neonatal formulary · aldactazide 2 - 4 mg/kg/day ÷ q12h po/og contains hydrochlorothiazide and...

NEONATAL FORMULARY

As drug elimination in this population is most closely related to the combination of gestational age (GA) and

postnatal age (PNA), postmenstrual age (PMA) - which combines GA and PNA - is frequently used to guide

drug dosing.

Example: 28 week GA neonate who is 3 weeks PNA is now (28 + 3) = 31 weeks PMA.

(NOTE: Post-conceptual age (PCA) and post-menstrual age (PMA) are used interchangeably.) DRUG DOSE COMMENTS

Acetaminophen < 33 wks PMA: 10-12 mg/kg q 6-8

hr PRN. MAX 40 mg/kg/day

>33wks PMA and term < 10 days

old: 10-15 mg/kg q 6 hr PRN.

MAX 60 mg/kg/day

TERM > 10 days: 10-15 mg/kg q

4-6 hr PRN. MAX 90 mg/kg/day

PO/OG/PR

Consider all sources of acetaminophen in total daily

max. Use of scheduled doses with immunizations

may diminish immune response: consider PRN

instead. Suppository available in 20, 40, and 80mg

precut doses.

Acetazolamide 5 mg/kg Q 12 hours

PO/OG/IV

Limit duration to 48 hours and re-evaluate need.

Used to assist with alkalosis management when

diuretic reduction and/or electrolyte

supplementation were ineffective

Acyclovir

Premature:

< 33 wks PMA: 20 mg/kg q12h IV

33-36 wks PMA: 20 mg/kg q8h IV

Term: 20 mg/kg q8h IV

Infuse over 1 hr; monitor serum Cr; adjust dosage if

renal dysfunction. Serial ANC twice/week

recommended when giving 15-20 mg/kg q8h.

Dosing for preterm infants is controversial; consultation with ID and

pharmacist is recommended. Dosage

modification is needed in renal impairment.

RESTRICTED antibiotic.

Adenosine 0.05 mg/kg rapid bolus, IV

If ineffective, increase dose to

0.1 mg/kg

Treatment for SVT; consult pediatric cardiologist

prior to use.

Albuterol

0.25 - 0.5 mg/kg by nebulization

q 4-8 hr

or

1-2 puffs by MDI q 4-8 hr

1.25 – 2.5 mg/hour continuous

nebulization

Continuous nebulization may be considered in

treatment of hyperkalemia. Tachycardia is common

with doses approaching 1mg/kg.

Drug delivery through ventilator circuits is

variable.

Available in 0.63 mg/3 mL and 1.25 mg/3 mL unit

dose as well as 5 mg/mL stock solution. MDI is

90 mCg/puff.

FOR HYPERKALEMIA

NOTE: Levalbuterol (Xopenex) is now non-

formulary. Consider use only when tachycardia

persists despite albuterol dosage reduction.

Levalbuterol dose should start at 50% of albuterol

dose listed.

Aldactazide 2 - 4 mg/kg/day ÷ q12h

PO/OG

Contains hydrochlorothiazide and spironolactone in

a 1:1 ratio. Concentration is 5 mg/mL. Order in mg

of either component.

Aldactone

See Spironolactone

Amikacin

Amikacin

INTERVAL (based on PMA):

Premature: 12-15 mg/kg/dose

IV, IM

< 28 wks PMA q36h

29-32 wks PMA q24h

33-36 wks PMA q18h

Term: 10 mg/kg/dose IV, IM

0-7 days: q18h

> 7 days: q12h

Levels not needed unless 1) treatment to continue

past 3 days; 2) there is renal impairment; 3) patient

received an unusually high dose. Monitor serum

concentrations and adjust dosage to achieve post

concentrations of 25-35 mCg/mL and trough

concentrations

Amphotericin B Initial dose: 0.5 mg/kg/day IV over

6 hours; subsequent daily doses

increased by 0.25 - 0.5 mg/kg/day

increments until reach

0.75-1 mg/kg/day. Infuse over 2-6

hours.

Closely assess vital signs during initial dose

infusion. Serum potassium, magnesium and

creatinine levels should be monitored.

Modify dose in renal failure. Patients with Candida

sepsis generally treated to a total dose of 15-30

mg/kg.

Amphotericin B

liposome

(AmBisome)

5 mg/kg IV Q 24 hours RESTRICTED antifungal Serum potassium, magnesium and creatinine levels

should be monitored.

Ampicillin < 1.2 kg: 50-100 mg/kg q12h

1.2 - 2 kg:

0-7 days: 50-100 mg/kg q12h

> 7 days: 50-100 mg/kg q8h

> 2 kg:

0-7 days: 50-100 mg/kg q8h

> 7 days: 50-75 mg/kg q6h IV, IM

For Group B Strep meningitis:

0-7 days: 100 mg/kg/dose q8h

> 7 days: 300 mg/kg/day in

4 to 6 divided doses

IV, IM

UTI prophylaxis: 50 mg/kg Q 24h

The higher doses are used in meningitis; for other

indications, use the lower doses.

