric pharmacology: Remember the excipients","volume":"63","author":"Fabiano","year":"2011","journal-title":"Pharmacol. Res."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Saito, J., Agrawal, A., Patravale, V., Pandya, A., Orubu, S., Zhao, M., Andrews, G.P., Petit-Turcotte, C., Landry, H., and Croker, A. (2022). The Current States, Challenges, Ongoing Efforts, and Future Perspectives of Pharmaceutical Excipients in Pediatric Patients in Each Country and Region. Children, 9.","DOI":"10.3390\/children9040453"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Alessandrini, E., Brako, F., Scarpa, M., Lupo, M., Bonifazi, D., Pignataro, V., Cavallo, M., Cullufe, O., Enache, C., and Nafria, B. (2021). Children\u2019s Preferences for Oral Dosage Forms and Their Involvement in Formulation Research via EPTRI (European Paediatric Translational Research Infrastructure). Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13050730"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Li, J., Li, C., Zhang, H., Gao, X., Wang, T., Wang, Z., and Zheng, A. (2022). Preparation of Azithromycin Amorphous Solid Dispersion by Hot-Melt Extrusion: An Advantageous Technology with Taste Masking and Solubilization Effects. Polymers, 14.","DOI":"10.3390\/polym14030495"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e16592","DOI":"10.1016\/j.heliyon.2023.e16592","article-title":"Preparations and characterizations of effervescent granules containing azithromycin solid dispersion for children and elder: Solubility enhancement, taste-masking, and digestive acidic protection","volume":"9","author":"Huynh","year":"2023","journal-title":"Heliyon"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cornil\u0103, A., Iurian, S., Tomu\u021b\u0103, I., and Porfire, A. (2022). Orally Dispersible Dosage Forms for Paediatric Use: Current Knowledge and Development of Nanostructure-Based Formulations. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14081621"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1208\/s12249-016-0558-3","article-title":"Paediatric Drug Development and Formulation Design\u2014A European Perspective","volume":"18","author":"Kozarewicz","year":"2017","journal-title":"AAPS Pharmscitech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1136\/archdischild-2011-300909","article-title":"Prescribing for children\u2014Taste and palatability affect adherence to antibiotics: A review","volume":"97","author":"Baguley","year":"2012","journal-title":"Arch. Dis. Child."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Yuliani, S.H., Putri, D.C.A., Virginia, D.M., Gani, M.R., and Riswanto, F.D.O. (2023). Prevalence, Risk, and Challenges of Extemporaneous Preparation for Pediatric Patients in Developing Nations: A Review. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15030840"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"MacArthur, R.B., Ashworth, L.D., Zhan, K., and Parrish, R.H. (2022). How Compounding Pharmacies Fill Critical Gaps in Pediatric Drug Development Processes: Suggested Regulatory Changes to Meet Future Challenges. Children, 9.","DOI":"10.3390\/children9121885"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.clinthera.2013.06.007","article-title":"The bad taste of medicines: Overview of basic research on bitter taste","volume":"35","author":"Mennella","year":"2013","journal-title":"Clin. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"188","DOI":"10.18773\/austprescr.2022.067","article-title":"Administration of medicines to children: A practical guide","volume":"45","author":"Smith","year":"2022","journal-title":"Aust. Prescr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.xphs.2020.12.036","article-title":"Paediatric Medicines\u2014Regulatory Drivers, Restraints, Opportunities and Challenges","volume":"110","author":"Vieira","year":"2021","journal-title":"J. Pharm. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1056\/NEJMra035092","article-title":"Developmental Pharmacology\u2014Drug Disposition, Action, and Therapy in Infants and Children","volume":"349","author":"Kearns","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e29854","DOI":"10.1002\/pbc.29854","article-title":"A systematic literature review to identify ethical, legal, and social responsibilities of nonprofit organizations when funding clinical trials in pediatric cancer","volume":"69","author":"Rahimzadeh","year":"2022","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Shaniv, D., Bolisetty, S., Young, T.E., Mangum, B., Ainsworth, S., Elbers, L., Schultz, P., Cucchi, M., de Wildt, S.N., and van der Zanden, T.M. (2023). Neonatal Drug Formularies\u2014A Global Scope. Children, 10.","DOI":"10.20944\/preprints202304.0265.v1"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3999\/jscpt.53.6_225","article-title":"Comparison of Regulations and Status of Promoting Drug Development and Authorization of Pediatric Indications among Japan, the United States and the United Kingdom","volume":"53","author":"Suwa","year":"2022","journal-title":"Rinsho yakuri\/Jpn. J. Clin. Pharmacol. