Neonatal Intensive Care Drug Manual
Neonatal Intensive Care Drug Manual
Neonatal Intensive Care Drug Manual
Canberra Hospital
Contents:
INTRODUCTION .................................................................................................................................. 7
ACICLOVIR ......................................................................................................................................... 11
ADENOSINE ........................................................................................................................................ 12
ALBUMIN............................................................................................................................................. 15
AMLODIPINE...................................................................................................................................... 16
AMPICILLIN ....................................................................................................................................... 17
AMPHOTERICIN B ............................................................................................................................ 18
ASPIRIN................................................................................................................................................ 21
ATENOLOL ......................................................................................................................................... 22
ATROPINE ........................................................................................................................................... 23
AZITHROMYCIN ............................................................................................................................... 24
BUDESONIDE ...................................................................................................................................... 26
CALCITRIOL ...................................................................................................................................... 31
CAPTOPRIL......................................................................................................................................... 32
CEFOTAXIME..................................................................................................................................... 33
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Canberra Hospital
CEPHAZOLIN ..................................................................................................................................... 35
CHLORAMPHENICOL...................................................................................................................... 38
CIPROFLOXACIN .............................................................................................................................. 39
CLONAZEPAM ................................................................................................................................... 41
CLOTRIMAZOLE ............................................................................................................................... 42
CO-TRIMOXAZOLE .......................................................................................................................... 43
CRYOPRECIPITATE ......................................................................................................................... 44
DEXAMETHASONE ........................................................................................................................... 49
DIAZEPAM .......................................................................................................................................... 51
DIAZOXIDE ......................................................................................................................................... 52
DIGOXIN .............................................................................................................................................. 53
DOBUTAMINE .................................................................................................................................... 54
DOPAMINE .......................................................................................................................................... 56
EPOPROSTENOL ............................................................................................................................... 57
ERYTHROMYCIN .............................................................................................................................. 58
ERYTHROPOIETIN ........................................................................................................................... 59
FENTANYL .......................................................................................................................................... 60
FLECAINIDE ....................................................................................................................................... 62
FLUCLOXACILLIN............................................................................................................................ 63
FLUCONAZOLE ................................................................................................................................. 64
FLUMAZENIL ..................................................................................................................................... 66
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FRUSEMIDE ........................................................................................................................................ 69
GANCICLOVIR ................................................................................................................................... 71
GENTAMICIN ..................................................................................................................................... 74
GLUCAGON......................................................................................................................................... 75
HEPARIN.............................................................................................................................................. 77
HYDRALAZINE .................................................................................................................................. 81
HYDROCHLOROTHIAZIDE ............................................................................................................ 82
HYDROCORTISONE ......................................................................................................................... 83
IBUPROFEN ........................................................................................................................................ 85
INDOMETHACIN ............................................................................................................................... 87
IMIPENEM/CILASTATIN ................................................................................................................. 89
INDOMETHACIN ............................................................................................................................... 92
INFANRIX HEXA................................................................................................................................ 94
INFLORAN® ........................................................................................................................................ 95
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LIGNOCAINE FOR SEIZURES ...................................................................................................... 107
4
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PHENOBARBITONE ........................................................................................................................ 146
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SURVANTA: BERACTANT ............................................................................................................. 184
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Introduction
Revision Date : 20 February 2015 Approved : Department of Neonatology
The following list is a compilation of drugs commonly and not so commonly used in
Neonatal Care. The list has developed over a period of years and is based on
experiences within this unit or on data collected from published reports in recent
perinatal literature.
The current revision includes data concerning drug compatibilities which have been
previously considered a problem but now which have been shown to be safe and
effective.
Some methods of administration may be considered new or novel but should not be
avoided for this reason. In general, recommendations are made on the best available
evidence. Should there be any discrepancies these should be brought to our attention.
Suggestions for change are welcome.
Entries in this manual should not be annotated or marked without the approval
of the Consultant in Charge as this will only serve to confuse and may lead to
mistakes or errors in administration.
Note that the following abreviations are used throughout this document:
This manual is constantly updated by the Dept of Neonatology and Pharmacy. Thank
you for your continued efforts in keeping this document up to date with the latest
evidence.
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Drug Name
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Total Daily Dose : Use with care in small babies where fluids are restricted.
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Acetylcysteine (Mucomyst)
Revision Date : 18 June 2012 Approved : AK, JD
Incompatibility :
10
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Aciclovir
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Dose : 20 mg/kg
< 30 weeks daily
30-32 weeks 18/24 1st week of life
32 - 37 weeks 12/24
> 37 weeks 8/24
11
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Serum Levels : Reduce dose in renal failure and hepatic failure.
Adenosine
Revision Date: 09/01/2014 14:40:00 Approved : AK, JD
Route : Rapid bolus IV, over 1-2 seconds directly into a vein or at
the most proximal port available. Follow rapidly with a
saline flush.
Total Daily Dose : Not Applicable.
Incompatibility : No data
12
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Adrenaline (Resuscitation)
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
13
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14
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Albumin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
15
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Amlodipine
Revision Date : 24 June 2013 Approved : AK, JD
Interval : Daily
Route : Oral
Serum Levels :
16
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Ampicillin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Comments : Slow intravenous infusion over not more than 100 mg/
minute
17
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Amphotericin B
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Serum Levels : Nil
Route : IV only infuse over 1-2 hours. Infuse each 2.5 mg/kg over 1
hour.
Total Daily Dose : Up to 5 mg/kg
19
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Compatibility: 5%D ONLY
*Available only as SAS drug from TGA. Can be used in Level 3 units only.
20
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Aspirin
Revision Date : 24 June 2013 Approved : AK, JD
Indication : Antiplatelet agent for use in neonates with cardiac shunts e.g.
Blalock-Taussig shunt
Dose : 1 - 5mg/kg/dose1
Route : Oral
21
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Atenolol
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
22
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Atropine
Revision Date : 23 April 2014 Approved : TC, LZ, JD
23
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Azithromycin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Dose : 0.5mL/kg/dose
Interval : As required
Route : Buccal
Stability :
References:
1. Dextrose Gel for treating neonatal hypoglycaemia: a Randomised Placebo-Controlled Trial
(The Sugar Babies Study), Harris D, Weston P, Harding JE; Lancet 2013, published September
25
2. Outcome at 2 years after Dextrose Gel treatment for neonatal hypoglycaemia: Follow up of a
Randomised Trial. Harris D, Alsweiler JM, Ansell JM et al; J Pediatr Mar, 2016; 170: 54-59.e2
3. Hypoglycaemia- Infant Management, The Royal Women’s Hospital, Melbourne
4. Hypoglycaemia in a neonate, Royal hospital For Women, Sydney.
25
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5. Incidence of neonatal hypoglycaemia in babies identified as being at risk, Harris D, Weston P,
Harding J; Journal of Paediatrics 2012:787-91
6. Neofax on line accessed 21/12/16
Budesonide
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Interval : 12 hourly
Comments : Avoid contact with eyes during nebulisation. Wash entire face
after use. Rinse mouth after use either by feeding or with a
moistened swab stick. Titrate to give effective control with the
lowest possible dose. Risk of systemic effects with higher
doses.
Supplied as : Budesonide nebuliser solution 500mcg/2 ml and 1000 mcg/2
ml
Dilution : Nil. If using a small volume, the dose can be diluted to an
appropriate volume (eg 2 mls) with normal saline.
Incompatibility :
26
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Caffeine Base
Revision Date: 09/01/2014 14:40:00 Approved : AK, JD
Canberra Hospital
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Calcium Gluconate
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Indication : 1] Resuscitation
2] Seizures due to hypocalcaemia
3] Hypocalcaemia
4] Daily maintenance
Dose : 1] 0.5 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)
2] 2.0 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)
3] 900 mg/kg/day (double daily maintenance)
4] continuous infusion over 24 hours. (10 ml of 1g/10 mL
solution added to 500 ml of maintenance fluids)
Interval : 1] stat, repeat if necessary, administer over 3-5 minutes
2] stat, repeat if necessary, administer over 15 minutes
3] continuous infusion over 24 hours.