Aspirin ~5 - 10 mg/kg/dose PO/OG Daily Prophylaxis after cardiac surgery. Pick the dose

closest to 20.25 or 40.5mg (1/4 or ½ tab of “baby”

aspirin). Refer to Cardiology/CV clinical notes.

Ativan

See Lorazepam

Atropine

0.01-0.03 mg/kg IV, SC, ET

0.02mg/kg IV/IM

Severe bradycardia; rarely indicated.

Premedication for Intubation

Atrovent

See Ipratropium

AZT

See Zidovudine

Beclomethasone

(QVAR) metered

dose inhaler

40mcg/accuation

Weight

Range

Dose

Less than

551grams

3 puffs BID X 7 days,


3 puffs daily X 7 days,

2 puffs daily X 7 days,

Then STOP

551-750

grams





Then STOP

751-850

grams



2 puffs TID X 7 days,

1 puff TID X 7 days,

Then STOP

Greater than

850 grams




1 puff TID X 7 days,

Then STOP

May order as “QVAR Wean Per Protocol” upon

initiation of dosing.

Neonates requiring mechanical ventilation.

Consider use as early as 3-14 days of age.

May reduce subsequent systemic steroid needs or

aid in weaning from mechanical ventilation.

Preferred over fluticasone because more neonatal

efficacy data and no documented HPA axis

suppression. 500mCg/day MAX.

Bicitra 2-3 mL/kg/day ÷ 3-4 doses

PO/OG

For metabolic acidosis unresponsive to usual

measures. 1 mL contains ~ 1 mEq of citrate and

1 mEq sodium. Citrate is metabolized to

bicarbonate.

Butorphanol

(Stadol)

5-10 mCg/kg/dose every 4-6 hours

slow IV push

Narcotic analgesic.

Caffeine Citrate Loading dose: 20 mg/kg

Maintenance dose: 5 mg/kg/dose

every 24 hours

IV, PO/OG

Minimum IV dose able to be

infused on pumps is 2 mg.

Serum caffeine concentrations of 5 to 20 mCg/mL

are desired. Consider checking trough level ~7 days

after starting caffeine in patients with PMA < 31

weeks. Consider checking level prior to extubation

or in patients failing to respond or with tachycardia.

Refer to Caffeine Monitoring in Apnea section of

text.

Calcium Chloride

(100 mg/mL)

Emergency use: 0.3 mEq/kg over

2-5 minutes; IV

For Rickets of Prematurity:

70 - 150 mg/kg/day ÷ bid PO/OG

* alternate bid dosing with K phos

so one or the other is given every 6

hours.

► Cardiac arrest/severe bradycardia; rarely

indicated. Very hyperosmolar. Avoid administration

through scalp veins or small peripheral veins. MAX

concentration for peripheral IV administration

20 mg/mL. Order in mEq.

(1.4 mEq elemental Ca+2 per mL)

► Give just prior to a feeding in a nipple or via

OG/NG tube; do not give mixed in formula or

breastmilk. Only given when full volume enteral

feeds are established.

Calcium Gluconate

10%

(100 mg/mL)

Emergency use: 0.3 mEq/kg over

2-5 minutes; IV

(1 mL Calcium/kg)

Hypocalcemia: 0.25-0.5 mEq/kg

infused over a minimum of 1 hour;

IV

May also be given PO/OG

Cardiac arrest/severe bradycardia; rarely indicated.

Hyperosmolar. Avoid administration through scalp

veins or small peripheral veins. 50 mg/mL is MAX

concentration for peripheral IV administration.

Addition to maintenance IV fluids and slow

administration over 24 hours is preferred to faster

intermittent infusions. Order in mEq.

(0.45 mEq elemental Ca+2 per mL). Do NOT infuse

into same line with TPN.

Captopril Initial dose:

0.05 to 0.1 mg/kg/dose every

8-12 hours. Slowly titrate as

needed up to 0.5 mg/kg/dose.

PO/OG

Monitor serum potassium in presence of K+-sparing

diuretics or K+ supplements. Neutropenia and

proteinuria may be seen. Begin at lowest dose and

titrate. Administer on empty stomach.

Contraindicated in renovascular disease. MAX

neonatal dose 2 mg/kg/d. MAX infant dose

6 mg/kg/d.

Cefazolin

(Ancef)

< 2 kg: 20 mg/kg/dose q12h; IV

> 2 kg: 20 mg/kg/dose q8h; IV

Neurosurgery may use for prophylaxis. Not for

routine Gram negative coverage.

