NICU Medication Reference Manual

(Updated by Jennifer Hale, PharmD, MPA, BCPPS 3/8/2017)

 

Please refer to Lexi-comp for the most up to date dosing and administration information.

Please refer to Lexi-comp for all medications not found in the NICU Medication Manual.

Please call pharmacy or refer to Micromedex for any questions regarding IV drug compatibility.  

 

·      No Medications via Peripheral Art Line                                                                                         

·      C=Compatible at Terminal Injection Site (Y-connector)

·      I=Incompatible (Ok to flush w/ NS before & after at Y-connector) 

·      All IV Medications must be given at the Y-connector site (not at another port up the line).  Compatibilities are only known for infusion at the Terminal Site.

 

 

MEDICATION

DOSE

DESCRIPTION

ADDITIONAL  CONSIDERATIONS

Acetaminophen

IV Dosing:

28-32 weeks: 7.5mg/kg/dose IV q8hr

33-36 weeks: 7.5-10 mg/kg/dose IV q6-8hr

≥37 weeks: 10mg/kg/dose IV q6-8hr

Post-op Pain

Scheduled use should not exceed 72 hours.

 

C= TPN/IL, Dexamethasone, Fentanyl, Hydrocortisone, Midazolam, Morphine, Vancomycin

 

I= Acyclovir

 

Acyclovir

< 1kg à

PNA ≤ 14 days: 20 mg/kg/dose IV q12hr

PNA > 14 days: 20 mg/kg/dose IV q8hr

 

1-2kg à  

PNA ≤ 7 days: 20 mg/kg/dose IV q12hr

PNA > 7 days: 20 mg/kg/dose IV q8hr

 

>2kg = 20 mg/kg/dose IV q8hr 

Antiviral for treatment of neonatal HSV & encephalitis. 

IV over 1hr, monitor site for phlebitis. 

Monitor renal & hepatic function. May cause nephrotoxicity.  Maintain good hydration to prevent crystallization in kidneys.

 

C= Gentamicin, Ampicillin, Vancomycin

 

I=TPN, IL, Caffeine, Cefepime, Dobutamine, Dopamine, Midazolam, Piperacillin/Tazobactam

                      

Albumin

0.5-1 g/kg/dose IV X 1

For hypovolemia or hypoalbuminemia

Infuse over 30-60min. Rapid infusion in preterm (<30min) may predispose to IVH. Monitor for signs of fluid overload.  

Do not dilute in sterile water. Fatal hemolysis could occur.

 

C=D5W, D10W, NS, TPN

I=IL

Alprostadil (Prostaglandin E1, Prostins, PGE)

IV infusion: 0.02–0.1 mcg/kg/minute

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

Not per UAC.  Recommended to obtain backup IV if administering peripherally.

 

The IV bag of medication should be changed q24h and new fluid flushed through the tubing as it is unstable for >24hrs.

 

C=TPN, IL, Ampicillin, Caffeine, Cefazolin, Dopamine, Dobutamine, Fentanyl, Furosemide, Gentamicin, Vancomycin

Amiodarone

IV bolus: 5mg/kg over 1 hour

Infusion: 5-15 mg/kg/day

For the treatment of life-threatening refractory arrhythmias.

Central Line required.

 

Obtain all doses of Amiodarone from the pharmacy. If a bolus dose (IV push or Intermittent infusion over 30 minutes) the dose will come in a syringe. If a continuous infusion, the dose will come in a bag.

 

All doses (other than IV push) should be run on the Alaris pump. Please obtain Alaris tubing from service center.

 

C=Dextrose, Dopamine, Epinephrine, Midazolam, Morphine

 

I=TPN, IL, Dobutamine, Fentanyl

Amphotericin B Conventional

1 mg/kg/dose IV q24hr

 

Follow instructions in WIZ for ordering in patient’s current dextrose concentration.  Electrolyte and nutrition requirements should be calculated to run over 20 hours as TPN or IVF will be turned off during Amphotericin infusion

 

Treatment of systemic fungal infections

Infuse over at least 4hrs.  Administration through Central Line is preferred.  If PIV, must be OK's by the Attending. Flush before & after w/ D5W.  

