NICU Medication Reference Manual

(Updated:  December, 2002)

 

MEDICATION

DOSE

DESCRIPTION

NURSING CONSIDERATIONS

Acetaminophen (Tylenol)

 

 

Oral=10-15mg/kg/dose

<32 wks=q8hr

 >32 wks=q6hr

Rectal=20mg/kg/dose

<32 wks=q12hr

 >32 wks=q8hr

Fever reduction or treatment of mild to moderate pain.

 

 

Administer 30 min prior to immunizations & afterwards for 24hrs.

 

 

Acyclovir

 

 

 

<1200g=20mg/kg/dose IV q12hr

 

>1200g=20mg/kg/dose IV q8hr

 

 

 

 

Antiviral for treatment of neonatal HSV &  varicella zoster infections. 

 

 

IV over 1hr, monitor site for phlebitis.  Monitor renal & hepatic function.                       

C=D5W, D10W, NS

I=TPN, IL, Dobutamine, Dopamine  

 

   

Adenosine

 

 

Start: 50 mcg/kg rapid IV push (1 –2 sec) increase in 50 mcg/kg increments q 2 min until sinus rhythm.

 

Acute treatment for sustained paroxysmal supraventricular tachycardia.

 

Flush w/ NS immediately after each bolus dose.

If dilution needed, use 1 ml in 9 ml NS to make 300 mcg/ml.

Monitor EKG and BP. Any adverse effects usually resolve within 1 minute.

Albuterol Sulfate 0.5%

 

 

 

<2000g=0.1ml of 0.5mg/ml solution via ETT.

>2000g=0.2ml of 0.5mg/ml via ETT

Dilution=0.1ml albuterol in 0.9ml NSà0.05mg per dose=0.1ml

MDIs = 2-4 puffs q 4-6hr

Bronchodilator

 

 

 

Given by RT. Do not give if HR > 180.  Assess degree of bronchospasm & response to treatment. Observe for hypoxia.

Discard mixed medication after 24h

 

 

 

Amikacin

 

 

 

0-4wks(<1200g)=7.5mg/kg/dose IV q24hr

<7d(1200g-2000g) =7.5mg/kg/dose IV q12hr

<7d(>2000g)=7.5mg/kg/dose IV q12h

>7d(1200-2000g)=7.5mg/kg/dose IV q8-12hr

>7d (>2000g)=7.5mg/kg/dose IV q8hr

Restricted to treatment of gram-negative. bacilli that are resistant to other aminoglycosides.  This is rarely used in the NICU. 

 

IV over 30 min.  Dilute to 5 mg/ml.

Monitor renal function.

 

C=TPN, Heparin(<1u/ml)

I=IL

 

Amoxicillin

10mg/kg/dose PO q day

UTI Prophylaxis

PO only.

Amphotericin B

(Fungizone)

 

 

 

 

 

Initial=0.25-0.5mg/kg/dose IV q24hr

Maintenance=0.5-1mg/kg/dose q24hr IV

 

 

 

 

Treatment of systemic fungal infections

 

 

Infuse over at least 4hrs via central line.  Flush before & after w/ D5W.  Monitor BUN, Cr, UOP, K+, & platelets.

 

C=Dextrose only

I=TPN, IL, NS

Ampho B Lipid Complex   (Abelcet)

 

Initial=1mg/kg/dose IV q24hr

Maintenance=increase daily in 1mg/kg increments to 5mg/kg/dose IV q24hr.

(Use Ampho MD Order Sheet)

Treatment of systemic fungal infections refractory to Amphotericin B or pts w/ renal dysfunction. 

Infuse over at least 4hrs via central line.  Flush before & after w/ D5W.  Monitor BUN, Serum Cr, UOP, K+, & platelets.

C=Dextrose only

I=TPN, IL, NS

Ampicillin

 

 

 

<1mo=100mg/kg/dose IV q12hr

>1mo=50mg/kg/dose IV q 6h

GBS meningitis

<7d=100mg/kg/dose IV q8h

>7d=100mg/kg/dose IV q6h

UTI prophylactic= 10mg/kg/day IV q day

Broad-spectrum antibiotic useful against enterococcus, GBS, Listeria, & susceptible E coli species.

 

IV over 3-5 minutes.

 

C=IL, Dopamine, Famotidine, Heparin, Insulin                                                       I=TPN

 

Ancef

(See Cefazolin)

 

 

Aquamephyton

(Vitamin K )

<1500gm=0.5mg= 0.25ml IM  >1500gm=1mg= 0.5ml IM

Prevention of hemorrhagic disease of the newborn.

Given within 1hr of birth.  Use filter needle to draw med from ampule. 

Aquasol A

(see Vitamin A)

 

 

Ativan

(See Lorazepam)

 

 

Beractant

(See Survanta)

 

 

Budesonide

0.25 mg via Nebulization per ETT or Mask q12h

Steroid respiratory inhalant

Mostly used in older infants.