Cefepime

(Maxipime) < 30wk PMA:

Scr 0.7-1.3:

20 mg/kg Q12h

Scr < 0.7 OR Meningitis:

30 mg/kg q12h

> 30 wk PMA:

Scr 0.7-1.3

30 mg/kg q12h

Scr < 0.7

50 mg/kg q12h

Meningitis

50 mg/kg q8h

May be preferred over cefotaxime due to less

promotion of bacterial resistance; less impact on GI

flora; and better Pseudomonas activity.

Dosage adjustment required in renal impairment.

Cefotaxime

(Claforan)

All doses are 50 mg/kg/dose

IV, IM

INTERVAL:

< 1.2 kg or 0-7 days PNA q12h

> 1.2 kg and > 7 days PNA q8h

Not generally used for initial rule-out sepsis. Some

suggest up to 300 mg/kg/day divided q6h for

meningitis in term neonates. Dosage adjustment

required in renal impairment.

Ceftazidime

(Fortaz)

All doses are 50 mg/kg/dose

IV, IM

INTERVAL:

< 1.2 kg or 0-7 days PNA q12h

> 1.2 kg and > 7 days PNA q8h

RESTRICTED ANTIBIOTIC

Reserve for pseudomonas aeroginosa or pathogens

resistant to other agents. Dosage adjustment

required in renal impairment.

Cefuroxime IV, IM Preterm 2 kg AND

< 7 days: 25 mg/kg q12h

≥ 7 days: 33.3 mg/kg q8h

Term: 33.3 mg/kg q8h

Chloral Hydrate

Sedative dose:

25 mg/kg/dose q8-12h PO/OG/PR

Hypnotic dose:

50 mg/kg PO/OG/PR

Watch for accumulation with repeated doses,

especially in preterms. Tolerance to sedation

develops.

► Single use before procedures.

Chlorothiazide

(Diuril)

2-8 mg/kg/day ÷ q12h IV

20-40 mg/kg/day ÷ q12h PO/OG

Monitor electrolytes. May cause hypokalemia,

hypochloremia, hyponatremia, or alkalosis. Do not

confuse with hydrochlorothiazide. For use in renal

failure, consult Nephrology.

Chlorpromazine

(Thorazine)

0.25 to 1 mg q6-8h IV, PO/OG

NOTE: Dose is not in mg/kg.

Dose is usually tapered rather than

abruptly discontinued.

Used in CV/cardiology patients to reduce

pulmonary vascular resistance. Watch for

hypotension, hypothermia, eosinophilia, and

excessive sedation. Efficacy data supporting

prolonged/intermittent dosing in neonates is lacking.

Cholecystokinin

(CCK)

(Sincalide)

0.02 mCg/kg/dose 2-3 times/day

IV

Promotes gallbladder contraction in cholestasis

Frequent shortage issues

Clindamycin

All doses are 5 mg/kg/dose IV, IM

INTERVAL:

< 1.2 kg q12h

1.2 - 2 kg:

0-7 days PNA q12h

> 7 days PNA q8h

> 2 kg:

0-7 days PNA q8h

> 7 days PNA q6h

May cause severe colitis. Stop drug if significant

diarrhea occurs.

Clonidine Neonatal Abstinence Syndrome

(Adjunct Therapy)

0.5-1 mCg/kg PO q4-6h

(depending on feeding schedule)

Note: dosing units are

MICROgrams.

Curent concentration is 50

mCg/mL. Minimum measurable

dose is 2.5 mCg.

PO/OG

- To be used along with morphine WHEN morphine

dose >0.2mg/kg q3hr AND Finnegan scores remain

>8

- Start at lower end of dosing range.

- If Finnegan scores >8 consistently while receiving

clonidine, may increase frequency or dose

- Consider written hold parameters for low heart rate

or blood pressure (ex. Hold for HR

Digoxin Premature:

Total digitalizing loading dose: 15-20 mCg/kg given over 24

hours in 3 divided doses IV

Maintenance: 4-6 mCg/kg/day ÷ q12h IV

Term:

Total digitalizing loading dose: 30-40 mCg/kg given over 24

hours in 3 divided doses IV

Maintenance: 5-10 mCg/kg/day ÷ q12h IV

All orders should be written in mCg.

► Oral doses 25% more than IV doses. Reduce

dose in renal impairment.

► Oral doses 25% more than IV doses. Reduce

dose in renal impairment.

IV preparation from pharmacy is 20 mCg/mL. PO

preparation is 50 mCg/mL.

Dobutamine

5-20 mCg/kg/min IV Less effective at raising BP than dopamine in

premature neonates. Consider for myocardial

dysfunction. Vasodilation at high dose.

Drips available as 0.5, 1, or 2 mg/mL. All

concentrations compatible with TPN.

Dopamine 2-5 mCg/kg/min IV

5-20 mCg/kg/min IV

► “Renal” dose

► “Inotropic and vasoconstrictive” dose.

Drips available as 0.4, 0.8, or 1.6 mg/mL.

Compatible with TPN up through 1.6mg/mL.