4] continuous infusion over 24 hours.
Route : I.V.
Dilution : 1] < 1 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with sterile water to a
total of 2 mls. 1-2 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with
sterile water to a total of 2.5 mls. 2-3kg – dilute 0.5 ml/kg of 1 g/10mL
solution with sterile water to a total of 3 mls. > 3kg – dilute 0.5 ml/kg of
1 g/10mL solution with sterile water to a total of 4 mls.
2] < 1 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with sterile water to a
total of 4 mls. 1-2 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with
sterile water to a total of 5 mls. 2-3kg – dilute 2.0 ml/kg of 1 g/10mL
solution with sterile water to a total of 6 mls. > 3kg – dilute 2.0 ml/kg of
1 g/10mL solution with sterile water to a total of 8 mls.
3] & 4] In peripheral I.V. infusion keep concentration 2 ml of 1g/10
mL solution to 100 ml of maintenance to prevent tissue burns.
Stability : Discard ampoules and unused portions after initial use.
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Serum Levels : Measure serum calcium as indicated.
Interval : 6 hourly.
30
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Calcitriol
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Captopril
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Indication : Hypertension
Cardiac Failure
Total Daily Dose : Not known for newborns. May require up to 0.4-4
mg/kg/day in larger infants.
Comments : ACE inhibitor functions in cases of presumed hyper-
reninaemia. May cause hyperkalaemia particularly if used
in conjunction with potassium sparing diuretics or
potassium supplements. Can cause cough
Supplied as : A clear, colourless, plum flavoured syrup containing 5
mg/ml of solution.
When syrup is unavailable, disperse one tablet in water to
make a 1mg/mL mixture. Discard unused portion
immediately after preparation.
Dilution : Dilute 1 ml of syrup with 4 ml of water to make 1 mg/ml
solution. Administer immediately and discard remainder
after use.
Stability : may be kept up to 28 days after opening.
Storage :
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Cefotaxime
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Ceftazidime penthydrate
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
34
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Cephazolin
Revision Date : 15 May 2015 DTC Approved: May 2015
Dose : 25 mg/kg/dose2
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Incompatibility3,5 : Ampicillin, dopamine, dobutamine, benzylpenicillin,
calcium chloride, gentamicin, vancomycin
Note: incomplete list of compatibilities/incompatibilities,
contact pharmacy if any concerns.
Serum Levels : Nil
36
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Chloral Hydrate
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Comments : Chloral hydrate and its active metabolites have very long half
lives in neonates, more so in premature infants (up to 40 hours).
Any baby who receives more than 50 mg/kg should be closely
monitored for adverse effects, in particular for respiratory
depression. Infants on regular sedative dosing may experience
accumulation. Side effects: respiratory depression, gastric
irritation, headache, ketonuria, hyperactivity occurs in 1-2% of
patients.
Supplied as : 500 mg/5 mL.
Incompatibility :
Serum Levels :
37
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Chloramphenicol
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Dose : 25 mg/kg/dose
Interval 24 hourly for all infants 0-14 days and 15-30 days when < 2000
grams.
12 hourly for infants > 2000 grams and 0-14 days.
12 hourly for infants < 2000 grams and 2-4 weeks.
Route : I.V. infuse over 15-30 minutes.
Oral
Do not give I.M.
Total Daily Dose : 25 mg/kg/day < 2000 grams at any age.
25 mg/kg/day > 2000 grams and 0-2 weeks.
50 mg/kg/day > 2000 grams and 2-4 weeks.
Comments : Use with reference to microbiology department. Adjust dosage
when used with anticonvulsants and penicillin. The grey baby
syndrome occurs after 3-4 days - abdominal distension,
vomiting, pallid cyanosis, vasomotor collapse, irregular
breathing, and death within hours. Occurs with blood levels >
90 mg/ml. Oral suspension is restricted to use by Director of
Neonatology. SAS drug only
Supplied as : Chloromycetin sodium succinate 1.2 gram vials or oral
suspension of chloromycetin 30 mg/ml.
Dilution : Usually made up by pharmacy. Add 11.0 ml of sterile water to
vial, giving solution of 100 mg/ml for I.V. use only.
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Ciprofloxacin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Interval : 12 hourly
Storage :
39
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Incompatibility :
Compatibility:
Serum Levels :
40
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Clonazepam
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Comments : Half-life varies, as for elimination maturity and plasma levels are not helpful in
determining effect. Oral route of administration is preferred for maintenance.
Hyper-secretion of saliva and/or bronchial glands is a possible side effect. Note
that benzodiazepines tend to limit spread of electrical activity rather than
completely suppress a focus entirely. Concurrent treatment with phenobarbitone
or phenytoin has been shown to cause increased serum phenytoin levels and
reduced clonazepam levels. Drug tolerance occurs if treatment is continued for
any extended period of time. Dose must be gradually reduced when the drug is
withdrawn to reduce the risk of rebound seizures.
Supplied as : Parenteral Prep. vial 1 mg/ml.
Oral drops 2.5 mg/ml.
Dilution : For loading doses and maintenance doses use water for injection
and dilute to 2 ml for administration (500 microg/ml).
For infusion take the baby’s weight in mls (3.0kg = 3ml) of
Clonazepam solution (1000 microg/ml=1mg/ml) and make upto 25
ml with 5 % Dextrose or saline.
1 ml/hr.= 40 microg/kg/hr.
Stability : As per pharmacy.
Serum Levels : 60-150 nmol/l. (Not very well defined). Not routinely performed.
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Clotrimazole
Revision Date : 09/01/2014 14:40:00 Approved AK, JD
Route : Topical.
Stability :
Serum Levels :
42
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Co-trimoxazole
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
43
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Cryoprecipitate
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
44
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45
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Incompatibility : Do not mix with anything.
46
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Incompatibility : NA
Serum Levels : NA
47
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Compiled: October Review: October 2020
2016
References:
1. RPA and KEMH neonatal guidelines-online, 0.25% cyclopentolate, accessed
21/10/15
2. Neofax online. Accessed 21/10/15
3. Ozgun U1, Demet T1, Ozge KA1, Zafer D2, Murat S3, Mehmet Y1, Nilgun
K1. Fatal necrotising enterocolitis due to mydriatic eye drops. J Coll
Physicians Surg Pak. 2014 May;24 Suppl 2:S147-9
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Dexamethasone
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Comments : For CLD: Effects maximal after 36 hours of treatment. Massive diuresis,
dehydration and shock have been described. Close check on fluid balance and
electrolytes essential. GI haemorrhage documented. Hyperglycaemia and
hypertension more common side effects. Watch urine for gylcosuria.
Potentiates rickets of prematurity. May mask infection. Causes raised WCC
generally without a toxic film. Use of this regime is potentially dangerous and
should be under consultant supervision.
Increased risk of systemic candidiasis. Infants on Dexamethasone should be
treated with nystatin prophylaxis.
Supplied as : 4 mg/ml as dexamethasone sodium phosphate
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Calculations:
Volume of 50% = Volume of IV solution (500 mL bag) x the required increase in percentage
Dextrose required 50% Dextrose – the percentage of the base solution (i.e. 5 or 10%)
50
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Diazepam
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
51
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Diazoxide
Revision Date : 5th March 2009 Approved : AK, JD
Interval : 8/24
Route : Oral
Incompatibility : n.a.