Given by RT.

Caffeine Citrate

 

 

Loading=20mg/kg IV/PO x 1

Maintenance=5-10mg/kg q24hr IV/PO. 1st maintenance dose begins 24hr after loading dose. May be increased in 2.5 mg/kg increments.

Treatment of neonatal apnea

 

 

IV over 30 min.  Consider holding dose if HR > 180.  May cause irritability or feeding intolerance.

 
C=TPN, IL, Dopamine, Fentanyl, Heparin

Cefazolin

(Ancef)

 

 

<7d=20mg/kg/dose IV q12hr

>7d ( <2000g)=20mg/kg/dose IV q12hr

>2000g=20mg/kg/dose IV q 8hr

 

1st gen. Cephalosporin for perioperative infection prophylaxis and Staph aureus (methicillin susceptible) infections.

IV over 30 min.  Dilute to 20 mg/ml. 

 

C=TPN, IL, Famotidine, Heparin, Insulin

Cefepime (Maxipime)

 

50mg/kg/dose IV q12hr

Limited neonatal info.

4th gen. Cephalosporin for treatment of gram-neg & gram-positive organisms including pseudomonas & Staph aureus.

IV over 30 minutes.

C=TPN, Dextrose, NS

I=Famotidine, Dopamine, Dobutamine.

Cefotaxime

(Claforan)

 

 

 

0-4wks(<1200g)=50mg/kg/dose IV q12h

<7d=50mg/kg/dose IV q12hr

>7d=75mg/kg/dose IV q8hr

Meningitis up to 66mg/kg/dose q8hr

3rd gen. Cephalosporin for treatment of gram-neg & some gram-positive organisms (e.g. E.coli, Klebsiella)

IV over 30 minutes. Don’t exceed 40mg/ml.      

 
C=TPN, IL, Famotidine, Heparin 

Ceftazidime

(Fortaz)

<7d=50mg/kg/dose q12hr     

>7d(>1200g)=50mg/kg/dose q8hr

3rd gen. Cephalosporin for treatment of gram-neg, esp. pseudomonas aeruginosa.

IV over 30 minutes.

C=TPN, IL

Ceftriaxone

(Rocephin)

 

 

 

50mg/kg/dose q24hr

(for non-CSF infections)

 

 

 

3rd gen. Cephalosporin for treatment of gram-neg & gram positive organisms.  Contraindicated in neonates w/ hyperbilirubinemia.

IV over 30 min.  Dilute to 40 mg/ml.

 
C=TPN, Famotidine, Heparin, IL

 

Chloral hydrate

 

25-75mg/kg/dose PO or PR x1

Use repeat doses with caution.

 

Sedative/hypnotic for short term use only.  Contraindicated in pts w/significant hepatic &/or renal disease.

Oral dose should be diluted or given after feeding. Has no analgesic properties, excitement may occur in pts. with pain.

Cyclopentolate/ phenylephrine (Cyclomydril)

Instill 1gtt in each eye.  Repeat in 5-10 min.

Ophthalmic agent used to dilate eyes prior to diagnostic procedures.  See NICU website.

Store at room temperature.

 

Dexamethasone

(Decadron)

 

 

 

 

 

 

 

 

 

 

Day            Daily dose(mg/kg/day)

1                            0.2

2                            0.2

3                            0.15

4                            0.15

5                            0.1

6                            0.1

7                            0.05

8                            0.05

Divide q 12hr. Give IV

Anti-inflammatory glucocorticoid used to facilitate extubation and improve lung function in infants at high risk for developing chronic lung disease.

 

 

 

IV over 3-5 min. Monitor BP, glucose, & trig levels.  Hold Vitamin A during & for 1 week following course.  Consider prophylactic pepcid.  Contraindicated in pts receiving Indocin.

 

C=TPN, IL, Famotidine, Heparin, Prostins

 

Diazepam

(Valium)

 

Neonates=0.1-0.3mg/kg/dose IV.  May repeat up to maximum of 2mg  

Infants=Maximum of 5mg

Anticonvulsant for refractory seizures.

 

Slow IVP, do not exceed 1-2 mg/min.  Risk for extravasation. Not per UAC. Monitor respiratory rate.

I=Dobutamine

Dilantin

(See Phenytoin)

 

 

Dobutamine

 

 

 

2 – 20 mcg/kg/minute continuous IV infusion.

See Calculation Formulas

 

 

 

 

Inotrophic vasopressor that increases myocardial contractility, cardiac index, O2 delivery, & O2 consumption.  Used for the treatment of hypoperfusion & hypotension.

Not per UAC.  Use a large vein or UVC (tissue ischemia occurs w/ infiltration).  Tachycardia noted at higher dosages.  May cause hypotension if pt is hypovolemic. 