Enoxaparin

(LMW heparin)

Subcutaneous

< 2 months or Preterm:

Prophylaxis: 0.75 mg/kg Q 12hr

Treatment: 1.5 mg/kg/dose Q 12hr

Term and > 2 months:

Prophylaxis: 0.5 mg/kg Q 12hr

Treatment: 1 mg/kg/dose Q 12hr

Anti-Xa (heparin) level may be monitored 4 hours

after the 3rd dose in patients receiving

TREATMENT or cardiac patients receiving

prophylactic doses.

Epinephrine

1:10,000 only

0.1 - 0.3 mL/kg/dose IV, ET; (the

higher dose preferred for ET); may

repeat every 3 - 5 min. Dilute to

0.5 - 1 mL with normal saline for

ET administration. Continuous

infusion: 0.05 - 1.0 mCg/kg/min IV

For cardiac arrest, severe bradycardia not responsive

to routine resuscitation. Causes vasoconstriction.

Continuously monitor heart rate, blood pressure,

and perfusion. Drips available as 10 or 16 mCg/mL.

ETT dosing 0.5ml/kg – 1ml/kg per 7th Ed NRP

Fentanyl 1 - 4 mCg/kg IV; may repeat every

2 - 4 hours as indicated.

2mCg/kg IV/intranasal for

intubation premedication

Continuous infusion: Start at

0.5 mCg/kg/hr and titrate to pain

relief. Mean required dose is 0.64-

0.75 mCg/kg/hour (range 0.5 – 2

mCg/kg/hr).

Higher doses may be required in

ECMO patients.

Tolerance may develop rapidly. Respiratory

depression, withdrawal, hypotension, bradycardia,

flushing, desaturations, and chest wall rigidity may

occur.

► Continuous infusion is indicated for severe pain

uncontrolled by intermittent administration of

opiates in patients intolerant of morphine infusion.

* Use of fentanyl in patients where analgesia is not

required is NOT indicated. Titrating to sedation

(side effect) often results in excessive doses.

Benzodiazepines (lorazepam or midazolam) may

be a better choice when sedation is the primary

desired effect. Drips available as 2 or 10 mCg/mL.

Ferrous sulfate

Order in mg

of salt

5 to 20 mg/kg/day in 1 or 2 divided

doses (1 - 4 mg/kg elemental)

20-30 mg/kg/day in 2 or 3 divided

doses (4 – 6 mg/kg elemental)

PO/OG

Prophylaxis

Treatment of iron deficiency anemia

Consider dietary sources of iron as well toward total

dose. Available as 75mg/mL (15mg/mL elemental

iron) drops. Standard doses are 11.25, 18.75, 26.25,

30, 37.5, and 45 mg.

Fluconazole For Systemic Candidiasis:

< 30wk PMA and < 7 days old

CONSULT CLINICAL

PHARMACIST

DOSE: 12 MG/KG

INTERVAL:

< 30wk PMA and 7-14 days old

Q24HRx2 DOSES then Q72hr

< 30wk PMA and >14 days old

Q24HR

> 30wk PMA and < 14 days old:

Q24HRx2 DOSES then Q48hr

> 30wk PMA and > 14 days old:

Q24HR

IV, PO/OG

For patients with serum creatinine > 1.3mg/dL,

dosing interval should be modified after first 2

doses. Check serum creatinine daily in renal

impairment and Consult Clinical Pharmacist

Modify dosage in renal impairment.

Monitor serum creatinine twice weekly and LFT’s

weekly. May significantly alter phenytoin levels.

Fluticasone

(Flovent)

MDI’s as 44, 110,

and 220

mCg/accuation

500 mCg/kg/day ÷ q12h for up to 4

weeks. (750 mCg/day MAX)

May taper:

500 mCg/kg/day x 1 week;




Stop

Neonates requiring mechanical ventilation.

Adrenal suppression. *Current MDI product

cannot be used in ventilator circuit.

Beclomethasone preferred over fluticasone because

more neonatal efficacy data and no documented

HPA axis suppression. The 44 mCg inhaler makes

tapering doses easier.

Fosphenytoin

(Cerebyx)

Loading dose: 15-20 mg PE/kg IV

at no greater than 1.5 mg/kg/minute

Maintenance dose: 4 - 8 mg

PE/kg/day divided BID

IV, IM

Ordered in PE (phenytoin

equivalents)

Causes less venous irritation than phenytoin.

Consider use in patients with only small peripheral

venous access available. Use with caution in hyper-

bilirubinemia. Much more expensive than

phenytoin. Serum concentrations should be

monitored and doses adjusted to maintain

concentrations between 8 and 15 mCg/mL. Trough

levels are most useful. Hypotension and bradycardia

possible. Consider checking free phenytoin level if

toxicity is suspected, total level is >15 or patient is

hypoalbuminemic.