 

C=D5W

 

I=TPN, IL, NS, 0.2 Micron Filter

Ampicillin

<7days

100 mg/kg/dose IV q12hr

Meningitis: 100mg/kg/dose IV q8hr

 

>7days

50 mg/kg/dose IV q8h

Meningitis: 75 mg/kg/dose IV q6hr

 

UTI prophylaxis

10 mg/kg/dose IV q24hr

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

 

Reconstitute with Sterile Water Only (can flush with NS, Sterile Water, or D5W)

 

IV over 3-5 minutes.

  

I=TPN, Dextrose, NS, Cefotaxime, Dobutamine, Dopamine, Fentanyl, Gentamicin, Midazolam

Bosentan (Tracleer)

Requires a Pulmonology Consult

 

PO Medication Only: 1mg/kg/dose BID

Endothelin Receptor Antagonist

Treatment of persistent pulmonary hypertension

This drug should not be handled by women who are pregnant or looking to become pregnant because it can cause birth defects. This medication is NOT cytotoxic but is TERATOGENIC.

 

Medication should be delivered double bagged

 

Gloves must be worn when administering/handling the medication and when handling residuals and emesis.

 

Gloves should be worn when changing diapers or bathing patients who have stooled. Accidental contact from urine and blood does not represent a significant exposure risk for this medication.

 

Throw away oral syringe in Red Sharps container to prevent further contact with the syringe.

Caffeine Citrate

Loading= 20 mg/kg IV/PO x 1

 

Maintenance = 5-10 mg/kg/dose IV/PO q24hrs

Treatment of neonatal apnea of prematurity

Loading dose -IV over 30 min.

Maintenance dose over 10 mins. 

Consider holding dose if HR > 180. 

 

C=TPN, Alprostadil

Calcium gluconate

Hypocalcemia:  100-200 mg/kg/dose of calcium gluconate IV x 1

 

Resuscitation:  60-100 mg/kg/dose IV

Calcium replacement 

Ordered as total mg Ca Gluconate (NOT ELEMENTAL).

CVC (Central Line) is preferred. 

Cardiac Arrest - Do not exceed 200 mg/min.

Do not administer through UAC. 

Observe IV site closely for extravasation.

Use hyaluronidase if extravasation occurs.

 

C= Dopamine, Dobutamine, famotidine, furosemide, midazolam, vancomycin, TPN (only if TPN does not contain phosphorus)

I=  Ceftriaxone, Indomethacin, TPN with Phosphorus

Cefazolin

(Ancef)

 

<2kg: 25mg/kg/dose q12hr

 

>2kg: ≤7 days: 25mg/kg/dose q12hr

           >7 days: 25mg/kg/dose q8hr

 

1st generation cephalosporin 

Peri-op infection prophylaxis MSSA infections.

Slow IVP over 3 – 5 minutes

 

C=TPN, IL

Cefepime

 

 

<14 days: 50 mg/kg/dose IV q12hr

  

>14 days: 50 mg/kg/dose IV q8hr

 

4th generation cephalosporin for treatment of gram-neg & gram-positive organisms including Pseudomonas.

Slow IVP over 3 – 5 minutes

 

C=TPN, Dextrose, NS

 

I=Famotidine, Dopamine, Dobutamine

Cefotaxime

(Claforan)

≤ 1kg

PNA ≤14 days: 50 mg/kg/dose IV q12hr

PNA >14 days: 50 mg/kg/dose IV q8hr

 

>1kg 

PNA ≤7 days: 50 mg/kg/dose IV q12hr

PNA >7 days: 50 mg/kg/dose IV q8hr

 

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

 

IV over 15 minutes. 

 

C=Acyclovir, Famotidine, TPN, IL

 

I= Ampicillin 

Dexamethasone

(Decadron)

Extubation: 0.25 mg/kg/dose q8h X 3 doses, started 4-6 hours prior to extubation.

 

Taper for chronic lung disease:

Day       

  1        0.1 mg/kg/dose IV q12h

  2        0.1 mg/kg/dose IV q12h

  3        0.075 mg/kg/dose IV q12h

  4        0.075 mg/kg/dose IV q12h

  5        0.05 mg/kg/dose IV q12h

  6        0.05 mg/kg/dose IV q12h

  7        0.025 mg/kg/dose IV q12h

  8        0.025 mg/kg/dose IV q12h

 

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.

 

Supplemental interventions for patients receiving 8 day taper: discontinue Vitamin A, initiate famotidine, avoid indomethacin if possible, increase protein intake and monitor triglycerides, blood pressure, and glucose.