C=TPN, IL, Dopamine, Famotidine, Fentanyl, Heparin, Insulin

I=Digoxin, Furosemide, Phenytoin

Dopamine

 

 

 

2 – 20 mcg/kg/min continuous IV infusion.

See Calculation Formulas

 

 

 

 

Catecholamine that increases blood pressure by increasing systemic vascular resistance.  Renal vasodilation noted in PTNB at 2.5-7.5mcg/kg/min. 

 

Not per UAC.  Use a large vein or UVC (tissue sloughing may occur w/ infiltration).  Observe for blanching.  Use higher doses w/ caution in pts w/ PPHN.

C=TPN, IL, Dobutamine, Fentanyl, Prostins, Famotidine, Heparin

I=Furosemide, Insulin

Epinephrine

 

 

 

0.1-0.3 ml/kg/dose IV or ETT of

1:10,000 dilution

(equal to 0.01 to 0.03 mg/kg). 

 

 

 

 

Used for acute cardiovascular collapse.  Most commonly used in the NICU for severe bradycardia and hypotension.

 

Given IV push or ET, immediately followed by 1 ml of NS.  Monitor HR & BP if possible.  Not per UAC.  IV infiltration may cause tissue ischemia & necrosis. 

C=TPN, Dobut, Dopamine, Famotidine, Fentanyl, Heparin, Prostins

I=Sodium Bicarbonate

Epinephrine, Racemic (2.25%)

0.3 – 0.5ml in 2.5ml NS PRN

Bronchodilator used for stridor, especially post-extubation stridor

Given by RT

Erythromycin

(EES)

 

 

 

 

 

 

 

 

<7d=10mg/kg/dose q12h IV/PO

>7d(<1200g)=10mg/kg/dose q12h IV/PO

>7d(1200-2000g)=10mg/kg/dose q8h IV/PO

>7d(>2000g)=10mg/kg/dose q6hr IV/PO

GI dose=1mg/kg/dose PO q6hr

Macrolide antibiotic for treatment of Chlamydia, Mycoplasma, & Ureaplasma.

May increase GI motility in pts w/ reflux symptoms. 

 

 

 

 

 

IV over 60 min.  Monitor HR & BP during infusion.    

 

C=TPN, IL, Famotidine, Heparin

I=Furosemide, Metoclopramide

 

 

 

 

 

Famotidine (Pepcid)

 

0.5-1 mg/kg/dose q12hr IV or PO

 

Prevention and treatment of stress ulcers & GI hemorrhage aggravated by gastric acid secretion.

IV over 3-5 min or ordered in TPN. 

C=TPN, IL, Dobutamine, Dopamine, Heparin, Insulin

Fentanyl    

(Sublimaze)

 

 

 

 

Dose=1-2 mcg/kg/dose IV q 2-4hr. (ELBW=May want to start @ 0.5mcg/kg/dose IV q2-4h)

Infusion=1-5 mcg/kg/hr.

ELBW=0.5mcg/kg/hr

Weaning= for <5d therapy, reduce dose by 25% q 12hr till D/C

For >2wk therapy, reduce by 10% daily till D/C.

Consider a Methadone taper.

See Calculation Formulas.

Sedation & Analgesia.

 

 

 

 

 

Dilution=l ml Fentanyl in 9 ml NS = 5 mcg/ml (Ampule=100 mcg in 2 mls)

IV over at least 5 min. Respiratory depression may occur.  Muscle rigidity, seizures, hypotension, & bradycardia have occurred following rapid infusion.  Naloxone reverses adverse effects.

 

C=TPN, IL, Dobutamine, Dopamine, Heparin, NaHCO3

 

Fluconazole 

(Diflucan)

 

0-14d(<29wks)=5-6mg/kg/dose q72hr

>14d(<29wk)=5-6mg/kg/dose q48hr

0-14d(30-36wk)=3-6mg/kg/dose q48hr

>14d=3-6mg/kg/dose qday

Antifungal agent used for treatment of systemic infections & meningitis caused by susceptible Candida species.

IV over 1 hr., dilute to 2 mg/ml. 

 

C=TPN, IL, Dobutamine, Dopamine, Famotidine, Heparin

Fortaz

(See Ceftazidime)

 

 

Fosphenytoin

 

 

 

Loading=10mg PE/kg, may repeat 10mg/kg up to 20mg PE/kg

Maintenance=2mg PE/kg/dose IV or IM q12hr                                  

Serum Level=10-20mcg/ml

Unbound (Free) Level=1-2mcg/ml

Water-soluable prodrug of phenytoin used to treat refractory seizures.  Dosing is expressed in phenytoin equivalents (PE). 