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S108","DOI":"10.1002\/jcph.1128","article-title":"Optimizing Antibiotic Drug Therapy in Pediatrics: Current State and Future Needs","volume":"58","author":"Le","year":"2018","journal-title":"J. Clin. Pharmacol."},{"key":"ref_48","first-page":"369","article-title":"A comparison of different methods for the first-in-pediatric dose selection","volume":"8","author":"Mahmood","year":"2022","journal-title":"J. Clin. Translat. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s13052-022-01361-z","article-title":"Drug dosing in children with obesity: A narrative updated review","volume":"48","author":"Gaeta","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref_50","first-page":"S10","article-title":"Developmental Changes in Pharmacokinetics and Pharmacodynamics","volume":"58","author":"Reed","year":"2018","journal-title":"J. Clin. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1136\/archdischild-2013-303720","article-title":"Understanding dosing: Children are small adults, neonates are immature children","volume":"98","author":"Anderson","year":"2013","journal-title":"Arch. Dis. Child."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1093\/pch\/pxaa108","article-title":"Prescribing drugs to overweight and obese children: Balancing efficacy and safety","volume":"26","author":"Roy","year":"2021","journal-title":"Paediatr. Child Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/j.clinthera.2015.05.495","article-title":"Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing","volume":"37","author":"Kendrick","year":"2015","journal-title":"Clin. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/bcp.12305","article-title":"Clinical trials in children","volume":"79","author":"Joseph","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1208\/s12248-021-00592-y","article-title":"Development of a Pediatric Relative Bioavailability\/Bioequivalence Database and Identification of Putative Risk Factors Associated with Evaluation of Pediatric Oral Products","volume":"23","author":"Pawar","year":"2021","journal-title":"AAPS J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/ped.14529","article-title":"Principles of ethical consideration required for clinical research involving children","volume":"63","author":"Matsui","year":"2021","journal-title":"Pediatr. Int."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1542\/neo.23-3-e151","article-title":"Ethical Considerations in Neonatal Research","volume":"23","author":"Krishna","year":"2022","journal-title":"NeoReviews"},{"key":"ref_58","unstructured":"Declaration of Helsinki (2023, July 30). Ethical Principles for Medical Research Involving Human Subjects. Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects."},{"key":"ref_59","unstructured":"(2023, August 24). The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subject of Research, Available online: https:\/\/www.hhs.gov\/ohrp\/sites\/default\/files\/the-belmont-report-508c_FINAL.pdf."},{"key":"ref_60","unstructured":"(2023, August 25). Guideline for Good Clinical Practice E6(R2). Available online: https:\/\/www.ema.europa.eu\/en\/documents\/scientific-guideline\/ich-guideline-good-clinical-practice-e6r2-step-5_en.pdf."},{"key":"ref_61","unstructured":"ICH Topic E11 (2023, August 05). Clinical Investigation of Medicinal Products in the Paediatric Population. CPMP\/ICH\/2711\/99. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/scientific-guideline\/e-11-clinical-investigation-medicinal-products-paediatric-population-step-5_en.pdf."},{"key":"ref_62","unstructured":"(2023, August 12). Directive 2001\/20\/EC of the European Parliament and the Council on the Approximation of the Laws, Regulations and Administrative Provisions of the Member States Relating to Implementation of Good Clinical Practice-GCP-in the Conduct of Clinical Trials on Medicinal Products for Human Use. Available online: https:\/\/health.ec.europa.eu\/system\/files\/2016-11\/dir_2001_20_en_0.pdf."},{"key":"ref_63","unstructured":"(2023, August 15). Code for Federal Regulations (CFR), Title 45, Part 46, Subpart D. Additional Protections for Children Involved as Subjects in Research, Available online: https:\/\/www.ecfr.gov\/current\/title-45\/subtitle-A\/subchapter-A\/part-46\/subpart-D."},{"key":"ref_64","unstructured":"(2023, August 15). NHI Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects. March 1998, Available online: https:\/\/grants.nih.gov\/grants\/guide\/notice-files\/not98-024.html."},{"key":"ref_65","unstructured":"(2023, August 21). Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans\u2014TCPS 2. Available online: https:\/\/ethics.gc.ca\/eng\/documents\/tcps2-2022-en.pdf."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e016293","DOI":"10.1136\/bmjopen-2017-016293","article-title":"Global shortage of neonatal and paediatric antibiotic trials: Rapid review","volume":"7","author":"Thompson","year":"2017","journal-title":"BMJ Open"},{"key":"ref_67","unstructured":"The World Bank (2023, August 25). Population Ages 0\u201314 (% of Total Population). Available online: https:\/\/data.worldbank.org\/indicator\/SP.POP.0014.TO.ZS."