Furosemide

(Lasix)

1 mg/kg/dose

Preterm: q24h

Term: q12h

IM, IV, PO/OG

Monitor electrolytes. May cause hypokalemia,

hypochloremia, hyponatremia, alkalosis,

dehydration, and ototoxicity. Oral doses

approximately twice IV doses. For renal failure,

consult Neonatology and Nephrology

Gentamicin INTERVAL: (based on PMA &

PNA):

Less than/equal to 3 weeks PNA:

- ≤28 weeks PMA: 3mg/kg q36h

- 29-32 weeks PMA: 3mg/kg q24h

- 33weeks PMA: 3.5mg/kg q24h

Greater than 3 weeks PNA:

- ≤28 weeks PMA: 3mg/kg q24h

- 29weeks PMA: 3.5mg/kg q24h

ECMO patients:

3.5 mg/kg q24h

Levels not needed unless treatment to continue past

3 days, or there is renal impairment, or patient

received an unusually high dose. Monitor serum

concentrations and adjust doses to achieve post

concentrations of 5 - 10 mCg/mL and troughs

< 2 mCg/mL. Give less frequently in neonates with

birth depression, congenital heart disease, renal

impairment, or on inotropic support. Consultation

with pharmacist for dosing recommendation in renal

impairment is suggested. Monitor respiratory status

closely in offspring of myasthenics and those

exposed to magnesium.

Glucagon 100 micrograms/kg IM Max 300 micrograms

Hepatitis B

immune globulin

(HBIG)

0.5 mL x 1 IM within 12 hours of

birth.

Indicated for newborns whose mothers have acute

Hep B infections or who are HBsAg-positive, or in

preterm newborns < 2 kg with unknown maternal

HBsAg status.

Hepatitis B vaccine Maternal HBsAg status positive or

unknown: 0.5 mL IM within 12

hours of age.

Maternal HBsAg negative:

0.5 mL IM at birth or before

discharge.

Refer to Hepatitis B section under Infectious

Diseases in the text.

0.5 mL Recombivax HB = 5 mCg

0.5 mL Engerix B = 10 mCg

In preterm infants < 2 kg at birth born of HBsAg

negative moms, delay administration of 1st dose

until 1 month chronologic age. Use of scheduled

acetaminophen doses with immunizations may

diminish immune response: consider PRN instead.

Hyaluronidase

(Wydase)

1 mL of 15 unit/mL solution as

5 separate 0.2 mL subcutaneous/

intradermal injections

Use within 1 hour of extravasation of hyperal/other

solution - NOT for pressors. Inject around periphery

of extravasation. Consult Plastic Surgery service if

affected area is > 1 cm.

Hydralazine IV: 0.1-0.2 mg/kg/dose q6-8h; may

slowly increase as needed to MAX

1 mg/kg/dose.

PO/OG: 1 mg/kg/day ÷ q6-8h;

may slowly increase as needed to

MAX 7 mg/kg/day.

► Acute hypertension or hypertensive crisis

► Chronic hypertension.

Hydrochlorothiazid

e

2 - 4 mg/kg/day ÷ q12h

PO/OG

May cause hypokalemia, hypochloremia,

hyponatremia, or alkalosis. Monitor electrolytes.

Only available PO

Hydrocortisone Hypotension unresponsive to

pressors: 1 mg/kg/dose q8h IV

Physiologic replacement:

10-15 mg/m2/day ÷ q8h IV

Stress dose:

20-50 mg/m2/day ÷ q8h

IV/PO/OG

When using for hypotension unresponsive to

pressors, limit use to 5 days.

Complications: hypertension, hyperglycemia, failure

to gain weight, GI ulceration/perforation (especially

when given concurrently with indomethacin).

BSA (m2) = [(0.05) x (wt in kg)] + 0.05

Hyperstat

See Diazoxide

Indomethacin

(Indocin) PROPHYLAXIS OF IVH

0.1 mg/kg/dose q24 hrs x 3 doses

IV

CLOSURE OF PDA Age Dose (mg/kg)

1st 2nd 3rd

< 48 hr 0.2 0.1 0.1

2-7 days 0.2 0.2 0.2

> 7 days 0.2 0.25 0.25

IV

Interval: q12 – 24h x 3 doses

► For premature infants < 1250gm birthweight

requiring ventilatory support for RDS. Give 1st dose

ASAP and within 12 hours of birth.

► To be used under direction of

neonatologist/pediatric cardiologist. Monitor platelet

count and serum creatinine. Q24 hour dosing may be

preferred in extreme premature infants.

Insulin 0.01-0.1 unit/kg/hour

0.1 unit/kg/hr X 1 hour

For Hyperglycemia unresponsive to glucose

reduction. Drip concentration 0.25units/mL with

3mL tubing prime & discard.

For Hyperkalemia: Using drip of 1 unit regular

insulin in 50mL D10W. Dose of 5mL/kg over 1

hour gives 0.1 units/kg insulin and 0.5gm/kg

glucose.