 

Loading=IV over 20 minutes.  Maint=Max rate 0.5mg/kg/min.  Monitor BP closely during infusion.  Use w/ caution in neonates with hyperbilirubinemia.  

C=Lorazepam, Phenobarbital, KCL                                    I=Midazolam

Furosemide

(Lasix)

 

 

 

IV =1 mg/kg/dose

PO= 2 mg/kg/dose q12-24hr

 

 

 

 

 

Diuretic that may also improve pulmonary function.

 

 

IV over 3-5 min.  Monitor UOP and serum electrolytes. Potentially ototoxic.  Hypercalciuria & nephrocalcinosis occur w/ long-term therapy.

C=TPN, IL, Famotidine, Heparin, Morphine, Prostins

I=Dobutamine, Dopamine

Gentamicin

 

 

 

 

<27 wks=3.5mg/kg/dose IV q48hr

>27 wks=3.5mg/kg/dose IV q24hr

>1mo(>2kg)=2.5mg/kg/dose IV q8-12h

Impaired Renal Func=2.5mg/kg x1 (Further doses based on level)

Trough Level=<2 mcg/ml

Trough & Peak for Meningitis

 

 

 

Aminoglycoside for aerobic gram-negative bacilli (e.g. Pseudomonas, E Coli, Klebsiella).

 

 

 

IV over 30 min.  Assoc. w/ ototoxicity & renal tubular dysfunction. Monitor UOP & serum Cr

Obtain trough 30min prior to 4th dose. 

If needed, obtain peak 30 min. after end of infusion. 

C=TPN, IL, Dopamine, Famotidine, Heparin, Insulin, Prostins.

Hydrochloro-thiazide

(HCTZ)

 

1 mg/kg/dose q12hr PO

 

Calcium sparing diuretic, may improve pulmonary function in pts w/ BPD.  Effect is enhanced when used with lasix or spironolactone.

Give w/ food (improves absorption).  Monitor UOP & serum electrolytes. 

 

Ilotycin

(Erythromycin ophthalmic

ointment)

Thin line (approx. 0.5-1 cm) instilled into each conjunctival sac before infant is 1hr old. 

Prophylaxis against gonococcal ophthalmic infection required by TN State Law. 

Preferably done after MD/NNP ophthalmoscopic exam.  If eyelids fused, apply along line of fusion p delivery.  No need to repeat when eyes open. 

Imipenem/

Cilastatin

(Pimaxin)

 

 

0-4wks(<1200g)=20mg/kg/dose q24h

All ages (1200-1500g) = 20mg/kg/dose q12hr

<7d(>1500g)=25mg/kg/dose q12h

>7d(>1500g)=25mg/kg/dose q8h

Treatment of non-CSF infections caused by Enterobacteriaceae & anaerobes resistant to other antibiotic.

IV over 30-60 minutes, assess site for phlebitis.                             

 

C=TPN, IL, Famotidine, Insulin

Indomethacin

(Indocin)

 

 

 

 

 

 

 

 

 

Prophylactic=0.2 mg/kg IV x 1 at 12hrs of age

Prophylactic candidates=

1)      all infants <1000gm BW

2)      ventilated infants 1001-1250gm BW

3)      infants <34 wk GA

Symptomatic=0.2mg/kg IV x1

If ductus still open after 24hrs, repeat dose x3 q12hr.

Treatment for a patent ductus arteriosus.  Prophylaxis use in ELBW infant significantly decreases incidence of symptomatic PDA (contraindicated if Indocin used as a tocolytic w/in 72hrs of birth).

 

IV over 30 min w/ filter.  Not per UAC.  Pts are NPO & fluid restricted.   Maintain optimal oxygenation; assess murmur, pulse pressure, abnormal bleeding.  Monitor urine output, serum electrolytes, platelets, BUN & Serum Cr.

 

C=Furosemide, Insulin, KCL, NaHCO3

I=TPN, IL, D7.5W, D10W, CaGlu, Dobutamine, Dopamine

Insulin

 

 

0.01-0.1U/kg/hr continuous infusion

 

 

Treatment of VLBW hyperglycemic infants with persistent glucose intolerance.  Adjuvant therapy for hyperkalemia.

Only regular insulin for injection may be used IV. Monitor blood glucose frequently.

C=TPN, IL, Dobutamine, Famotidine, Heparin, Morphine, NaHCO3

I=Dopamine

Lasix

(See Furosemide)

 

 

Lorazepam

(Ativan)

 

 

 

 

0.05mg/kg/dose IV, may repeat in 10-15 min.

 

 

Anticonvulsant for refractory seizures.

 

 

IV over 3-5 min. Monitor IV for phlebitis or extravasation. Not per UAC. 