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1002\/cpt.2736","article-title":"Off-Label, but on-Evidence? A Review of the Level of Evidence for Pediatric Pharmacotherapy","volume":"112","author":"Smeets","year":"2022","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"238","DOI":"10.5582\/irdr.2021.01104","article-title":"Off-label medication use in rare pediatric diseases in the United States","volume":"10","author":"Fung","year":"2021","journal-title":"Intractable Rare Dis. Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1136\/archdischild-2019-318676","article-title":"Challenges in clinical trials for children and young people","volume":"106","author":"Lagler","year":"2021","journal-title":"Arch. Dis. Child."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.clinthera.2016.01.012","article-title":"Improvement of Pediatric Drug Development: Regulatory and Practical Frameworks","volume":"38","author":"Tsukamoto","year":"2016","journal-title":"Clin. Ther."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Song, L., Jia, Y., Ran, S., Li, B., Xu, J., Huo, B., Yin, N., Ai, M., and Liu, Y. (2022). Current situation of pediatric clinical trials in China: Focus on trials for drug marketing application and administrative approval. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03208-2"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1136\/archdischild-2020-321433","article-title":"Recommendations by the European Network of Paediatric Research at the European Medicines Agency (Enpr-EMA) Working Group on preparedness of clinical trials about paediatric medicines process","volume":"106","author":"Siapkara","year":"2021","journal-title":"Arch. Dis. Child."},{"key":"ref_74","first-page":"609","article-title":"Systematic Review of Early Phase Pediatric Clinical Pharmacology Trials","volume":"27","author":"Subramanian","year":"2022","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"4250","DOI":"10.1111\/bcp.14769","article-title":"Paediatric pharmacotherapy and drug regulation: Moving past the therapeutic orphan","volume":"88","author":"Rieder","year":"2022","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s11096-021-01303-5","article-title":"Regulating pediatric off-label uses of medicines in the EU and USA: Challenges and potential solutions: Comparative regulation framework of off label prescriptions in pediatrics: A review","volume":"44","author":"Guidi","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rpped.2015.10.001","article-title":"Challenges on off label medicine use","volume":"34","author":"Carvalho","year":"2016","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_78","unstructured":"(2023, August 15). Regulation (EC) No. 1901\/2006 of the European Parliament and of the Council of 12 December 2006 on Medicinal Products for Paediatric Use. Available online: https:\/\/eur-lex.europa.eu\/legal-content\/EN\/TXT\/PDF\/?uri=CELEX:32006R1901."},{"key":"ref_79","unstructured":"European Commission, Directorate-General for Health and Food Safety, Marjolein, W., Hoebert, J., Vertvloet, M., Puigmarti, C.M., Damen, N., Marchange, S., Langedijk, J., Lisman, J., and van Dijk, L. (2023, August 27). Study on Off-Label Use of Medicinal Products in the European Union. Available online: https:\/\/data.europa.eu\/doi\/10.2875\/464022."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s40272-017-0261-1","article-title":"Enabling Development of Paediatric Medicines in Europe: 10 Years of the EU Paediatric Regulation","volume":"19","author":"Tomasi","year":"2017","journal-title":"Pediatr. Drugs"},{"key":"ref_81","unstructured":"(2023, August 12). Pediatric Research Equity Act of 2003. Public Law, 108\u2013155, 2003, Available online: https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-108publ155\/pdf\/PLAW-108publ155.pdf."},{"key":"ref_82","unstructured":"(2023, August 25). Best Pharmaceuticals for Children Act. Public Law, 107\u2013109, 2002, Available online: https:\/\/www.congress.gov\/107\/plaws\/publ109\/PLAW-107publ109.pdf."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1542\/peds.2013-4060","article-title":"Off-Label Use of Drugs in Children","volume":"133","author":"Neville","year":"2014","journal-title":"Pediatrics"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S2352-4642(23)00083-4","article-title":"Off-label is not always off-evidence: Authorising paediatric indications for old medicines","volume":"7","author":"Foeldvari","year":"2023","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_85","unstructured":"General Medical Council (2023, August 28). Good Practice in Prescribing and Managing Medicines and Devices. General Medical Council (5 April 2021). Available online: https:\/\/www.gmc-uk.org\/-\/media\/documents\/prescribing-guidance-updated-english-20210405_pdf-85260533.pdf."