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Digoxin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Comments : May cause vomiting and arrhythmias. Be aware of toxic signs. If used with
phenytoin profound bradycardia may result. Increased toxicity with adrenaline
and frusemide. Toxic signs on ECG include scooping of ST segment; inversion
of T waves; various degrees of heart block; arrhythmias. Care when used in
infants < 1500 gm. Adjust dose for renal failure. Ensure normal serum
potassium, as hypokalaemia increases the risk of adverse effects. Loading doses
are only necessary in the management of arrythmias. In other situations start with
maintenance dose. Do not use in patients with underlying Wolff-Parkinson-
White syndrome. When giving mixture orally with a syringe do not flush the
syringe after the dose – the drug left in the syringe may lead to toxicity if
repeatedly administered. For the treatment of life-threatening digoxin toxicity
use Digibind (Digoxin Immune Fab)
Supplied as : 50 microg/2 ml ampoules
50 microg/ml oral solution
Dilution : Dilute using 1ml of ampoule with 4ml NS or WFI. (= 5microgm/ml
) Administer over 5 minutes. Observe ECG during administration.
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Serum Levels : Normal serum levels = 1-2 nmol/L. Sampling time at least 6 hours
after the dose. Approximate time to steady state is 1 week.
Dobutamine
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Route : I.V.
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Serum Levels :
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Dopamine
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Route : I.V.
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Epoprostenol
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Serum Levels :
57
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Erythromycin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
58
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Erythropoietin
Revision Date : 09/01/2014 14:40:00 Approved AK, JD
Total Daily Dose : N/A. Total weekly dose is 500-1400 Units per kg.
Dilution :
Serum Levels :
59
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Fentanyl
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Storage : DD cupboard
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Interval : Daily from 14 days (to 28) when on full feeds as tolerated.
Dilution : Nil.
Stability :
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Flecainide
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Dose : 2 mg/kg
Interval : 12 hourly
Route : I.V.
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Flucloxacillin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
63
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Fluconazole
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
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Serum Levels : Not required. Reduce dosage in renal failure. Concomitant
administration with Cisapride is contra indicated. May
interfere with metabolism of Caffeine, Theophylline and
Midazolam. Check Drug levels during concomitant use.
65
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Flumazenil
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Route : I.V.
66
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Fluticasone (Flixotide)
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Interval : 12 hourly
Comments : Shake canister well before use. Avoid contact with eyes. Wash
face after use. Rinse mouth after use either by feeding or with a
moistened swabstick. Titrate to give effective control with the
lowest possible dose. Risk of systemic effects with higher
doses.
Supplied as : Fluticasone 50 mcg/dose metered aerosol inhaler.
Dilution : Nil
Incompatibility :
67
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Folic Acid
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Route : Oral.
Total Daily Dose : Daily requirements are 50 microg. Weekly dosage will
satisfy overall needs.
Comments : Involved in the maturation of rapidly proliferating tissues
particularly bone marrow, gastrointestinal tract, etc. Do not
mix with other multivitamin preparations. Contains a
negligible amount of ethanol.
Supplied as : Folic acid solution 0.5 mg/mL = 50 microg/0.1 mL
Dilution : Nil.
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Frusemide
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Interval : Stat, repeat if necessary but preferably not more than 12 hourly.
Route : I.M.
I.V. over 20 minutes at minimum.
Oral.
Total Daily Dose : Not more than 4 mg/kg.
Comments : Correct electrolyte imbalance before and after use. Competes with bilirubin
for albumin binding. Chronic usage may lead to excessive calcium loss, renal
calcification and chronic hypochlorhydria. Diuresis by means of increased
sodium loss in loop of Henle, therefore in chronic usage treat hyponatraemia
by reduction of dosage rather than sodium supplementation. Treatment with
KCl, rather than spironolactone, will prevent both hypokalaemia and
hypochloraemia. Potentially nephrotoxic and ototoxic, particularly when used
with aminoglycosides. Drug may precipitate at low pH. Caution with dextrose
solutions as pH is variable.
Supplied as : 20 mg/2 ml Ampoules.
10 mg/ml oral mixture
Dilution : Dilute 1 ml (10 mg) of ampoule up to 10 mls with NS = 1
mg/ml. Give by slow infusion at a rate not exceeding
0.05mg/kg/min (i.e. 20 minutes for a 1 mg/kg dose).
For infusion: Take 0.4 ml (10 mg/ml ampoule) x baby’s weight
(kg) and make upto total of 48 mls with NS 1 ml/hour =
2mg/kg/day.
Stability : Discard after use.
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70
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Ganciclovir
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Interval : 12 hourly
Supplied as : Cymevene
Stability :
Incompatibility :
Serum Levels :
71
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Route : Oral.
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Incompatibility :
Serum Levels :
73
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Gentamicin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
74
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Glucagon
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Indication : Hypoglycaemia.
75
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76
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Heparin
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
77
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Compatibility:
Incompatibility :
78
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Hepatitis B Immunoglobulin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.M.
Stability :
Storage : At 2-8oC.
79
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Hepatitis B Vaccine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 0.5 ml
Route : I.M. Give into anterior thigh, not buttocks at birth. Given at
the same time as Vitamin K. Hep. B in Left thigh and Vit. K
in right thigh. Subsequent doses are given in the form of
Infanrix Hexa: (Diptheria; Tetanus; Acellular Pertussis;
Hepatitis B; Haemophilus Influenzae type B (Hib); and
Inactivated Poliomyelitis)
Total Daily Dose : Not Applicable.
80
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Hydralazine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Comments : May increase heart rate. Always start with a lower dose and
increase the dose depending upon the response. Exerts
effect by directly relaxing vascular smooth muscle tone and
lowering peripheral vascular resistance.
Supplied as : Apresoline ampoules containing 20 mg Hydralazine HCl
powder.
Dilution : Dissolve powder 1 ml water for injection. Add 1 ml of drug
to 9 ml of Normal Saline to make up a solution of 2 mg/ml.
Give slowly over 5-10 minutes.
Add 9 x Xmg of drug (4.5 x Xml of the solution) where X
is the weight in kg, to a syringe and make up to 25 mls with
NS. 1 ml/hour = 6 microgram/kg/min
Stability : Discard unused portion.
81
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Hydrochlorothiazide
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : Diuretic. Used for congestive heart failure and in long term
management of chronic lung disease. May improve
pulmonary function in patients with BPD.
Interval : 12 hourly.
Route : Oral.
82
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Hydrocortisone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : 1] Shock
2] Intractable hypoglycaemia.
3] Physiological replacement
Route : I.M.
I.V. slowly over one minute.
Total Daily Dose :
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Serum Levels :
84
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Ibuprofen
Revision Date :28 January 2017 DTC Approved: March 2017
85
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Supplied as : Oral: Fenpaed® (Ibuprofen100 mg/5 mL suspension - 20mg/mL).6
IV: 'Pedea'® (Ibuprofen Sodium Salt 5 mg/mL ampoule).
IV Ibuprofen is unregistered in Australia. A ‘Category A’ SAS
form and a patient consent form must be completed for each
course. The SAS form must be returned to pharmacy. The patient
consent form should be kept in the patient notes. The blank forms
are kept with the medication in the clean utility room.
Administration : Oral: preferably give with feeds. If baby is not on enteral feeds or
EBM is not available give dose via intra-gastric tube and flush
with 1 mL water for injection.
References:
1. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low
birth weight infants. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.CD003481.
2. Erdeve O, Yurttutan S, Altug N, Ozdemir R, Gokmen T, Dilmen U, Oguz SS, Uras N. Oral versus
intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low
birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F279-83.
3. Hirt D, Van Overmeire B, Treluyer JM, Langhhendries JP, Marguglio A, Eisinger MJ, Schepens, P, Urien S.,
An optimized ibuprofen dosing scheme for preterm neonates with patent ductus arteriosus, based on a
population pharmacokinetic and pharmacodynamic study. Brit J Clin Pharmaco 2008;65:629-36
4. Dani C, Vangi V, Bertini G, Pratesi S, Lori I, Favelli F, et al. High-dose ibuprofen for patent ductus
arteriosus in extremely preterm infants: A randomized controlled study. Clinical Pharmacology and
Therapeutics 2012;91(4):590-6.