  

C= Dopamine, Famotidine, Furosemide. TPN

 

I= Dobutamine, Gentamicin

Dobutamine

Infusion: 2 – 20 mcg/kg/minute

Increases myocardial contractility with less of an impact on heart rate than other catecholamines. May cause vasodilation at high doses.

 

Not per UAC.  Central Line Preferred (or use large vein) (tissue ischemia occurs w/ infiltration).  

May see blanching of vein. Observe closely.  Use phentolamine if extravasation occurs.

 

Tachycardia noted at higher dosages.  May cause hypotension if patient is hypovolemic. Can cause arrhythmias.

 

C=TPN, IL, Dopamine, Famotidine, Fentanyl, Gentamicin, Vancomycin

I=Acyclovir, Ampicillin, Furosemide, Midazolam, Fosphenytoin

Dopamine

Infusion: 2 – 20 mcg/kg/minute

Low doses increase renal blood flow and urine output. 

Intermediate doses increase renal blood flow, cardiac output, contractility, and blood pressure. 

High doses cause alpha-adrenergic effects with vasoconstriction and increased blood pressure.

Not per UAC.  Central Line Preferred (or use large vein) (tissue sloughing may occur w/ infiltration).  

Observe for blanching. Use phentolamine if extravasation occurs

 

Monitor for tachycardia and arrhythmias.

 

C=TPN, IL, Alprostadil, Cefotaxime, Dobutamine, Fentanyl, Gentamicin, Famotidine, Midazolam, Vancomycin

I=Acyclovir, Furosemide, Indomethacin, Insulin

Enoxaparin

< 3 months

Treatment dose: 1.7 mg/kg/dose subcut q12h

Prophylaxis: 0.8 mg/kg/dose subcut q12h

 

3-12 months

Treatment dose: 1.5 mg/kg/dose subcut q12h

Prophylaxis: 0.75 mg/kg/dose subcut q 12h

 

See Thrombolytic Therapy Protocol

Low-molecular weight heparin

Given Subcutaneous route only. 

Dispensed by pharmacy undiluted 100 mg/mL in an insulin syringe.  1 unit = 1 mg = 0.01 mL

Antifactor-Xa (LMWH) levels should be monitored.  Draw levels 4 hrs after dose.

Avoid IM injections, lumbar punctures, arterial punctures, or other invasive procedures during anticoagulation/thrombolysis.

Epinephrine

Resuscitation: 0.01-0.03 mg/kg/dose IV (0.1-0.3 mL/kg) of 1:10,000 dilution.

 

IV preferred but may be given ETT.  Dosing ETT: 0.1 mg/kg/dose (1 mL/kg) of a 1:10,000 dilution 

 

Infusion:    0.05-2.0 mcg/kg/min

 

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

Resuscitation: Given IV over 1 min.

 

Not per UAC.  IV infiltration may cause tissue ischemia & necrosis. Use phentolamine if extravasation occurs.

 

C=TPN, Dobutamine, Dopamine, Famotidine, Fentanyl, Fluconazole, furosemide, Gent, Hydrocortisone, Midazolam, Morphine

I=Sodium Bicarbonate, Ampicillin, IL

Famotidine

(Pepcid)

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

H2-antagonist used for GERD.  Routine use is not recommended.

Infuse over 3-5 min.

Can be ordered in TPN.  

 

C=TPN, IL, Dexamethasone, Dobutamine, Dopamine, Fentanyl, Fluconazole, Gentamicin, Midazolam, Morphine

I=Alprostadil, Ampicillin, Cefepime, Furosemide, Piperacillin/Tazobactam

Fentanyl 

Intermittent Dose=1-2 mcg/kg/dose IV    q2-4hr. 

Infusion= 0.5-3 mcg/kg/hr

 

Tachyphylaxis to fentanyl may develop with chronic use which may improve with a conversion to morphine.  

Sedation & Analgesia

Intermittent doses may cause chest wall rigidity, therefore administer over at least 5 minutes. Respiratory depression may occur.  Muscle rigidity, seizures, hypotension, & bradycardia have occurred following rapid infusion.  Naloxone reverses adverse effects.