CONSULT NEONATOLOGIST

Ipratropium

(Atrovent)

25 mCg/kg q6-8h – round to

nearest unit dose. Nebulized into

the ventilator circuit.

Tachycardia.

Iron See Ferrous Sulfate

Isoproterenol 0.05 – 2 mCg/kg/min IV infusion

Treatment of bradycardia. Continuous ECG and

blood pressure monitoring; essential to watch for

hypertension and tachycardia.

IVIG 400 mg/kg/dose IV

400-1000 mg/kg/day for 2-5 days

IV

► Neonatal sepsis

► For alloimmune thrombocytopenia.

Administer 5% solution at 0.5 mL/kg/hr and

gradually increase to maximum of 4 mL/kg/hr if

tolerated. Availability of drug is limited. See

PowerPlan

Kayexalate 0.5 - 1 gm/kg/dose q6h PRN

PO/OG or PR

Rectal may be given more

frequently if needed.

Approximately 1 mEq potassium is

removed per 1 gm of resin.

Use sorbitol as diluent (oral 3-4 mL/kg of 10%

sorbitol solution; rectal 2-3 mL/kg of 25% sorbitol

solution).Avoid commercially available suspension.

May also decant daily feeding volume: add

kayexalate to total daily feed volume, let sit for 1

hour. Pour off top layer to use for feeds and discard

residue at the bottom (use in consultation with renal

service)

Lansoprazole

(Prevacid)

1 mg/kg qday x 3 weeks

PO/OG

For ENT patients following supraglottoplasty/ENT

laser procedures.

Levocarnitine 50mg/kg/day in 3-4 divided doses

IV/PO

For use in consultation with metabolism service

Up to 50mg/kg/day may be added to TPN

Linezolid 0 – 7 days and < 34 weeks PMA:

10 mg/kg IV/PO q 12 hr

> 7 days or > 34 weeks PMA:

10 mg/kg IV/PO q8 hr

For treatment of vancomycin resistant

entrococcal infection.

RESTRICTED antibiotic.

Lorazepam

(Ativan)

0.05-0.1 mg/kg/dose every 6-8

hours PRN for sedation.

IV, PO/OG

Use the longer intervals in prematures. Tolerance

may develop. Respiratory and cardiac depression,

withdrawal, hypotension, bradycardia, myoclonic

movements, and desaturations may occur.

Potential for drug accumulation with frequent

dosing.

Magnesium

Sulfate

Hypomagnesemia:

0.1 - 0.25 mEq/kg/dose IV, IM.

Dilute to 0.5 mEq/mL and infuse

over 2 - 4 hours.

Calcium gluconate should be available as an

antidote; monitor serum concentrations.

Addition to maintenance IV fluids and slow

administration over 24 hours is preferred to faster

intermittent infusions.

Meropenem

INTERVAL: (based on PMA &

PNA):

< 32 wks PMA: 20 mg/kg

< 2 wks PNA: q12h

> 2 wks PNA: q8h

Reserve for bacteria not susceptible to other

antibiotics. RESTRICTED antibiotic.

Meropenem

INTERVAL: (based on PMA &

PNA):

> 32 wks PMA

< 2 wks PNA: 20 mg/kg q8h

> 2 wks PNA: 30 mg/kg q8h

> 90 DAYS PNA: 20 mg/kg q8h

40 mg/kg q8h

Reserve for bacteria not susceptible to other

antibiotics. RESTRICTED antibiotic.

Sepsis or Pneumonia

Meningitis

Metoclopramide

(Reglan)

0.1 – 0.2 mg/kg/dose q6h

PO/OG/IV

Irritability; dystonic reactions possible and may be

irreversible. Give before feedings. Use in GER is

controversial

Metronidazole

(Flagyl)

< than 34 weeks PMA: 15mg/kg x

1 then 7.5mg/kg IV q12hr

34-40 weeks PMA: 15mg/kg x 1

then 7.5mg/kg IV q8hr

Greater than 40 weeks PMA:

15mg/kg x 1 then 7.5mg/kg IV

q6hr

****Initial dosage of 15mg/kg given IV for all

gestational ages then begin dosing 12 hours later

based on DOL and weight ****

Midazolam

(Versed)

0.05-0.1 mg/kg/dose; may repeat

every 2 - 6 hrs as needed.

Continuous infusion: Start at

20 mCg/kg/hr and titrate to desired

sedation. Mean required dose is

30-60 mCg/kg/hr.

PO/OG/IV

Use the longer intervals in prematures. Tolerance

may develop. Respiratory and cardiac depression,

withdrawal, hypotension, bradycardia, myoclonic

movements, and desaturations may occur.

Potential for drug accumulation with frequent

dosing. Drips available as 0.1 or 1mg/mL.

* Lorazepam is preferred for intermittent

administration because it has no active metabolites,

doesn’t require continuous infusion, and is less

expensive.