5. Gournay V. Savagner C. Thiriez G. Kuster A. Roze JC. Pulmonary hypertension after ibuprofen prophylaxis
in very preterm infants. Lancet. 2002:359(9316):1486-8
86
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6. Product Information: Fenpaed. "http: http://www.drugs.com/uk/fenpaed-100mg-5ml-oral-suspension-
leaflet.html"
Indomethacin
Revision Date :October 2016 Approved: October 2016
Interval : 24 hourly
May consider 12 hourly dosing for a 3 dose course
Route : IV
87
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Contraindications : Active bleeding
Thrombocytopenia
Coagulation defects
NEC
Congenital heart disease, PPHN
Significantly impaired renal function
Supplied as : Indomethacin Agila 1mg per vial.
88
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Imipenem/Cilastatin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
89
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Comments : -IVIg is issued in accordance with the criteria for the clinical use of
intravenous immunoglobulin in Australia. The medical officer requesting
IVIg will be required to complete and submit a 2 page ‘Authorisation
Request Form’ to the Australian Red Cross Blood Service for authorisation.
This form could be downloaded from www.blood.gov.au/Ig-governance.
Once authorised, IVIg would be issued from Canberra Hospital Blood
Bank.4
-The dose of Intragam P is not clearly defined and the drug is expensive and
in short supply. Dosages should be rounded down to whole vials and we
should not require more than 1 x 50ml vial (3g) per dose.
-Passively acquired antibody can interfere with the response to live attenuated
vaccines, therefore administration of such vaccines (eg rotarix, oral polio, BCG)
should be delayed for approximately 3 months after passive immunity
-Generally a dose of 0.5-1 g/kg is given over 4 hours. The rate should be started
slowly and gradually increased after 15 minutes if no reactions occur. Too rapid
a rate may cause flushing and changes in heart rate and BP. Adverse reactions
include vomiting, chest pain, rigors, arthralgia for 24 hours.5
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Contraindications : Anaphylaxis to human immunoglobulin preparations.5
Serum Levels : NA
References:
1. Paediatrics and Neofax ®. Application Version: 7.1.2.2014-Q4
2. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of
gestation. Pediatrics 2004; 114; 297
3. Rand EB, Karpen SJ, Kelly S et al. Treatment of neonatal hemochromatosis with
exchange transfusion and intravenous immunoglobulin. Journal of Pediatrics, 2009,
vol. 155, no. 4, pp. 566–571
4. National blood authority, Australia. Website- http://blood.gov.au/Ig-governance
5. Intragram®P product information. Available at-
http://www.csl.com.au/docs/146/668/Intragam%20P%20AU%20PI%2014.00%20(Su
pplied).pdf. Accessed 18/2/15
91
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Indomethacin
Revision Date :October 2016 Approved: October 2016
Interval : 24 hourly
May consider 12 hourly dosing for a 3 dose course
Route : IV
92
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Contraindications : Active bleeding
Thrombocytopenia
Coagulation defects
NEC
Congenital heart disease, PPHN
Significantly impaired renal function
Supplied as : Indomethacin Agila 1mg per vial.
1.
Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application
2.
http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/PDA_2014_gui
deline.pdf
3.
Tammela O, Ojala R, Iivainen T et al. Short vs Prolonged indomethacin therapy for
patent ductus arteriosus in preterm infants. J Pediatr 1999;134:552-557.
4.
Herrera CM, Holberton JR, Davis PG. Prolonged versus short course of
indomethacin for the treatment of patent ductus arteriosus in preterm infants.
Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003480. DOI:
10.1002/14651858.CD003480.pub3
5.
NeoMed, August 2015
6.
Colditz P, Murphy D, Rolfe P, Wilkinson AR. Effect of infusion rate of
indomethacin on
cerebrovascular responses in preterm neonates. Arch Dis Child. 1989; 64: 8-12.
93
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INFANRIX hexa
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
94
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Infloran®
Revision Date : 15 May 2015 DTC Approved: 29/5/15
Route : Oral
95
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Dilution : Contents of one capsule of Infloran is dissolved
in 2 mL of mother’s expressed breast milk or
formula (1mL = 125mg). To be administered with
routine feeds.
References:
1. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in
preterm infants. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.:
CD005496 DOI: 10.1002/14651858.CD005496.pub4
2. Wang Q, Dong J, Zhu Y. Probiotic supplement reduces risk of necrotizing
enterocolitis and mortality in preterm very low-birth-weight infants: an updated meta-
analysis of 20 randomized, controlled trials. J Pediatr Surg. 2012;47:241-8.
3. Deshpande G, Rao S, Keil A, Patole S. Evidence-based guidelines for use of
probiotics in preterm neonates. BMC Medicine. 2011; 9 92-105
4. Lin H-C, Hsu C-H, Chen H-L, Chung M-Y, Hsu J-F, Lien R-i, Tsao L-Y, Chen C-
H, Su B-H. Oral probiotics prevent necrotizing enterocolitis in very low birth weight
preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008; 122
(4):693-700
5. Infloran product information. Natural Medicines Comprehensive data base:
Available at
http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=nd&pt=103&i
d=70621 (Accessed: 8th Jan 2015)
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Indication : Hyperglycaemia.
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Comments : -Insulin enhances the cellular uptake of potassium, which decreases the
concentration of potassium in the blood. This is only a temporising
measure to lower the serum potassium levels acutely, while awaiting
more definitive measures.
Bolus injection is usually reserved for emergency treatment of
cardiac arrhythmia associated with hyperkalemia.
Measure blood glucose concentrations every 15 – 30 minutes after
starting the insulin infusion and after changes are made to the infusion
rate. When stable, the glucose can be checked at 2 hour intervals. Aim
for normal BSL between 3-10mmol/L. Watch for late hypoglycaemia.
Insulin has a tendency to bind to binding sites in PVC. The IV line must
be primed with the insulin infusion solution and allowed to stand for one
hour, then flushed with at least 10 mLs of the insulin solution prior to
connecting to the infant. This will saturate the insulin binding sites in
the line and prevent erroneous changes to the concentration of the
solution during the subsequent infusion. In an emergency, omit the one
hour conditioning but still prime and flush the line prior to connecting.
Insulin is NOT to be administered through any filter
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Supplied as : Actrapid® neutral insulin injection:
100 units per mL, 3mL vial.
Dilution Can be made up in pharmacy during working hours. Pharmacy
will connect and prime tubing to the syringe/bag.
Bolus injection
Step 1: Transfer 100 units (1 mL) of insulin from an insulin
syringe into a 10mL syringe and make up to 10mL using sodium
chloride 0.9%. This gives a 10 unit in 1mL solution
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Stability : Discard after use
Storage : Refrigerate, do not freeze
Ipratropium Bromide
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 50 microg
Interval : 6 hourly.
Route : Nebuliser.
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Isoprenaline
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Serum Levels : Use extreme caution if patient has high serum digoxin
levels. Must not flush line for other drugs because of risk of
bolus effect. An alternative IV/IA line is needed.
101
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Isovue
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 0.5ml
Stability :
Serum Levels :
102
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103
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Labetalol
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : Hypertension.
Route : Oral
Stability :
Incompatibility :
Serum Levels :
104
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Lactulose
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 1) 1 ml/kg
2) 0.5 ml/kg
Interval : 1) 6 hourly
2) 24 hourly
Route : Oral.
Supplied as : 3.3g/5ml.
Dilution :
Stability :
Incompatibility :
Serum Levels :
105
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Levetiracetam (Keppra)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 10 mg/kg per dose, increase 10 mg/kg once per week until
seizures controlled
Interval : First 28 days of life – daily
≥ 29 days of life – 12 hourly
Maximum of 30 mg/kg/dose
Route : IV or PO
Comments : Sedation and irritability have been reported in neonates and young
infants. When discontinuing therapy wean slowly to minimise risk
of seizure recurrence. Trough serum levels are generally not
measured. Therapeutic concentrations 10-40 mcg/mL. Keppra® is
renally cleared so dosage should be adjusted in patients with renal
failure. Mechanism of action thought to involve intraneuronal Ca
levels, GABA and the synaptic vesicle protein 2A. Conversion
from iv doses to oral doses can be done directly without titration.