 

C=TPN, IL, Alprostadil, Dobutamine, Dopamine, Famotidine, Fluconazole, Gentamicin, Hydrocortisone, Furosemide, Midazolam, Morphine

 

I= Ampicillin, Pantoprazole

Fluconazole 

(Diflucan) 

 ≤29 wks

 ≤ 14 days: 5-6 mg/kg/dose IV/PO q72h

 > 14 days: 5-6mg/kg/dose IV/PO q48h

 

 30-36 wks

≤ 14 days: 3-6mg/kg/dose IV/PO q48h

> 14 days: 3-6 mg/kg/dose IV/PO q24h

 

 ≥37 wks (Loading dose 6-10 mg/kg IV/PO )

≤ 7 days 3-6 mg/kg/dose IV/PO q48h

 > 7 days: 3-6 mg/kg/dose IV/PO q24h

 

Prophylaxis Dosing:

3 mg/kg/dose IV Q Mon & Thur x 6wks as long as central line is in.  Avoid in liver failure

Treatment of systemic fungal infections including meningitis caused by Candida albicans and other susceptible fungi. 

  

Twice weekly prophylaxis may be used in high risk infants.

Doses <6mg/kg: Infuse over 1 hours

Doses ≥ 6mg/kg: Infuse over 2 hours  

 

C=TPN, IL, Dexamethasone, Dopamine, Dobutamine, Famotidine, Fentanyl, Gentamicin, Midazolam, Morphine, Vancomycin

I= Ampicillin, Alprostadil, Furosemide

Fosphenytoin

Loading=10 mg PE/kg IV x1. May repeat 10 mg/kg up to 20 mg PE/kg IV total.

 

Initial Maintenance=2 mg PE/kg/dose IV q12hr                                  

 

Monitor: Unbound (Free) Level=1-2 mcg/mL

Water soluble prodrug of phenytoin used to treat seizures refractory to phenobarbital.

Dosing is expressed in phenytoin equivalents (PE). 

Loading=IV over 20 minutes.  

Infuse no faster than 1.5 mg/kg/min. 

 

C=Lorazepam, Phenobarbital   

 

 I= TPN, IL, Ampicillin, Alprostadil, Dobutamine, Dopamine, Midazolam

Furosemide

(Lasix)

Intermittent:

1 mg/kg/dose IV q12-24h

2 mg/kg/dose PO q12-24h

 

Infusion:
Initial 0.1 mg/kg/hr
Range 0.05-0.4 mg/kg/hr

 

Loop Diuretic that may also improve pulmonary function.  Used in patients with BPD.

IV over 3-5 min.  (Max=0.5 mg/kg/min).

 

C=TPN, IL, Heparin, Fentanyl

 

I=Ampicillin, Dobutamine, Dopamine, Famotidine, Fluconazole, Gentamicin, Midazolam, Morphine, Vancomycin

Gentamicin

< 30 weeks

≤ 7 days=  5 mg/kg/dose IV q 48 hours

>7 days=  4 mg/kg/dose IV q 24 hours

 

≥ 30 weeks

≤ 30 days=  4 mg/kg/dose IV q 24 hours

> 30 days, ≤ 2kg=  4 mg/kg/dose IV q 24 hours

> 30 days, > 2kg =  5 mg/kg/dose IV q 24 hours

 

Goal:

Trough Level=<2 mcg/mL

Obtain a trough & peak for meningitis

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

IV over 30 min. 

Obtain trough 30min prior to 4th dose. 

C=TPN, IL, Alprostadil, Dobutamine, Dopamine, Famotidine, Fentanyl, Fluconazole,  Midazolam, Morphine

I=Ampicillin, Dexamethasone, Furosemide, Heparin (>1unit/mL), 0.2 micron filter

Heparin

Anti-Coagulation Doses:

Bolus:  75 units/kg IV x1

Infusion:  28 units/kg/hr

 

Prophylaxis Dose:

10 units/kg/hr

Added to UAC and UVC fluids (0.25 units/mL) to decrease clotting of line.  Flushes (10 unit/mL) used intermittently with PICC lines (q6h and PRN) and Broviac® catheters (q24h and PRN) to prevent clotting of the line. 

Provides anticoagulation.

 

(See Heparin in NICU Guidelines and Policies)

May give undiluted through any line.