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"892574","DOI":"10.3389\/fphar.2022.892574","article-title":"Recommendations on Off-Label Drug Use in Pediatric Guidelines","volume":"13","author":"Meng","year":"2022","journal-title":"Front. Pharmacol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1111\/bcp.12750","article-title":"Awareness, knowledge and views of off-label prescribing in children: A systematic review","volume":"80","author":"Balan","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1089\/cap.2014.0131","article-title":"Experiences with Patient Refusal of Off-Label Prescribing of Psychotropic Medications to Children and Adolescents in Japan","volume":"26","author":"Tsujii","year":"2016","journal-title":"J. Child Adolesc. Psychopharmacol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1007\/s00431-013-2111-7","article-title":"Paediatric drug use with focus on off-label prescriptions in Lombardy and implications for therapeutic approaches","volume":"172","author":"Carnovale","year":"2013","journal-title":"Eur. J. Pediatr."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1111\/apa.12541","article-title":"Unlicensed and off-label drug use in an Irish neonatal intensive care unit: A prospective cohort study","volume":"103","author":"Kieran","year":"2014","journal-title":"Acta Paediatr."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.therap.2018.02.002","article-title":"Off-label and unlicensed drug use in children population","volume":"73","author":"Moulis","year":"2018","journal-title":"Therapies"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2174\/1574884712666170317161935","article-title":"Pediatric Off-Label and Unlicensed Drug Use and Its Implications","volume":"12","author":"Gore","year":"2017","journal-title":"Curr. Clin. Pharmacol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00228-014-1768-9","article-title":"Use of off-label and unlicenced drugs in hospitalised paediatric patients: A systematic review","volume":"71","author":"Rodrigues","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.sapharm.2017.05.013","article-title":"Non-regulatory related factors leading to off-label prescribing in children: A concept map","volume":"13","author":"Balan","year":"2017","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Knopf, H., Wolf, I.-K., Sarganas, G., Zhuang, W., Rascher, W., and Neubert, A. (2013). Off-label medicine use in children and adolescents: Results of a population-based study in Germany. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-631"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s11096-012-9699-y","article-title":"Off-label drug prescribing in a Portuguese Paediatric Emergency Unit","volume":"35","author":"Ribeiro","year":"2012","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1824-7288-40-12","article-title":"Incidence of unlicensed and off-label prescription in children","volume":"40","author":"Vrtal","year":"2014","journal-title":"Ital. J. Pediatr."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5530\/jyp.2015.3.5","article-title":"Off-label and Unlicensed Drug Use in Paediatric Outpatient Department\u2014A Prospective Study at a Tertiary Care Teaching Hospital","volume":"7","author":"Bhadiyadara","year":"2015","journal-title":"J. Young Pharm."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1080\/14740338.2017.1344639","article-title":"Off-label prescribing for children with chronic diseases in Nigeria; findings and implications","volume":"16","author":"Oshikoya","year":"2017","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/jcpt.12119","article-title":"Prescribing for off-label use and unauthorized medicines in three paediatric wards in Finland, the status before and after the European Union Paediatric Regulation","volume":"39","author":"Hakkarainen","year":"2014","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/jphp.12581","article-title":"Off-label and unlicensed medicines to hospitalised children in Norway","volume":"69","author":"Teigen","year":"2017","journal-title":"J. Pharm. Pharmacol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1111\/j.1651-2227.2012.02656.x","article-title":"Paediatric drug use with focus on off-label prescriptions at Swedish hospitals\u2014A nationwide study","volume":"101","author":"Kimland","year":"2012","journal-title":"Acta Paediatr."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1007\/s00228-012-1221-x","article-title":"Unlicensed and off-label drug use in hospitalized children in Croatia: A cross-sectional survey","volume":"68","year":"2012","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_104","first-page":"48","article-title":"Off-label drug use among hospitalized children: Identifying extent and nature","volume":"59","year":"2012","journal-title":"Eur. Pharm. J."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1177\/2150135113481042","article-title":"Off-Label Drug Use in a Single-Center Pediatric Cardiac Intensive Care Unit","volume":"4","author":"Maltz","year":"2013","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/pch\/21.2.83","article-title":"Unlicensed and off-label drug use in paediatrics in a mother-child tertiary care hospital","volume":"21","author":"Corny","year":"2016","journal-title":"Paediatr. Child Health"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Czarniak, P., Bint, L., Favi\u00e9, L., Parsons, R., Hughes, J., and Sunderland, B. (2015). Clinical Setting Influences Off-Label and Unlicensed Prescribing in a Paediatric Teaching Hospital. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0120630"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1111\/1742-6723.12431","article-title":"Off-label and unlicenced medicine administration to paediatric emergency department patients","volume":"27","author":"Taylor","year":"2015","journal-title":"Emerg. Med. Australas."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Landwehr, C., Richardson, J., Bint, L., Parsons, R., Sunderland, B., and Czarniak, P. (2019). Cross-sectional survey of off-label and unlicensed prescribing for inpatients at a paediatric teaching hospital in Western Australia. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0210237"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s11096-013-9846-0","article-title":"Unlicensed and off-label use of medicines in children admitted to the intensive care units of a hospital in Malaysia","volume":"35","author":"Lee","year":"2013","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Tukayo, B.L.A., Sunderland, B., Parsons, R., and Czarniak, P. (2020). High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.\u2014Oct. 2014. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227687"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s11096-014-0049-0","article-title":"Respiratory drugs prescribed off-label among children in the outpatient clinics of a hospital in Malaysia","volume":"37","author":"Mohamad","year":"2014","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3233\/JRS-150653","article-title":"Off-label and unlicensed drug use in children admitted to Pediatric Intensive Care Units (PICU)","volume":"27","author":"Jobanputra","year":"2015","journal-title":"Int. J. Risk Saf. Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/jpc.12065","article-title":"Off-label use of medicines in paediatric inpatients at an Australian teaching hospital","volume":"49","author":"Ballard","year":"2013","journal-title":"J. Paediatr. Child Health"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1179\/204690513X13656734979929","article-title":"Off-label and unlicensed paediatric prescribing in a community setting: A prospective longitudinal cohort study in Malta","volume":"34","author":"Ellul","year":"2014","journal-title":"Paediatr. Int. Child Health"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1111\/jcpt.12276","article-title":"Off-label paediatric drug use in an Indonesian community setting","volume":"40","author":"Abdulah","year":"2015","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"62","DOI":"10.2174\/1573396314666181113101506","article-title":"The Unlicensed and Off-label Prescription of Medications in General Paediatric Ward: An Observational Study","volume":"15","author":"Dornelles","year":"2019","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1136\/bmj.320.7227.79","article-title":"Survey of unlicensed and off label drug use in paediatric wards in European countries. European Network for Drug Investigation in Children","volume":"320","author":"Conroy","year":"2000","journal-title":"BMJ"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1111\/ppe.12870","article-title":"Prescribed medicine use and extent of off-label use according to age in a nationwide sample of Australian children","volume":"36","author":"Schaffer","year":"2022","journal-title":"Paediatr. P\u00e9rinat. Epidemiol."},{"key":"ref_120","first-page":"296","article-title":"Evaluation of Off-label Prescribing at a Children\u2019s Rehabilitation Center","volume":"19","author":"Luedtke","year":"2014","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_121","first-page":"11","article-title":"Frequency of prescriptions of off-label drugs and drugs not approved for pediatric use in primary health care in a southern municipality of Brazil","volume":"34","author":"Heineck","year":"2016","journal-title":"Rev. Paul Pediatr."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.farma.2010.12.008","article-title":"Drug utilization study in pediatric prescriptions of a university hospital in southern brazil: Off-label, unlicensed and high-alert medications","volume":"36","author":"Heineck","year":"2012","journal-title":"Farm. Hosp."},{"key":"ref_123","first-page":"176","article-title":"Off-label and unlicensed utilization of drugs in a Brazilian pediatric hospital","volume":"39","year":"2015","journal-title":"Farm. Hosp."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s11096-017-0485-8","article-title":"Unlicensed and off-label use of drugs in pediatric surgical units at tertiary care hospitals of Pakistan","volume":"39","author":"Aamir","year":"2017","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40780-021-00208-9","article-title":"Potentially harmful excipients in neonatal medications: A multicenter nationwide observational study in Japan","volume":"7","author":"Saito","year":"2021","journal-title":"J. Pharm. Health Care Sci."