Supplied as : Keppra® injection for IV use – 500 mg in 5 mLs (100 mg/mL)
Keppra® oral solution – 100 mg/mL
Dilution : Dilute iv doses to 5mg/mL to administer. Take 1mL of Keppra®
100mg/mL and 19 mL of 0.9% NaCl or 5% Dextrose, making
100mg/20mL (=5mg/mL).
Administer iv doses slowly over 15 minutes.
Stability : IV ampoules - use once only and discard any residue.
Where practical, the Pharmacy IV room will prepare the doses in
syringes.
Storage : IV ampoules - Room temperature.
Oral solution – Room temperature
Compatibility : Normal saline, Hartmann’s, 5% Dextrose
Incompatibility :
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Canberra Hospital
Compatibility : NS, 5% Dextrose, Aminophylline, Caffeine, Calcium,
Ciprofloxacin, Dexamethasone, Digoxin, Dobutamine,
Dopamine, Flucloxacillin, Frusemide, Heparin, Hydrocortisone,
Insulin (regular), Lipid emulsion, Metoclopramide, Penicillin
G, Potassium, Ranitidine. Compatible at the Y site only:
Adrenaline, Cephazolin, Gentamicin, Midazolam, Morphine,
Noradrenaline, Propofol, Timentin, TPN, Vancomycin
Incompatibility : Ampicillin (variable compatibility/incompatibility depending
on concentration. Check with Pharmacy for more information)
Milrinone, Phenobarbitone, Phenytoin,
Serum Levels : Lignocaine levels are not performed at TCH. If required they
can be sent away to RNS, ring specimen referrals on 42845.
Levels above 9mg/L are associated with cardiac toxicity in
adults, but there is little information regarding levels in
neonates.
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109
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Magnesium Sulphate
Revision Date : October 2016 Dtc Approved: October 2016
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Dilution : 1] For IM and IV use: Dilute 4mL (2000mg) of MgSO4 50%
solution with 6mL of water for injection.3
This dilution = 200mg/m
L.
2] Dilute to 200mg/mL (as above).3
3] Dilute 10mL (5000mg) of MgSO4 50% with 40mL of
water for injection. This dilution = 100mg/mL.
Loading dose: 200mg/kg = 2mL/kg over 20-30minutes.
Maintenance dose: 20-75mg/kg/hr = 0.2-0.75mL/kg/hr.
Stability : Discard ampoule and unused portion after initial use. Fresh
solution must be prepared every 24 hours
Storage : Room temperature.
111
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Magnesium Aspartate
Revision Date : October 2016 DTC Approved: October 2016
Indication : Hypomagnesaemia
Route : PO
Incompatibility N/A
:
Serum Levels : Normal newborn serum magnesium is 0.7 - 1.1 mmol/l2
112
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Meropenem
Revision Date : 9 January 2014 Approve : AK, JD
113
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Metoclopramide
Revision Date : 9 January 2014 Approved: AK, JD
Interval : 12 or 8 hourly.
Route : Oral
I.V.
Total Daily Dose : Do not exceed 0.3 mg/kg/day.
114
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Metoprolol
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Incompatibility: Amphotericin
Serum Levels:
115
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Metronidazole
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
≤ 29 weeks 0-28 48
≥29 24
30 to 36 weeks 0-14 24
≥15 12
37 to 44 weeks 0 to 7 24
≥8 12
More than 44 weeks All 8
Dilution : Nil.
116
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117
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Route : Oral
Incompatibility : Nil.
Serum Levels :
118
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Midazolam
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
119
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Canberra Hospital
Milrinone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : IV
Comments : Milrinone may cause hypotension and this should be managed with a
Noradrenaline infusion and preload support. A Noradrenaline infusion
should be prepared and ready to commence when starting milrinone to
manage hypotension should it occur. Milrinone may cause hypotension
if run at high doses – hence must not exceed 0.75 mcg/kg/min.
Frusemide should never be administered in an IV line containing
Milrinone as this will cause precipitation. Milrinone is primarily renally
excreted and reductions in infusion rate may be required in renal failure.
Milrinone may also cause arrhythmias, hypokalaemia and
thrombocytopenia.
Supplied as : Primacor 10 mg/10 ml ampoule (1 mg/ml)
Serum Levels :
120
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Morphine IV
Revision Date : 15 April 2014 Approved: TC, LZ, JD
121
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Morphine Oral
Revision Date : 15 April 2014 Approved: TC, LZ, JD
122
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Incompatibility : NA
Serum Levels : NA
Mylanta
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : Oral.
123
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Naloxone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.V.
I.M.
Intra-tracheal, if necessary.
Total Daily Dose : Not more than 400 microg/kg
Serum Levels :
124
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125
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Canberra Hospital
Neostigmine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Serum Levels :
126
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127
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Canberra Hospital
Noradrenaline
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Canberra Hospital
Nystatin (Oral)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval : 6 hourly.
Dilution :
Stability :
129
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Nystatin (Topical)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : Topical.
Dilution :
Stability :
130
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Octreotide
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : IV
131
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Indication : Sterile fat emulsion for IV infusion for infants on long term
TPN with TPN induced liver disease. 1
Dose2 :
Lipid dose per Amount of
day Omegaven 10%
1g/kg/day 10mL/kg/day
2g/kg/day 20mL/kg/day
(MAX)
Interval : Daily
132
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Dilution : Vitamins can ONLY be added to the 2g/kg/day Omegaven solution, not
the 1g/kg/day solution (there is no compatibility data).
Example calculation:
3kg neonate 2g/kg/day Omegaven with vitamins
Total volume: 3 x 20 = 60mL
Total fat = 6g
Vitalipid 10% lipid solution 4mL/kg/day (10mL max) = 10mL (1g lipid)
Solutvit 0% lipid solution 1mL/kg/day (10mL max) = 3mL
(0g lipid)
Omegaven 10% lipid solution to make up to 60mL (60mL final volume
– 3mL Soluvit – 10mL Vitalipid) = 47mL (4.7g lipid)
Final lipid = 1g + 4.7g = 5.7g
Final lipid concentration = 5.7g/60mL = 9.5%
Serum Levels : NA
References:
1. Royal Hospital for Women Omegaven Drug Page. Accessed online at-
https://www.seslhd.health.nsw.gov.au/rhw/Newborn_Care/Guidelines/Medication/pdf/LipidOmegApril
14.pdf
2. Park KT, Nespor, Kerner J J. The use of Omegaven in treating parenteral nutrition-associated liver
disease. Journal of Perinatology (2011) 31, S57–S60; doi:10.1038/jp.2010.182
3. Lam HS, Tam YH, Poon TC, Cheung HM, Yu X, Chan BP et al. Double-blind randomised
controlled trial of fish oil-based versus soy-based lipid preparations in the treatment of infants with
parenteral nutrition-associated cholestasis. Neonatology 2014;105:290–6.
4. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may
reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis. J
Nutr 2015;145:277–83
133
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5. Omegaven product information. https://www.drugs.com/uk/omegaven-leaflet.html. Accessed online
on 25-08-16
Omeprazole
Revision Date : 28 January 2015 DTC Approved: March 2015
134
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Comments : Babies with feeding tubes should be given omeprazole
2mg/mL mixture, prepared by the pharmacy department.
For babies without a feeding tube, dispersed tablets are
preferred. It is unreliable to measure doses other than 5mg
or 10mg from a 10mg tablet. Adjust dose to 5mg increments
(when possible) for ease of administration.
Half of a 10mg dispersible tablet (5mg) may be dispersed in
an oral dispenser with a small amount of water for injection
(WFI). DO NOT CRUSH the tablet as it is composed of
tiny enteric coated granules. Vigorously agitate the oral
dispenser to disperse the tablet. Administer the dose and
rinse the oral dispenser with more WFI to retrieve any
remaining granules from the dispenser. The granules settle
in the dispenser rather quickly. The dose should be agitated
and administered immediately. This dispersed fluid is
unsuitable for babies with small bore feeding tubes as the
granules may block the tube.