C=TPN, Dobutamine, Dopamine, Famotidine, Fentanyl, Fosphenytoin, Heparin, Morphine

I=IL

Maxipime

(See Cefepime)

 

 

Meropenem

(Merrem)

 

 

 

 

<7d=20mg/kg/dose IV q 12h

>7d(1200g-2000g)=20mg/kg/dose IV q12h

>7d(>2000g)=20mg/kg/dose IV q8h

 

 

Treatment of gram-negative & gram positive aerobic & anaerobic organisms resistant to other antibiotics.

 

IV over 30 min.

C=D5W, D10W, NS, Heparin, IL, TPN, Dopamine

I=Amphotericin B, Metronidazole

Methadone

 

 

See Methadone Taper Protocol on next page

 

Used to taper opioid dependence.

 

IV over 3-5 min. Monitor cardiac, respiratory & GI status.

C=NS.  No data available on TPN, IL, D5W, D10W

I=Heparin

METHADONE TAPER

  • While continuing fentanyl, begin methadone at 0.1mg/kg/dose IV q 6hr.  Give PRN dose (0.05mg/kg/dose q 2-4h) of methadone for breakthrough agitation.  (For atypical high doses of fentanyl, pharmacy can help to calculate an appropriate equivalent dose of methadone to start taper.

  • After 3rd dose, reduce fentanyl dose in ½.

  • 4th dose – DC fentanyl & cont. methadone q 6hr & PRN.  PRN dose can be given anytime during interval between scheduled doses.

  • If no PRN doses for 24h, increase scheduled dosage interval to q 8h.  Continue PRN dose.

  • If no PRN dose for 24h, increase scheduled dosage interval to q12h.  Continue PRN.

  • If no PRN doses for 24h, increase scheduled dosage interval q 24h.  Continue PRN.

  • As long as baby remains comfortable without signs of abstinence, decrease dose by 10-20% q 2-3days until DC scheduled does & PRN dose.

  • (Given the extremely small doses our babies receive, one can effectively wean the q24h dose by 0.01mg q 1-3d to zero & DC PRN dose.)

  • NOTE: if IV access lost when starting methadone, & fentanyl has not been DC, PO methadone should be started at 0.2mg/kg/dose, with a PRN dose of 0.1 mg/kg/dose.

Metoclopramide

(Reglan)

 

0.1mg/kg/dose q6hr IV or PO

 

Facilitates gastric emptying and GI motility.  May improve feeding intolerance.  GE reflux use is controversial. 

IV over 15 min.  Observe for increased irritability or vomiting.                           C=TPN, IL, Famotidine, Fentanyl, Heparin, Insulin, Morphine, Prostins
Metronidazole

(Flagyl)

 

 

 

 

 

 

 

 

0-4wk(<1200g)=7.5mg/kg/dose IV q48h

<7d(1200g-2000g)           =7.5mg/kg/dose IV q24h

<7d(>2000g)=7.5mg/kg/dose IV q12h

>7d(1200-2000g)=7.5mg/kg/dose IV q12h

>7d(>2000g)=15mg/kg/dose IV q12h

>1mo=7.5mg/kg/dose IV q6h

Treatment of anaerobic & protozoal infections (B.fragilis, C.difficile)

 

 

 

IV over 60 min.

 

C=D5W, NS, TPN, IL, Heparin, Prostins, Dopamine

I=Meropenem

 

 

Midazolam

(Versed)

 

 

 

 

 

 

 

0.05-0.1mg/kg/dose IV q2-4hr PRN

 

 

 

Sedative/hypnotic/amnestic      Benzodiazepine also used for refractory seizures.

 

 

IV over 5 min, not per UAC.   Seizure-like myoclonus has been reported in some premature infants. Monitor Resp. rate.

C=TPN, Dobutamine, Dopamine, Famotidine, Fentanyl, Heparin, Insulin, Morphine, Pancuronium, Prostins

I=IL, Furosemide, NaHCO3

Morphine

 

 

 

0.05-0.1mg/kg/dose IV q2-4hr PRN or continuous infusion

 

 

 

Analgesia/ Sedation.

 

 

 

IV over 5 min.  Naloxone used to reverse adverse effects (respiratory depression, hypotension, & bradycardia).  Possible loss of bowel sounds and urinary retention noted.

C=TPN, IL, Dobut, Dopa, Famotidine, Fentanyl, Heparin, Insulin, Prostins

Naloxone (Narcan)

 

0.1mg/kg/dose

 

Given at birth for neonatal depression secondary to maternal narcotic administration.  Give 4hrs PTD.  May need to repeat doses q 2-3 min.

IV or ETT.  May be given IM if adequate perfusion.

Will cause adverse events with narcotic addicted mothers.

Oxacillin

 

 

<7d(<2000g)=25mg/kg/dose IV q12h

<7d(>2000g)=25mg/kg/dose IV q8h

>7d(<1200g)=25mg/kg/dose IV q12h

>7d(1200-2000g)=25mg/kg/dose IV q8hr

>7d(>2000g)=25mg/kg/dose IV q6hr

Antibiotic for treatment of methicillin-sensitive Staph aureus.