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1111\/bcp.13563","article-title":"Large differences in neonatal drug use between NICUs are common practice: Time for consensus?","volume":"84","author":"Flint","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_127","first-page":"237","article-title":"Use of off-label drugs in neonatal intensive care","volume":"91","author":"Alonso","year":"2019","journal-title":"Anal. Pediatr."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/ped.12771","article-title":"Off-label and unlicensed use of medicinal products in the neonatal setting in the Slovak Republic","volume":"58","author":"Schweigertova","year":"2016","journal-title":"Pediatr. Int."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"297","DOI":"10.20344\/amp.5271","article-title":"Off-Label and Unlicensed Drug Use in Neonatology: Reality in a Portuguese University Hospital","volume":"28","author":"Silva","year":"2015","journal-title":"Acta Med. Portug."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"e228","DOI":"10.1111\/apa.12924","article-title":"Unlicensed and off-label drug use: A prospective study in French NICU","volume":"104","author":"Riou","year":"2015","journal-title":"Acta Paediatr."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s00228-015-1962-4","article-title":"Off-label and unlicensed drug treatments in Neonatal Intensive Care Units: An Italian multicentre study","volume":"72","author":"Cuzzolin","year":"2016","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_132","first-page":"465","article-title":"Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores","volume":"88","author":"Carvalho","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Costa, H.T.M.d.L., Costa, T.X., Martins, R.R., and Oliveira, A.G. (2018). Use of off-label and unlicensed medicines in neonatal intensive care. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204427"},{"key":"ref_134","first-page":"266","article-title":"Prescription of off-label and unlicensed drugs for preterm infants in a neonatal intensive care unit","volume":"33","author":"Vieira","year":"2021","journal-title":"Rev. Brasil. Ter. Intens."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1007\/s13312-014-0468-y","article-title":"Off-label use of drugs in neonatal intensive care units","volume":"51","author":"Jain","year":"2014","journal-title":"Indian Pediatr."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s13312-017-1184-1","article-title":"Drug utilization in neonatal intensive care unit of a tertiary-care hospital in Mumbai, India","volume":"54","author":"Chauthankar","year":"2017","journal-title":"Indian Pediatr."},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Aamir, M., Khan, J.A., Shakeel, F., Shareef, R., and Shah, N. (2018). Drug utilization in neonatal setting of Pakistan: Focus on unlicensed and off label drug prescribing. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1211-y"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1007\/s12325-018-0732-y","article-title":"Unlicensed and Off-Label Medication Use in Pediatric and Neonatal Intensive Care Units: No Change Over a Decade","volume":"35","author":"Toledano","year":"2018","journal-title":"Adv. Ther."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1365-2710.2008.01005.x","article-title":"Off-label and unlicensed drug prescribing in three paediatric wards in Finland and review of the international literature","volume":"34","author":"Korhonen","year":"2009","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"20503121221096534","DOI":"10.1177\/20503121221096534","article-title":"Off-label medication use in pediatrics and associated factors at public hospitals in east Gojjam zone, Ethiopia","volume":"10","author":"Belayneh","year":"2022","journal-title":"SAGE Open Med."},{"key":"ref_141","first-page":"186","article-title":"Patterns of Off-Label Prescribing in the Pediatric Intensive Care Unit and Prioritizing Future Research","volume":"20","author":"Czaja","year":"2015","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_142","first-page":"1","article-title":"Drug utilization pattern in children and off-label use of medicines in a pediatric intensive care unit","volume":"40","year":"2015","journal-title":"Med. Intensiv."},{"key":"ref_143","first-page":"371","article-title":"Off-label and unlicensed drug use in a Spanish Neonatal Intensive Care Unit","volume":"41","year":"2017","journal-title":"Farm. Hosp."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"e15595","DOI":"10.1111\/ped.15595","article-title":"Evidence of off-label inhalation therapy on pediatric asthma practice in Japan","volume":"65","author":"Oishi","year":"2023","journal-title":"Pediatr. Int."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1111\/bcp.15781","article-title":"Guiding future paediatric drug studies based on existing pharmacokinetic and efficacy data: Cardiovascular drugs as a proof of concept","volume":"89","author":"Smeets","year":"2023","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_146","unstructured":"Zodidi, M. (2019). Off Label and Unlicensed Drug Use in Neonatal Wards (Excluding Neonatal ICU) at Tygerberg Children\u2019s Hospital (TBH). [Master\u2019s Thesis, (MMed)-Stellenbosch University]. Available online: http:\/\/hdl.handle.net\/10019.1\/106987."