 

C= TPN/IL, Dopamine, Dexamethasone, Famotidine, Fentanyl, Fluconazole, Furosemide, Midazolam, Milrinone, Morphine

 

I= Alteplase (tpa), Dobutamine, Furosemide, Gentamicin, Vancomycin

Hydrocortisone sodium succinate

 

 

 

Physiologic replacement: 6-8 mg/m2/day IV/PO in 2-3 divided doses

 

Pressor- or volume-resistant hypotension (stress dose):  30-50 mg/ m2/day divided q6-8hr (usually equivalent to 1 mg/kg/dose IV/PO q8hr)

 

Please refer to Hydrocortisone for Vasopressor-Resistant Hypotension

Steroid

 

 

 

 

 

 

 

Concentration of 1mg/mL: Infuse over 20-30 min. 

Concentration of 50 mg/mL can be given as an IV bolus over at least 30 seconds; for doses >500mg, administer over 10 minutes.

 

C=TPN/IL, Acyclovir, Cefepime, Dopamine, Famotidine, Fentanyl, Fluconazole, Fosphenytoin, Furosemide, Morphine

I= Dobutamine, Midazolam, Phenytoin

Hydromorphone

 Infusion:
 Usual starting dose: 4 mcg/kg/hr
 Range: 4-30 mcg/kg/hr

Not first-line analgesic in the NICU.

 

C=TPN, Dobutamine, Dopamine, Famotidine, Gentamicin, Heparin, Furosemide, Midazolam, Morphine,  Vancomycin

 

I= IL

Indomethacin

(Indocin)

 

 

See Indomethacin protocols for indications and qualifying labs:

Indomethacin prophylaxis in the ELBW infant

and

 Indomethacin treatment for PDA

Treatment for a patent ductus arteriosus. 

Prophylaxis use in ELBW infant significantly decreases incidence of symptomatic PDA

IV over 30 minutes.  Not per UAC. 

Pts are NPO for 12-24 hrs after dose & fluid restricted (decrease maintenance IV fluids by 30%).  

 

C=Furosemide, Fluconazole, Insulin

 

I=TPN, IL, D10W, Dobutamine, Dopamine, Famotidine, Gent, Morphine, Vancomycin

Insulin

0.05-0.2 units/kg/hr. 

Usual initial dose is 0.1 units/kg/hr

Treatment of hyperglycemia with persistent glucose intolerance. 

Adjuvant therapy for hyperkalemia. Should be used in conjunction with dextrose infusion when used for hyperkalemia. 

See NICU hyperkalemia protocol in Wiz for specific dosing information

Insulin binds to plastic tubing and may effect response if time is not allowed to saturate the tubing.  Prime line with insulin and allow to sit for at least 20 minutes prior to administration. Flush/re-prime the tubing after saturation of tubing prior to administration. 

 

The IV bag of medication should be changed q 24h and new fluid flushed through the tubing as it is unstable for >24hrs.

 

C= TPN, IL, Fentanyl, Fosphenytoin 

 

I= Dopamine, Dobutamine, Phenytoin, 0.2 micron filter

 

IVIG (Gamunex)

Dose varies per indication.  Commonly dosed at 1-2 gm/kg/dose.

May be used for sepsis, neonatal immune thrombocytopenia

Start at 0.6 mL/kg/hr for 30 minutes. Increase gradually every 30 minutes to max of 4.8 mL/kg/hr.

 

If hypotension, sweating, fever & flushing occur, stop infusion for 15-30 min & then resume at lower rate.

 

Flush before and after with D5W or NS. Do Not Y-in any sodium containing fluids.

 

Usually well tolerated in neonates.

 

Monitor renal function, urine output, blood pressure and signs of anaphylaxis. 

 

C= Dextrose only

I=Everything except dextrose

Levetiracetam (Keppra®)

Loading Dose: 20-30mg/kg/dose

20-60 mg/kg/day IV/PO q12h

Used for seizures

 

PO and IV doses are equivalent.

Infuse over 15 minutes.

 

Please notify physician if you feel your baby is experiencing any side effects or if you’ve noticed a change in mental status.

Levothyroxine

 

 

PO = 10-12 mcg/kg/dose PO q24h

IV = 5-8 mcg/kg/dose IV q24h

 

Treatment of hypothyroidism

 

 

Administer as IV push over 2-3 minutes.  Product from pharmacy expires 1 hr after mixing

Call for medication.  Give immediately upon receiving!

 

Oral doses should be given on an empty stomach if possible 30 min before or after a feeding.  Oral iron can decrease the concentration of PO levothyroxine – separate doses by 4 hrs if possible

 

 C= NS only.  Do not add to other solutions

I=Everything except NS

Lorazepam

(Ativan)

 

 

 

 

 

Status epilepticus: 0.05 mg/kg/dose IV.