Milrinone 0.2 – 0.75 mCg/kg/minute

continuous infusion

For short term use (1-3 days)

Not for premature neonates due to possibilities of

hypotension, tachycardia, and slowed ductal closure.

CONSULT CARDIOLOGY.

For use only in patients with cardiac failure who

have not adequately responded to other

inotropes. Start with lowest dose and titrate. May

have a role in PPHN patients who fail to respond

adequately to iNO. Limited information in

neonates. MODIFY DOSE IN RENAL

IMPAIRMENT. Incompatible with furosemide

Morphine

0.05 - 0.1 mg/kg/dose q 4-8h as

needed IV, IM

PO dose is 1.5 to 2 times the IV

dose

Continuous infusion:

23-26wk PMA: 10 mCg/kg/hr

27-29wk PMA: 20 mCg/kg/hr

> 30wk PMA: 30 mCg/kg/hr

When used for drug withdrawal,

refer to Neonatal Abstinence

Syndrome section under

“Miscellaneous” in text.

Use the longer intervals in premature infants.

Tolerance may develop. Respiratory depression,

withdrawal, hypotension, flushing, bradycardia, and

desaturations may occur.

► Continuous infusion indicated for severe pain not

controlled by intermittent dosing of opiates. Use in a

setting where analgesia is NOT indicated.

* Titrating to sedation (side effect) often results in

excessive doses. Benzodiazepines (lorazepam or

midazolam) may be a better choice when sedation is

the primary desired effect. Drips available as 0.2 or

1 mg/mL.

Nafcillin Dose: 25 mg/kg IV

Venous irritation

INTERVAL:

0-7 days PNA:

< 2 kg q12h

> 2 kg q8h > 7 days PNA:

< 1.2 kg q12h

1.2 – 2 kg q8h > 2 kg q6h

Narcan

(Naloxone)

0.1 mg/kg/dose IV, ET preferred;

IM, SC acceptable. May be

repeated every 3-5 minutes.

* Contraindication: maternal narcotic addiction

Nitroglycerin Initial: 0.1-0.5 mCg/kg/min IV

Usual dose: 1-3 mCg/kg/min

Titrate to effect. Vasodilator – reduces preload.

Continuously monitor blood pressure, heart rate,

oxygen saturation.

Nystatin 100,000 units 4 times/day PO

Opium, tincture of Use for neonatal drug withdrawal.

Refer to Neonatal Abstinence

Syndrome section under

Miscellaneous in text.

Oxacillin Dose: 25 mg/kg IV

INTERVAL:

0-7 days PNA:

< 2 kg q12h

> 2 kg q8h > 7 days PNA:

< 1.2 kg q12h

1.2 – 2 kg q8h

> 2 kg q6h

Causes venous irritation

Pancuronium

(Pavulon)

0.04 - 0.1 mg/kg/dose q30-120

minutes PRN IV

Monitor blood pressure and heart rate. Reduce dose

in renal dysfunction.

Pediarix (DTaP +

Hepatitis B + IPV)

0.5 mL IM 2 months chronologic age despite degree of

prematurity. Use of scheduled doses with

immunizations may diminish immune response:

consider PRN instead.

Penicillin G Dose: 25,000 – 50,000 units/kg

IV, IM

INTERVAL:

< 1.2 kg q12h

The higher doses are used in meningitis; for other

indications, use the lower doses.

> 1.2 – 2 kg:

0-7 days PNA: q12h

> 7 days PNA: q8h

> 2 kg:

0-7 days PNA: q8h

> 7 days PNA: q6h

For Group B Strep meningitis:

0-7 days: 150,000

units/kg/dose q8h

> 7 days: 112,000 units/kg/dose

q6h

* For treatment of congenital syphilis, refer to

Congenital Syphilis section under Infectious

Diseases in the text.

Phenobarbital Initial loading dose: 15-20 mg/kg

IV over no less than 20 minutes.

Subsequent loading doses: 5-10

mg/kg.

Maintenance dose: 3-5 mg/kg/day

qday or divided bid

Cholestasis/augment biliary

conjugation: 2-3 mg/kg/day

IV, IM, PO/OG

Trough level should be monitored to maintain

concentrations between 15 and 35 mCg/mL.

Check level at point of seizure resolution and

weekly thereafter x 2 weeks. Consult clinical

pharmacist for additional monitoring plan. Some

patients may require more frequent level

monitoring. Dosing may be divided q12h if single

daily dose not tolerated. Use the lower maintenance

dose in patients with history of birth depression or

prematurity.

Phentolamine

(Regitine)

For vasopressor infiltrate: Infiltrate

affected area with multiple small

subcutaneous injections of a 0.5

mg/mL solution. Change needles

between injections.

Use ASAP after pressor extravasation. Dilute with

normal saline. Not for hyperal extravasation.

Hypotension with large doses or doses given IV.

Do not administer more than 2.5 mg total.