 

IV over 30 minutes.

C=TPN, IL, Dopamine, Famotidine, Heparin, Morphine

Pancuronium

(Pavulon)

 

 

 

 

 

0.05–0.1mg/kg/dose IV q1-2hrs PRN                          

 

 

 

 

 

 

 

 

 

 

 

 

Skeletal muscle relaxation/paralysis. Desirable effects are improved oxygenation/ventilation, reduced barotrauma and reduced fluctuations in cerebral blood flow.                

 

 

 

Slow IV push. 

Monitor vital signs frequently. 

This med has no analgesic or sedative effects. Must be given with sedation. Once opened, stable 24hrs if refrigerated.

Use some form of eye lubrication to decrease risk of corneal abrasion since eyelids will be paralyzed. 

C=TPN, Dobutamine, Dopamine, Fentanyl, Heparin, Midazolam, Morphine, Prostins

Penicillin G

 

 

 

 

 

 

 

 

<7d(<2000g)=25,000u/kg/dose IV q12h 

<7d(>2000g)= 25,000u/kg/dose IV q8h

>7d(<1200g)= 25,000u/kg/dose IV q12h

>7d(1200-2000g)= 25,000u/kg/ dose IV q8h

>7d(>2000g)=25,000u/kg/dose IV q6h

Congenital Syphilis

<7d(all wts)=50,000u/kg/dose IV q12h

>7d(all wts)=75,000u/kg/dose IV q8h

GBS meningitis

<7d(all wts) =83,000-150,000u/kg/dose IV q8h

>7d(all wts)=112,000u/kg/dose IV q6h

Antibiotic for confirmed GBS or congenital syphilis.

 

 

 

 

 

 

 

 

IV over 30 minutes, monitor site for extravasation.

 

C=TPN, IL, Dopamine, Heparin, Morphine, Prostins

 

 

 

 

 

 

Pepcid

(See Famotidine)

 

 

Phenobarbital

 

 

 

 

Loading=20mg/kg, may repeat 10mg/kg x 2 up to 40 mg/kg.                             Maintenance=2mg/kg/dose q12hr IV or PO

Level=15-40mcg/ml

ECMO=5mg/kg/dose IV q6h

Cholestasis=2-2.5mg/kg/dose IV/PO q12h

Anticonvulsant

Sedative for ECMO babies.

Enhances bile excretion w/ cholestasis

 

 

Loading=IV over 20 minutes.

Maintenance= IV over 3-5 minutes. 

Not per UAC.

C=Dextrose, Fosphenytoin, Heparin, Prostins, NaHCO3.

I=TPN, IL, Insulin, Morphine

Phentolamine

(Regitine)

 

Add 9ml NS to 5mg vial to make 0.5mg/ml.

 

Used for extravasation of:  Dopamine, Dobutamine, Epinephrine, Norepinephrine, Phenylephrine.  Should be admin. ASAP after infiltration.

Give 5 injections(0.2ml/injection) subcutaneous clockwise around affected area.  Using 26g needle, change after each injection.

Phenytoin

(Dilantin)

 

 

 

Loading=10mg/kg, may repeat 10mg/kg up to 20mg/kg.              Maintenance=2mg/kg/dose q12hr

Serum Level=10-20mcg/ml

Unbound (Free) level=1-2mcg/ml

 

 

Anticonvulsant for seizures uncontrolled by Phenobarbital.

 

 

 

Loading= IV over 20 minutes.

Maint.= Max. IV rate=0.5mg/kg/min.

Not per UAC.  Monitor IV site for extravasation.  Rapid infusion can cause hypotension, bradycardia, & cardiac collapse.

C=NS

I=Everything, flush well a & p w/ NS. 

Prostaglandin E1 (Alprostadil) (Prostins) (PGE)

 

 

 

Continuous IV infusion= 0.05–0.1mcg/kg/minute

Transport=Mix 300mcg in 100ml D5W =3mcg/ml.(300mcg=0.6ml of 500 mcg/ml amp)

Wt unknown=order 3mcg/ml from pharmacy

 

To promote dilation of ductus arteriosus in infants w/ CHD dependent on ductal shunting for oxygenation / perfusion.

 

 

Not per UAC.  Side effects: apnea, fever, cutaneous flushing, hypotension, seizure, and bradycardia.

C=Dopamine, Epinephrine, Heparin, Furosemide, Morphine, Versed.   Historically have infused with TPN in NICU, but no data currently available on TPN in literature. 

Reglan

(See Metoclopramide)

 

 

Retinyl Palmitate

(See Vitamin A)

 

 

Rocephin

(See Ceftriaxone)

 

 

Sodium Bicarbonate             (NaHCO3)

 

 

 

 

Resuscitation=1-2 mEq/kg (4.2%) IV over 3-5 minutes.