References:
135
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Pancreatic Enzymes/Creon
Revision Date : 21/3/17 Approved KO/TC
136
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Route : Orally.
Pancuronium
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
137
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Comments : Non-depolarising neuromuscular blocking agent that produces skeletal muscle
paralysis mainly by causing a decreased response to acetylcholine at the
myoneural junction. Ensure that pH, electrolytes and fluid balance are normal.
Generally not usually associated with a fall in BP, but both hypo- and
hypertension can occur. Ventilator support may need to be increased
particularly in larger infants, where spontaneous respiratory effort may be
underestimated. Cardiac output and heart rate usually increased. Sensation
remains intact in babies on paralysis and sedation should be used along with
paralysis. Peak effect in 4 - 5 minutes. Duration 40-60 minutes
Reversal :
Neostigmine 50 microg/kg with Atropine 20 microg/kg IV
Draw up 0.5 mg (1 ml) of Neostigmine into a 5 ml syringe. Add 200 microg
(0.5 ml) of Atropine. Add NS or N/2Saline to make up 5 ml of solution. Give
0.5 ml/kg of solution = 50 microg/kg Neostigmine and 20 microg/kg Atropine.
Supplied as : Pancuronium bromide 4 mg/2 ml (4000 microg/2 ml) ampoules.
Storage : Refrigerator.
138
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Pantoprazole
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
139
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Paracetamol (Draft)
Revision Date : 27/04/2017 DTC Approved: (TBA)
140
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Comments : Non-narcotic analgesic and antipyretic. Paracetamol is rapidly absorbed by
mouth and widely distributed in the body. Extensively metabolized in the
liver, primarily by sulfation with a small amount by glucuronidation.
Metabolites and unchanged drug are excreted by the kidney. Elimination
half-life is approximately 3 hours in term neonates, and up to 11 hours in
preterm neonates. Elimination is prolonged in patients with liver
dysfunction or jaundice. Optimum pain relief occurs over an hour after the
blood level peaks. Caution should be used in the presence of hepatic
impairment. Overdose may result in liver cell necrosis and death. Caution in
dehydration and severe renal impairment.
141
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Serum Levels : Routine levels not recommended. Levels to be taken if concerns of toxicity.
References:
1. Neomed consensus guideline. http://192.168.104.10/neomed/Drug.aspx?@drugid=87. Accessed 28-
04-2017
2. Härkin P, Härmä A, Aikio O, Valkama M, Leskinen M, Saarela T, Hallman M. Paracetamol
Accelerates Closure of the Ductus Arteriosus after Premature Birth: A Randomized Trial. J Pediatr.
2016 Oct;177:72-77.e2. doi: 10.1016/j.jpeds.2016.04.066. Epub 2016 May 20.
3. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-
birth-weight infants. Cochrane Database of Systematic Reviews. 2015;3:CD010061
4. Terrin G, Conte F, Oncel MY, Scipione A, McNamara PJ, Simons S, et al. Paracetamol for the
treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis. Arch
Dis Child Fetal Neonatal Ed. 2016;101:F127-36
5. Dash SK, Kabra NS, Avasthi BS, Sharma SR, Padhi P, Ahmed J. Enteral paracetamol or Intravenous
Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A Randomized Controlled
Trial. Indian pediatrics. 2015;52:573-8
6. El-Mashad AE, El-Mahdy H, El Amrousy D, Elgendy M. Comparative study of the efficacy and
safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm
neonates. Eur J Pediatr. 2017 Feb;176(2):233-240. doi: 10.1007/s00431-016-2830-7. Epub 2016 Dec
21.
142
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Cardiac arrest and CNS toxicity has been reported with high
doses and rapid administration. Bone Marrow Depression,
granulocytopenia and hepatitis are rare side effects.
143
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Dilution : IV: Dilute with 1.6 ml of WFI to make a 300mg/mL solution.
Further dilute with WFI to final volume 10mL (60mg/mL) and
then withdraw desired volume5.
References:
1. Paediatric Pharmacopoeia 13th Edition 2002. Pharmacy Department, Royal
Children’s Hospital
2. Neomed Consensus group.
http://192.168.104.10/neomed/Drug.aspx?@drugid=4. Accessed online
27/3/15
3. Neofax Penicillin G Drug Monograph, 2015. Accessed Online 25/03/2015
4. Paediatric Injectable Drugs Handbook, 10th Edition 2013. Penicillin G
Potassium/Sodium American Society of Health-System Pharmacists
5. SHPA Australian Injectable Drugs Handbook, 6th Edition 2014.
Benzylpenicillin Sodium
6. Product Information, BenPen, MIMS Amended 01/12/2006
144
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Dose : 0.45 ml BD
Route : Oral.
Incompatibility : None.
Serum Levels :
145
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Phenobarbitone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
146
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147
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Incompatibility : NA
Serum Levels : NA
References:
1. Neofax online. Accessed 21/10/15
148
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2. Minims Phenylephrine Product Information.
https://gp2u.com.au/static/pdf/P/PHENYLEPHRINE_EYE_DROPS_MINIMS-
PI.pdf. Accessed online 21/10/15
Phenytoin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : Seizures.
149
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Compatibility: Compatible with fluconazole, sodium bicarbonate, N Saline
150
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Phosphate Supplement
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval : 6 hourly
Route : Oral
Compatibility:
151
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Piperacillin/Tazobacatam
≤ 29 weeks 0 to 28 12
>28 8
30 to 36 weeks 0 to 14 12
>14 8
37 to 44 weeks 0 to 7 12
>7 8
>45 weeks ALL 8
152
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Serum Levels Not applicable
153
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Potassium Chloride
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : Oral.
IV infusion.
Total Daily Dose : As needed.
Serum Levels :
154
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Povidone-Iodine (Betadine)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Stability :
Serum Levels :
References
eMIMs; 2012
http://www.orion.net.au/products/pdf/rio01598_ug.pdf
155
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Prednisolone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 1 mg/kg/dose
Route : Orally
Dilution :
Stability :
Compatibility:
Incompatibility :
Serum Levels :
156
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Prevenar 13
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Stability: Prevenar is for single use in one patient only. When using vials,
Prevenar is to be administered immediately after being drawn
up into a syringe.
Storage: Store in refrigerator 2 to 80 Celsius
Incompatibility: Do not mix with other vaccines or products in the same syringe.
Serum Levels:
157
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Propofol
Revision Date : 30 June 2009 Approved: AK, JD
Compatability: 5% Glucose
158
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Propanolol
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval : 1. 6 - 8 hourly.
2. 8 hourly
Route : Orally
Compatibility:
Incompatibility :
159
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Serum Levels :
160
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Prostaglandin E1(Alprostadil)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.V.
Storage : Refrigerated
161
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Prostacyclin PGI2(Epoprostenol)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.V.
Incompatibility : This drug should not be mixed with other drugs and is administered
through a dedicated line. The line should not be flushed or stopped and
the solution must be changed every 12 hours.
162
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Serum Levels :
Pyridoxine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Stability :
Compatibility: 5%D, NS
Serum Levels :
163
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Ranitidine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Serum Levels :
164
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Storage : Store in refrigerator. Protect from light. Do not use after expiry
date.
Incompatibility : Do not mix with infusion solutions.
Serum Levels :
165
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Resonium A
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
166
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Rifampicin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Comments : Drug is 35% protein bound. 35% appears in urine after 4 hours.
Penetrates CSF well. Can cause gastrointestinal upset and intolerance,
jaundice, and a transient rise in liver AST and ALP. Commonly colours
urine and other body fluids a reddish tinge. Increases the metabolism of
various drugs like chloramphenicol, diazepam, digoxin, fluconazole and
phenytoin. Monitor tramsaminases and bilirubin.
Supplied as : Syrup 100 mg/5 ml.