May repeat in 10-15 min.

Intermittent doses for sedation: 0.05 – 0.1 mg/kg/dose IV/PO q4-8h

 

Anticonvulsant for refractory seizures.

Used for sedation.  Does not provide pain relief.

IV over 3-5 min. Not per UAC. 

Do not give with renal impairment. Risk of propylene glycol toxicity.

 

C=TPN, Dobutamine, Dopamine, Famotidine, Fentanyl, Fosphenytoin, Gentamicin, Morphine, Vancomycin

 

I=Ampicillin, IL

Magnesium sulfate

25-50 mg/kg/dose IV x 1

Treatment of hypomagnesemia

Infuse over 3-4hr.  Do NOT exceed 1 mEq/kg/hr.

 

C=Acyclovir, Dobutamine, Famotidine, Fosphenytoin, Gentamicin,  Heparin, Morphine, Vancomycin

 

I= Cefepime, Indomethacin

Meropenem

≤ 2 kg: 20mg/kg/dose q8-12h

> 2 kg: 20-30mg/kg/dose q8h 

Carbapenem Antibiotic

Used to treat multi-drug resistant organisms

Infuse over 30 minutes.

NOT in Medfusion Pump; Infuse volume over 30 minutes  

 

C= Fosphenytoin, Vancomycin

 

I= Amiodarone, Pantoprazole

Midazolam

(Versed)

 

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

IV Infusion:  Range: 0.05-0.15 mg/kg/hr

 

Intranasal: 0.2mg/kg (single dose) divided between the nares

Sedative/hypnotic/amnestic

Used for refractory seizures.

Does not provide pain relief.

IV over 5 min. Not per UAC.  

Intranasal administration via atomizer.

C= Dopamine, Famotidine, Fentanyl, Gentamicin, Morphine, Vancomycin

I=IL, Amp, Cefepime, Ceftazidime, Furosemide, Indomethacin, Phenobarbital

Milrinone

0.25-1 mcg/kg/min 

Phosphodiesterase inhibitor. Positive inotropic effect with decreases in preload and afterload, increased cardiac output, and decreased systemic and arterial pressures

Not per UAC.  Use a large vein or UVC (tissue ischemia occurs w/ infiltration).  Use in UVC port where no lab draws to avoid extra dosing as line is flushed.

 

C=TPN, Ampicillin, Acyclovir, Dopamine, Dobutamine, Fentanyl, Fosphenytoin, Midazolam, Morphine, Vecuronium

 

I=Furosemide

Morphine

 

 

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

Infusion: 0.01 - 0.3 mg/kg/hr

 

Analgesia/ Sedation.

 

 

Naloxone used to reverse adverse effects (respiratory depression, hypotension, & bradycardia). 

 

C=TPN, IL, Dobutamine, Dopamine, Famotidine, Fentanyl, Fluconazole, Gentamicin, Lorazepam

Palivizumab

(Synagis)

15 mg/kg/dose IM x 1 dose prior to discharge during RSV season.

Given to decrease severity of RSV.  Given once as inpatient prior to discharge and then monthly as an outpatient.  Should meet AAP criteria and approval by case managers.

Should meet AAP criteria and approval by case managers.

Phenobarbital

Loading=20 mg/kg IV x 1 dose. May repeat 10 mg/kg x 2 up to 40 mg/kg         

Initial maintenance=2 mg/kg/dose q12hr IV or PO

Level=15-40 mcg/mL

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

Initial drug of choice for most types of seizures in neonates. 

 

Used as a sedative in higher doses for ECMO babies.

Enhances bile excretion w/ cholestasis

Loading: IV over 20 minutes.

Maintenance: IV over 3-5 minutes. Not per UAC.

 

C=TPN, Fosphenytoin, Heparin,

 

I= Morphine, Phenytoin, IL

Phentolamine

0.2mL/injection

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.

Please refer to IV infiltrate policy.

Piperacillin / Tazobactam (Zosyn)

  

<1kg

≤14 days: 100mg/kg/dose q12hr

>14 days: 100mg/kg/dose q8hr

 

≥1kg

≤7 days: 100mg/kg/dose q12hr

>7 days: 100mg/kg/dose q8hr

For empiric therapy for non-CNS infections that involve non-CoNS/MRSA gram-positives, gram-negatives (includingPseudomonas) and anaerobes (e.g. gram-neg pneumonia, VAP with GNR in ETT aspirate, aspiration pneumonia, abdominal infections, etc

Infuse over 30 min.