Full correction of metabolic acidosis=Wt (kg) x Base deficit (mEq/L) x 0.3 = mEq/kg solution.

Infant= 4.2% NaHCO3 =5 mEq (0.5 mEq/ml)

 

 

Treatment of metabolic acidosis after establishment of effective ventilation.  Also, treatment of bicarbonate deficit caused by renal or GI losses. 

 

 

 

Emergent IV push over 3-5 min.

IV over 1hr. (Max: 1Meq/kg/hr)

Once opened, stable 24hrs.

Rapid infusion linked to IVH.  Adverse effects include local tissue necrosis, hypocalcemia, & hypernatremia.  

C=IL, Atropine, Famotidine, Fentanyl, Heparin, Insulin, Morphine, KCL

I=TPN, CaCl, Ca Gluc, Dobutamine, Dopamine, Epinephrine, Midazolam

Sotalol

Refer to NICU website for link to dosing nomogram

Antiarrhythmic

Monitor HR, BP, EKG, UOP, Serum Cr, Electrolytes

Survanta (Beractant)

 

 

 

4 ml/kg/dose via ETT only.   May be given up to 4 doses in the first 48 hrs of life, no more frequently than q6hrs.

 

 

Man made surfactant used to treat infants at high risk for RDS or treat infants with moderate to severe RDS.  May also be used to treat mature lungs with respiratory failure due to MAS, pneumonia, or PPHN.

Medication should be given at room temperature.  Assess ETT patency and placement before administering. Monitor oxygenation closely after giving.  Avoid ETT suctioning for at least 2hrs after administering. 

Synagis (Palivizumab)

 

15mg/kg/dose IM

 

 

Given once /month to decrease severity of RSV.  Babies should meet AAP criteria.

IM injection.  Vial can be split between babies if given together. Notify Pharmacy. 

THAM   (Tromethamine)

 

 

 

3.3 to 6.6 ml/kg/dose IV

Full correction=Wt (kg) x Base deficit (mEq/L) x 1.1 =ml of 0.3M solution.

3.3ml = 1 mEq of Tham

 

 

 

Treatment of metabolic acidosis, w/out elevation of serum Na, primarily in mechanically ventilated patients with significant hypercarbia or hypernatremia.

 

Infuse in a large vein over at least 1hr, monitor site for extravasation.  Not per UAC. Once opened, stable 24hrs.

 

C=Unknown

I=TPN, IL

Ticarcillin/

Clavulanate

(Timentin)

75mg Ticarcillin / kg/dose IV q8hr (>2kg)

 

Antimicrobial for pseudomonas, Gram negative & positive.

 

IV over 30 minutes.  Dilute to 50mg/ml.

 

C=TPN, IL

Tobramycin

See Gentamicin for dosing

 

 

Vancomycin

 

 

 

 

 

<35 wks=20mg/kg/dose IV q24hr

>35 wks=20mg/kg/dose IV q12hr

>1mo(2kg)=15mg/kg/dose IV q8h

>1mo(2kg) w/documented / suspected Meningitis = 20mg/kg/dose IV q8h

Impaired renal function= 15mg/kg/dose x 1 (further doses based on level)

Trough Level=5-10mcg/ml

Trough & Peak for Meningitis

Antibiotic of choice for MRSA, Staph epidermidis, or septic workup of pt w/ PICC. 

 

 

 

 

IV over 60 min.  Dilute to 5mg/ml.

Monitor UOP, Serum Cr

Obtain trough 30min prior to 4th dose.

If needed, obtain peak 1 hr after end of infusion.

 

C=TPN, IL, Famotidine, Heparin (<1u/ml), Insulin

 

Vecuronium

(Norcuron)

 

 

 

 

 

 

 

 

0.05-0.1mg/kg/dose IV q1-2hrs PRN              

 

 

 

 

 

 

 

 

Skeletal muscle relaxation/paralysis. Desirable effects are improved oxygenation/ventilation, reduced barotrauma, and reduced fluctuations in cerebral blood flow.

 

Slow IV push.  Monitor vital signs frequently.  Use some form of eye lubrication.  This med has no analgesic or sedative effects. Must be given with sedation. Once opened, stable 24hrs.

C=TPN, Dobut, Dopa, Fentanyl, Heparin, Midazolam, Morphine, IL

I=Diazepam, Furosemide, NaHCO3

Versed

(See Midazolam)

 

 

Vitamin A Preparations

 

IM=Aquasol A (50,000IU/ml)

PO=Retinyl Palmitate (10,000IU/ml)

 

 

 

 

 

Criteria := <34wk or <1000g, or BW1001-1250g & vent at 12hr age. (No major congenital anomalies)

Phase 1=2000 IU/kg/dose IM qod DOL 1àFull Feeds

Phase 2=4000 IU/kg/day IM q day starting day of full feeds until discharge/BT

Round off dose to closest 250 IU.