Vials 600 mg powder for reconstitution.
Dilution : Reconstitute with 10 ml of sterile water to make a strength
of 60 mg/ml. A 3 mg/ml solution is prepared by adding 0.5
ml of reconstituted solution to 9.5 ml of 5% Dextrose or
saline. The required amount is infused over 60 minutes.
Stability : Vials for single use only. Discard any unused portion.
Compatibility: 5% D, NS.
167
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Rotavirus Vaccine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 1.5 mL
Interval : Two doses at least 4 weeks apart. The first dose is given
between 6 and 14 weeks of age, and the second dose must
be given by 24 weeks of age.
Route : Oral. Under no circumstances should the vaccine be given
by injection. The child should be in a reclining position.
Administer orally (i.e. into the child's mouth towards the
inner cheek) the entire contents of the oral applicator.
Total Daily Dose : Not applicable
168
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Compatibility : No data.
Serum Levels :
169
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Salbutamol (Nebulised)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval : 4 - 6 hourly.
Route : Nebuliser.
170
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Route : I.V.
Serum Levels :
171
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Sildenafil
Revision Date : 16/11/2015 DTC Approved: 2/12/15
Route : Oral
Incompatibility :
Serum Levels :
172
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Compiled: November 2015 Review: November 2019
References:
1. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates.
Cochrane Database Syst Rev. 2011 Aug 10;(8):CD005494. doi:
10.1002/14651858.CD005494.pub3. Review
2. Yaseen H, Darwich M, Hamdy H. Is Sildenafil an Effective Therapy in the
Management of Persistent Pulmonary Hypertension? J Clin Neonatol. 2012
Oct-Dec; 1(4): 171–175.
3. Wardle AJ, Wardle R, Luyt K, Tulloh R. The utility of sildenafil in pulmonary
hypertension: a focus on bronchopulmonary dysplasia. Arch Dis Child. 2013
Aug;98(8):613-7. doi: 10.1136/archdischild-2012-303333. Epub 2013 Apr 26.
Review.
4. Joint Formulary Committee. 2010-2011 ed. London: British Medical
Association and Royal Pharmaceutical Society of Great Britain; 2010. British
National Formulary
5. Neofax online, accessed 21/10/15
173
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For example:
Add 5.6 mL of 20% NaCl to a 500 mL bag of 10% Dextrose to make N/4 10% Dextrose
174
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Sodium Bicarbonate
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : 1] Resuscitation.
2] Metabolic acidosis.
Dose : 1] 1 - 3 mmol/kg
2] Body Deficit: 0.3x weight in kg. x base deficit.
Generally, half correction is given, followed by another
quarter correction, if indicated on the basis of blood gas
analysis.
Interval : Stat
175
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176
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Dose : 1] Oral/Nasogastric:
Starting dose depends on degree of hyponatraemia. Usual
dose 2-4mmol/kg/day. Higher doses (up to 6mmol/kg/day)
may be required for severe depletion. Adjust the dose
according to clinical requirements. Higher doses may be
required in premature infants due to significant renal losses
of electrolytes.
Prescribe medication name as 20% NaCl
Prescribe dose in terms of mL
Prescribe dose calculation in terms of mmol/kg/day
2] IV:
Required dose of sodium in mmol
= weight (kg) x 0.6 x {x – serum sodium (mmol/L)}
Where x is the desired serum sodium concentration
Maximum recommended correction in 24 hours is
12mmol/L
Interval : 1] 2 - 12 hourly
2] continuous infusion
Route : 1] Oral/nasogastric
2] Intravenous infusion
Total Daily Dose : As directed by level of hyponatraemia
IV: Correct sodium level slowly, not raising serum level by
more than 0.5mmol/L per hour. Maximum recommended
correction in 24 hours is 12mmol/L
177
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Comments : Never administer undiluted hypertonic 20% sodium chloride
intravenously. 20% NaCl must be diluted prior to use. Give via
central line if available.
Osmolality information:
Isotonic solution = 300mOsmol/L
Max via peripheral line = 900mOsmol/L
Peripheral lines aim for 14.4 – 43.2mOsmol in 48mL i.e. 300-
900mOsmol/L, but this may be adjusted at consultant discretion
1mmol of NaCl provides 2mOsmol
1mL of 5% Dextrose (5%D) provides 0.278mOsmol
1mL of 10% Dextrose provides 0.556mOsmol
e.g. 2.5kg baby, peripheral line, desired serum Na 135, actual serum Na
120: Dose of Na (mmol) = 2.5 x 0.6 x 12 = 18mmol (÷3.4mL) = 5.3mL
of 20% NaCl
48mL syringe will contain 36mOsmol (NaCl) plus 42.7mL diluent
Using WFI: 36+0 = 36mOsmol/48mL (WFI preferred)
Using 5%D: 36+(42.7 x 0.278) = 48mOsmol/48mL
e.g. 1kg baby, desired serum Na 135, actual serum Na 128, peripheral
line: Dose of Na (mmol) = 1 x 0.6 x 7 = 4.2mmol (÷3.4mL) = 1.24mL
of 20% NaCl
48mL syringe contain 8.4mOsmol (NaCl) plus 46.76mL diluent
Using WFI: 8.4+0 = 8.4mOsmol/48mL (5%D preferred)
Using 5%D: 8.4+(46.76 x 0.278) = 21.4mOsmol/48mL
Supplied as : 1] Pharmacy prepare a 20% NaCl solution
(1mL = 3.4mmol) every Friday
2] Ampoule: 20% Sodium Chloride (2g in 10 mL)
1 mL = 3.4 mmol NaCl
Dilution : 1] Oral: Into feed
2] Intravenous: Consider total osmolality of solution
Central line: Draw up (the required mmol dose of sodium divided by
3.4)mL of 20% sodium chloride and transfer to a 25mL syringe. Further
dilute to 24 mL with or WFI, 5% or 10% dextrose. Run the solution at 1
mL/hr. Solution may be more concentrated in fluid restricted ELBW
infants with central access
Peripheral IV: Calculate the osmolality of solution before making
syringe. Aim for 14.4 -43.2Osmol in 48mL i.e. 300-900mOsmol/L
Draw up (the required mmol dose of sodium divided by 3.4)mL of 20%
sodium chloride and transfer to a 50mL syringe. Further dilute to 48 mL
with WFI or 5% Dextrose. Run the solution at 2 ml/hr
Stability : 1. Discard according to expiration date on label
2.Discard according to expiration date on ampoule
Storage : 1. Refrigerate
2. Store at room at room temperature
Discard any unused portion of ampoule
Compatibility : Water for injection, 5% dextrose, 10% dextrose
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Incompatibility : Not Applicable.
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Sotalol
Revision Date : 28 May 2012 Approved: AK, JD
Incompatibility :
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Serum Levels : Not required
Spironolactone
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 1 mg/kg.
Interval : 12 hourly.
Route : Oral.
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Streptokinase
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.V.
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Sucrose
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval: First dose is given 2 minutes prior to the procedure, then the
same dose can be administered, if required, every 2 minutes up
to a total of 1 mL. This 1 mL dose can be given no more than 3
times in a 24-hour period.
Route: Orally, either onto the anterior portion of the tongue, or
administered on a dummy.
Total Daily Dose: 3 mL
Dilution : Nil
Incompatibility : Nil
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Survanta: Beractant
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Comments : Infants less than 28 weeks gestation are usually given prophylactic
surfactant at the time of birth, preferably before the institution of
the first mechanical breath. Infants > 28 weeks gestation are
administered surfactant if they require IMV or are on CPAP and
40-50% oxygen with the diagnosis of HMD on CXR.
Given with a size 5 infant feeding tube directly down the ETT or
via the suction port of the Trach-care device.
Supplied as : Survanta (Beractant): 200 mg/8 ml.
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Route : I.V.