 

C=TPN, IL, Cefepime, Dopamine, Fentanyl, Furosemide, Milrinone, Morphine

 

I=Acyclovir, Ampicillin, Dobutamine, Famotidine, Midazolam, Vancomycin

Sodium Polystyrene Sulfonate

(Kayexalate)

PO: 1 g/kg/dose every 6 hours

 

PR: 1g/kg/dose every 2-6 hours until potassium normalizes

Potassium Binder

Antidote for hyperkalemia

For Potassium Binder: Pour Kayexalate into the enteral feeding, STIR WELL, and then allow to settle for 1 hour.

Kayexalate will bind potassium and form a sludge at the bottom.  Decant off the liquid feeds at the top to give to the patient.  Leave sludge in container and discard.

 

Sucrose 24%

<1mo. and <1000g: 0.05mL/dose

 

<1mo and 1-2kg: 0.05-0.2mL/dose

 

<1mo and >2kg: 0.05-0.5mL/dose

 

1-9mo: 0.5-2mL/dose

Non-opioid analgesic used for minor procedures

DO NOT use entire ampule of sucrose for a patient (unless dose is 2mL)

Can cause hyperglycemia

Vancomycin

>1 month:

< 28 wks: 10 mg/kg/dose IV q12

≥ 28 wks: 10 mg/kg/dose IV q8

 

≥ 1 month

< 2 kg: 10 mg/kg/dose IV q8

≥ 2 kg: 15 mg/kg/dose IV q8

 

Desired trough level= 5-20mcg/mL

Initial gram positive antibiotic coverage for clinically septic infants and infants with indwelling hardware (central line, VP shunt, etc) pending culture and sensitivity results. 

Antibiotic of choice for MRSA, Staph epidermidis, and where indicated by sensitivity patterns of culture proven isolates.

IV over 60 min. 

 

Obtain trough 30min prior to 4th dose.

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

Vecuronium

Intermittent = 0.05-0.1 mg/kg/dose IV q1-2hrs              

 

Range= 0.05-0.1 mg/kg/hr

 

 

 

Neuromuscular blocker

Slow IV push.  Must be on ventilator and given with sedation. 

Use some form of eye lubrication. 

 

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

I= Furosemide

Vitamin A 

See Vitamin A protocol for criteria for use.

2000 IU/dose IM MWF x12 doses

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

Discontinue Vitamin A when giving dexamethasone

Zidovudine

(AZT)

<30wk=

PO: 2 mg/kg/dose PO q12hr

IV: 1.5 mg/kg/dose IV q12hr

For the first 4wks of life, then increase dose per Lexi-comp dosing

 

30-34wk

PO: 2 mg/kg/dose PO q12hr

IV: 1.5 mg/kg/dose IV q12hr

For the first 2 wks of life, then increase dose per Lexi-comp dosing

 

>35wk

PO: 4 mg/kg/dose PO q12h

IV: 3 mg/kg/dose IV q12h

Post-exposure prophylaxis for patients born to HIV-infected mothers. Should be started within 6-12 hours of birth.  

 

 

IV over 1 hour

 

 

 

 

 

Immunizations

DTaP (diphtheria and tetanus toxoids with acellular pertussis)

 

0.5 mL IM      

Hib (haemophilus influenzae type B; ActHib®)

 

0.5 mL IM      

IPV (inactivated poliovirus)

 

0.5 mL IM/SC

Hepatitis B (Recombivax HB®)

 

0.5 mL IM      

PCV (pneumococcal 13-Valent Conjugate Vaccine; Prevnar-13®)

 

0.5 mL IM      

 

Hib and Hep B (Comvax®)

0.5 mL IM

 

Hib, IPV, DTaP (Pentacel®)                                                   

0.5 mL IM

Please notePentacel® is supplied in two vials, one containing DTaP-IPV liquid and one containing Hib (ActHIB®) powder. First, gently shake vial containing DTaP-IPV component; withdraw liquid contents, and inject into vial containing Hib (ActHIB®) powder; shake until uniform, cloudy suspension results.  Use immediately after reconstitution

Hepatitis B Immune Globulin for babies born to HBsAg+ mothers

0.5 mL IM