IM dose does not need to be adjusted weekly but enteral dose should be adjusted for wt change in 250 IU increments q week.

Begin IM if feeds held >24hr & continue until full feeds.

 

Essential for normal lung growth & development.  Has been shown to decrease incidence of BPD.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Given IM or PO only.  Should be given within 30min. of dispensing from pharmacy.

Should be shielded from light until administered.

 

 

 

 

 

 

Vitamin K

(See Aquamypheton)

 

 

Zidovudine

(AZT)

 

 

 

 

 

<30wk=2mg/kg/dose PO q12hr, or 1.5mg/kg/dose IV q12hr for 1st 4wks of life then change dosing interval to q8hr thereafter.

>30wk=2mg/kg/dose PO q12hr or 1.5mg/kg/dose IV q12hr for lst     2 wks of life then change dosing interval to q8hr thereafter.

Dosage interval may be further reduced to q6hr when baby reaches 40wks.

Term=2mg/kg/dose PO q6h or 1.5mg/kg/dose IV q6h

Used in Treatment or prophylactic treatment of HIV

 

 

 

 

 

IV over 1 hr.

Monitor hemoglobin, CBC

 

 

 

 

 

Calculation Formulas

 

 

 

  • To Calculate mcg / kg / min                    ** Rate x Concentration (mcg/ml)       = mcg / kg / min
     (Dopamine, Dobutamine, PGE)                                        Weight(Kg) x 60

 

  • To Calculate mcg / kg                               ** Rate  x  Concentration (mcg/ml)       =  mcg / kg / hour
     (Fentanyl)                                                                            Weight(kg)

 

  • To Calculate Rate                                     ** Dose (mcg/kg/min) x Weight(Kg) x 60      =  Rate      
     (Dopamine, Dobutamine, PGE)                          Concentration (mcg/ml)

 

OR

** Pressors = Weight (kg) x 60 = the number of mg of pressor to mix in 100ml D5W then an IV infusion rate of 0.1ml/hr = 1mcg/kg/min.                       

 

**PGE = Weight (kg) x 0.3 = the number of mg of PGE to mix with 100ml D5W then 1ml/hr = 0.05 mcg/kg/min.

 

  • To Calculate Rate                                      ** Dose (mcg/kg/hour)  x  Weight(Kg)          =  Rate
     (Fentanyl)                                                               Concentration (mcg/ml)

OR

** Weight (kg) = the number of mg of fentanyl to add to 100ml D5W then an IV infusion of 0.1ml/hr = 1ml

     ·          To Calculate Insulin 

** Weight (kg) x 10 = the number of units of insulin to add to 100ml D5W then IV infusion of 0.1ml/hr = 0.01 U/kg/hr.

     ·          To Dilute Medications  

        Dose Desired (mg/ml)

**  Dose on Hand (mg) =           Total  #  of  mls

 Then :  Total # mls minus on hand = amount of dilutent to use

 

Immunizations

Dosage

Age

Special Considerations for all immunizations

HbsAg(negative mother)

Dose 1

 

0.5cc IM

2 months or prior to discharge

  • Administer acetaminophen 10 – 15 mg/kg/dose PO/OG or 20 – 25 mg/kg/dose per rectum, 30 min prior to immunization and q6-8hr for 24hour

Dose 2

0.5 cc IM

4 months

  • Delay for administration of immunizations may be required due to infant’s condition

Dose 3

0.5cc IM

6 months

  • Very small infants may benefit from having total immunizations given over 2 days

HbsAg (unknown Mother)

Dose 1

 

0.5cc IM

Within 12 hrs of birth (send mother’s blood for hepatitis screen and if positive give HBIG no later than 7 days of age. Dose 0.5cc IM)

 

 

 

Dose 2

0.5cc IM

1 month

 

Dose 3

0.5cc IM

6 month

 

HbsAg positive mother

Dose 1

 

0.5cc IM

Within 12 hour of birth (also give HBIG within 12 hours of birth. Dose 0.5cc IM in opposite leg)

 

 

Dose 2

0.5cc IM

1 month

 

Dose 3

0.5cc IM

6 month

 

 

 

Immunization at 2 months, 4 months, 6 months

Dosage

DTaP (diphtheria and tetanus toxoids with acellular pertussis)

0.5cc IM

Hib (haemophilus influenzae type B)

0.5cc IM

IPV (inactivated poliovirus)

0.5cc SQ

Hepatitis B (Recombivax HB) For Babies born to HBSAg+ mothers

0.5cc IM

PCV (pneumococcal 7-Valent Conjugate Vaccine)

0.5cc IM

        Archived Versions: None