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/s12519-018-0186-y","article-title":"Two decades of off-label prescribing in children: A literature review","volume":"14","author":"Balan","year":"2018","journal-title":"World J. Pediatr."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"233","DOI":"10.2515\/therapie\/2013041","article-title":"Off-label Prescriptions: How to Identify Them, Frame Them, Announce Them and Monitor Them in Practice?","volume":"68","author":"Billon","year":"2013","journal-title":"Therapies"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s00431-019-03556-9","article-title":"Off-label use of medicines in neonates, infants, children, and adolescents: A joint policy statement by the European Academy of Paediatrics and the European society for Developmental Perinatal and Pediatric Pharmacology","volume":"179","author":"Schrier","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1002\/cpt.2336","article-title":"Benefit-Risk Assessment of Off-Label Drug Use in Children: The Bravo Framework","volume":"110","author":"Mooij","year":"2021","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"184","DOI":"10.2174\/1573396309666131209211017","article-title":"Issues Impacting Therapeutic Outcomes in Pediatric Patients: An Overview","volume":"10","author":"Kalra","year":"2014","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1542\/peds.2013-3225","article-title":"Pediatric Drug Formulations: A Review of Challenges and Progress","volume":"134","author":"Ivanovska","year":"2014","journal-title":"Pediatrics"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ijpharm.2016.12.032","article-title":"A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice","volume":"518","author":"Richey","year":"2017","journal-title":"Int. J. Pharm."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1007\/s43441-022-00453-6","article-title":"Pediatric Clinical Research Networks: Role in Accelerating Development of Therapeutics in Children","volume":"56","author":"Greenberg","year":"2022","journal-title":"Ther. Innov. Regul. Sci."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1002\/cpt.1001","article-title":"Pediatric Drug Development: Outlook for Science-Based Innovation","volume":"103","author":"Green","year":"2018","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/jcph.2160","article-title":"Pediatric Efficacy Extrapolation in Drug Development Submitted to the US Food and Drug Administration 2015\u20132020","volume":"63","author":"Samuels","year":"2023","journal-title":"J. Clin. Pharmacol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s43441-022-00411-2","article-title":"Accelerating the Availability of Medications to Pediatric Patients by Optimizing the Use of Extrapolation of Efficacy","volume":"56","author":"Dunn","year":"2022","journal-title":"Ther. Innov. Regul. Sci."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jpeds.2017.08.011","article-title":"The Need for Pediatric Drug Development","volume":"192","author":"Ward","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_160","unstructured":"(2023, August 28). State of Paediatric Medicines in the EU. Available online: https:\/\/health.ec.europa.eu\/system\/files\/2017-11\/2017_childrensmedicines_report_en_0.pdf."},{"key":"ref_161","unstructured":"Boosting the Development of Medicines for Children (2023, August 26). Closing Report of the European Medicines Agency and European Commission (DG Health and Food Safety) Action Plan on Paediatrics. EMA\/635567\/2022. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/report\/boosting-development-medicines-children-closing-report-european-medicines-agency-european-commission_en.pdf."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/bcp.12222","article-title":"Adverse drug reactions and off-label and unlicensed medicines in children: A prospective cohort study of unplanned admissions to a paediatric hospital","volume":"77","author":"Bellis","year":"2014","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3233\/JRS-150642","article-title":"Is off-label use a risk factor for adverse drug reactions in pediatric patients? A prospective study in an Indian tertiary care hospital","volume":"27","author":"Saiyed","year":"2015","journal-title":"Int. J. Risk Saf. Med."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.therap.2022.11.010","article-title":"Paediatric drug development and evaluation: Existing challenges and recommendations","volume":"78","author":"Kaguelidou","year":"2023","journal-title":"Therapie"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/MPG.0b013e318272af1f","article-title":"Drug Development: The use of unlicensed\/off-label medicines in pediatrics","volume":"55","author":"Yamashiro","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.anpedi.2020.07.010","article-title":"Comparative assessment of off-label and unlicensed drug prescription in neonatal intensive care: FDA versus Brazilian guidelines","volume":"94","author":"Costa","year":"2021","journal-title":"An. 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