Can be given I.M. if necessary (use 2.5 mg/kg)
Total Daily Dose :
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Teicoplanin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
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Theophylline
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
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Thyroxine
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : Hypothyroidism
Interval : daily
Route : orally
Comments : Round doses off to nearest 12.5 microg (1/4 x 50 microg tablet). Some
babies may need to give alternating daily dose. For example of a baby
requires 20 microg/kg/day = 140 microg/week, give Mon/Wed/Fri 12.5
microg and the other 4 days give 25 microg = 137.5 microg/week. If a
baby needs 30 microg/day = 210 microg/week give 37.5 microg (3/4
tablet) Mon/Wed/Fri and 25 microg (1/2 tablet) the other 4 days = 212.5
microg/week.
Long plasma half-life 6-7 days in euthyroid, 9-10 days in hypothyroid,
and 3-4 days in hyperthyroid states. Slow onset of action, peak effect
occurs 3-4 weeks after initiating therapy. Effect of dosage adjustment is
thus very slow.
Supplied as : 50 microg tablet
Stability :
Compatibility:
Incompatibility :
Serum Levels : Aim to maintain serum thyroxine in the upper half of the
normal range and serum TSH in the normal range.
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Ticarcillin/clavulanic acid
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Interval : Weight:
< 2000 gm & < 7 days 12 hourly
< 2000 gm & > 7 days 8 hourly
> 2000 gm & < 7 days 8 hourly
> 2000 gm & > 7 days 6 hourly
Route : IV
189
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Tobramycin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
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Interval : 12 hourly
Route : Oral
Compatibility:
Incompatibility :
191
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Valproate
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : Anticonvulsant
Route : Orally
Dilution :
Stability :
Compatibility:
Incompatibility :
192
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Vancomycin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : MRSA and MRSE colonisation or sepsis, nosocomial or late neonatal infection.
This is a restricted ORANGE ANTIMICROBIAL and may be prescribed
without prior ID approval when used for the indications outlined in the AMS
SOP.
Dose : 15 mg/kg/dose.
Interval : CGA PostNatal Interval
(weeks) (days) (Hours)
≤29 0 - 14 18
>14 12
30-36 0 - 14 12
>14 8
37-44 0–7 12
>7 8
≥45 ALL 6
Adjust dosages according to levels. If therapeutic levels are
attained there is no need to increase the dosage when the weight
increases.
Route : I.V.
Total Daily Dose : 15 - 60 mg/kg/day according to age and bodyweight.
30 mg/kg/day for 24 hour infusion (reduce to 20 mg/kg/day if
Creat > 90 micromol/L)
Comments : Causes thrombophlebitis and tissue necrosis if extravasation occurs.
Febrile convulsions, anaphylaxis and eosinophilia have been reported.
Give infusion over 60 minutes to avoid Red Man syndrome.
Nephrotoxicity is enhanced when combined with aminoglycosides (eg.
gentamicin)
Supplied as : Vials 500 mg powder. Pharmacy will prepare 50mg/10mL syringes during
normal working hours.
Dilution : Reconstitute 500mg vial with 10mL WFI (500mg/10mL). Dilute
1mL (50 mg) of this solution to a total volume of 10mL with NS
(5 mg/mL)
Stability : Discard vials after single use
Prepared syringes – expiry date on label
Storage : Vials: Room temperature, refrigerate after reconstitution.
Prepared syringes: Refrigerator
Compatibility : TPN, Amikacin, Calcium gluconate, Fluconazole, Hydrocortisone, Insulin,
Meropenem, Midazolam, Morphine, Tolazoline, Vecuronium 10% D,
Aciclovir, Ampicillin, Ranitidine.
Incompatibility : Cefotaxime, Dexamethasone, Heparin, Phenobarbitone, Benzylpenicillin
193
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Serum Levels : Trough levels should be taken immediately prior to the dose at the
48 hour point. Do not withhold doses whilst waiting for levels to be
reported. Levels to be maintained between 10-20 mg/L for non-CNS
infections and 15-25 mg/L for CNS infections. Trough levels for 24
hour infusions should be maintained between 15-30 mg/L. Adjust
dosages to achieve adequate levels, above the total daily doses
recommended above, if required.
Once therapeutic levels are attained there is no need to increase the
dosage when body weight increases.
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Vecuronium
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : I.V.
infusion
Comments : A shorter acting agent than pancuronium but with similar
properties. Vagal and ganglion blocking activity minimal
and less histamine release. Cardiovascular side effects are
thus less marked. Hypotension may be a problem and
counteraction by volume loading may be necessary.
Reports of excessively prolonged action in neonates
reported (i.e. > 1-2 days). Some form of eye lubrication is
necessary in infants paralysed with vecuronium.
Action reversed by neostigmine.
Effect increased by aminoglycosides and other antibiotics,
diuretics, -blocking agents, verapamil. Effect decreased
by steroids, theophylline, anticholinesterases.
Supplied as : Powder for reconstitution 4 mg and 10 mg vial.
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Serum Levels :
Vigabatrin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 20 mg/kg/dose
Increase to 40-80/mg/kg/dose if necessary
Interval : 12 hourly
Route : Oral
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Vitamin A (Retinol)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Route : Oral.
Dilution : Nil.
Incompatibility :
197
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Vitamin E (Alpha-Tocopherol)
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 5 mg.
Interval : Daily.
Route : Oral.
Comments : Efficacy has been debated. Suggested value has been in the
prevention of BPD, reduction in the severity of IVH and of
ROP, and the prevention of anaemia of prematurity.
Toxicity results in inhibition of prostaglandin synthesis in
platelets, decreased platelet aggregation, increased
haemorrhagic tendency in Vitamin K deficiency,
creatinuria. High dose intravenous use has resulted in liver
necrosis and death. Trials have shown an increased rate of
sepsis and death.
Supplied as : Solution 100 mg/ml.
Dilution : Nil.
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Vitamin K
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dose : 1 mg IM or IV (0.1ml)
< 1500 grams: 0.5 mg IM (0.05ml)
Prophylaxis for maternal anticonvulsant therapy: parenteral 1 mg.
Therapeutic: 1 mg parenterally.
Interval : Parenteral prophylaxis at birth.
.
Route : I.M. (preferred), I.V. Generally given IM on the right thigh soon
after birth.
Total Daily Dose:
Dilution : Nil
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Zidovudine
Revision Date : 28 January 2015 DTC approved: March 2015
Route : PO:
IV: one hour infusion (for infants unable to tolerate oral dosing)
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Dilution : IV: MUST be diluted with sodium chloride 0.9% or glucose 5%
to a maximum concentration of 4mg/mL prior to infusion. 4
Withdraw 40mg (4mL) of zidovudine and add to 16mL of diluent
fluid (makes 2mg/mL). For fluid restricted pts, add 40mg (4mL)
of zidovudine to 6mL of diluent fluid (makes 4mg/mL)
Infuse required dose over one hour
Stability : IV ampoules - use once only and discard any residue.
Where practical, the Pharmacy IV room will prepare IV doses in
syringes.
Storage : Oral solution – Room temperature, protect from light
IV vials - Room temperature, protect from light
Compatibility : glucose 5%, sodium chloride 0.9%, aciclovir, amifostine,
amikacin, anidulafungin, aztreonam, ceftazidime, ceftriaxone,
cisatracurium, clindamycin, dexamethasone, dobutamine,
dopamine, doripenem, erythromycin, filgrastim, fluconazole,
gentamicin, granisetron, heparin sodium, imipenem-cilastatin,
linezolid, lorazepam, metoclopramide, morphine sulfate,
oxytocin, pentamidine, phenylephrine, piperacillin-tazobactam
(EDTA-free), potassium chloride, ranitidine, remifentanil,
tobramycin, trimethoprim-sulfamethoxazole, vancomycin 4,5
Incompatibility : Blood products, albumin, meropenem. 4,5
Compiled: January 2015 Review: January 2019
References
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Zoster Immunoglobulin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Dilution : Nil.
Stability :
Incompatibility :
Serum Levels :
202
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References:
203
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