Phenylephrine

0.125%

(Neo-Synephrine)

1-2 drops intranasally q8-12h; use

for no more than 24 hours.

For nasal congestion. Monitor blood pressure.

Phenytoin

(Dilantin)

Loading dose: 15-20 mg/kg IV at

no greater than 0.5 mg/kg/min;

may be diluted in 0.9% NaCl only

to a concentration of < 6 mg/mL.

Maintenance dose: 5-8 mg/kg/day

divided bid IV, PO. Higher oral

doses may be necessary to maintain

therapeutic levels.

Loading dose should be administered with

continuous ECG monitoring. Serum concentrations

should be monitored and doses adjusted to maintain

concentrations between 8 and 15 mCg/mL. Trough

levels are the most useful.

Hypotension and bradycardia possible. Check free

phenytoin level if toxicity is suspected, total level is

>15 or patient is hypoalbuminemic. Consider

fosphenytoin if only small peripheral venous access

is available. Can only be infused with normal saline.

Not compatible with heparin.

Piperacillin Dose: 75 mg/kg IV

INTERVAL (based on PMA &

PNA):

< 36 wks PMA:

< 7 days PNA: q12h

> 7 days PNA: q8h > 36 wks PMA:

< 7 days PNA: q8h > 7 days PNA: q6h

Adjust dosage in renal impairment.

Piperacillin/

Tazobactam

(Zosyn)

Dose: 84.4 mg/kg IV

INTERVAL (based on PMA &

PNA):

< 36 wks PMA:

< 7 days PNA: q12h

> 7 days PNA: q8h > 36 wks PMA:

< 7 days PNA: q8h

> 7 days PNA: q6h

Polytrim

Ophthalmic

See Trimethoprim and

Polymyxin B Ophthalmic

Potassium chloride For Hypokalemia:

0.5-1mEq/kg/dose IV

Infuse over a minimum of 2 hours.

Potassium

Phosphate

(IV preparation)

For Rickets of Prematurity:

0.5 - 2 mM/kg/day ÷ bid PO/OG

* alternate bid dosing with calcium

chloride so one or the other is

given every 6 hours.

May be added to formula or breastmilk feedings to

mask its unpleasant taste. Only given when full

volume enteral feeds are established.

Propranolol IV: 0.01 mg/kg/dose by slow IV

push q6-8h PRN. May increase

slowly to MAX of 0.15

mg/kg/dose.

PO/OG: 0.25 mg/kg/dose q6-8h.

May increase slowly to MAX of

5 mg/kg/day.

For Tetralogy Spells:

0.15-0.25 mg/kg/dose IV

For arrhythmias, hypertension. Avoid in patients

with respiratory compromise.

Prostaglandin E1

(PGE1)

Initial continuous infusion dose of

0.1 mCg/kg/min IV; wean to

0.025 - 0.05 mCg/kg/min as

tolerated.

To be used under direction of neonatologist or

pediatric cardiologist.

Protamine 0.5 - 1 mg IV for every 100 units

of heparin in the previous hour (50

mg/dose MAX).

Bleeding with excessive doses

Ranitidine

(Zantac)

Preterm:

IV: 1 mg/kg/day ÷ q12h

PO/OG: 2 mg/kg/day ÷ q12hrs

Term:

IV: 4 mg/kg/day ÷ q8h

PO/OG: 4-6 mg/kg/day ÷ q8h

* Can also be added to a 24 hour bag of

hyperalimentation at the same total daily dose.

Regitine See Phentolamine

Reglan See Metoclopramide

Rifampin 10 mg/kg/day ÷ q12h IV For synergy in persistently positive Staphylococcal

bacteremia.

Sildenafil 0.25 – 0.5 mg/kg q6-8h PO/OG

Consult Pediatric Cardiology

Sincalide 0.02 mCg/kg IV BID-TID For cholestasis. Use is controversial.

Sodium

Bicarbonate

For Cardiac arrest:

1-2 mEq/kg IV over 5 minutes; use

only for prolonged arrest.

For Metabolic acidosis:

1-2 mEq/kg IV over 1 - 2 hours

Use concentration of 0.5 mEq/mL (4.2%) only.

Use only after adequate ventilation is established.

Not to be used as first line for treating thick

respiratory secretions as no clinical trials exist to

support use. Use Normal Saline as first line.

Spironolactone

(Aldactone)

1-3 mg/kg/day ÷ q12h PO/OG Monitor serum potassium especially when used with

captopril or potassium supplements. May take

several days to see maximal effect. Survanta (Beractant)

RDS: 4 mL/kg/dose per ET

divided into 4 aliquots. Repeat

doses are given at least 6 hours

apart if indicated. MAX of 4 doses

in the first 48 hours of life.

Meconium aspiration syndrome:

6 mL/kg/dose q6h per ET for

MAX of 4 doses.

Use only under direction of neonatologist. Refer to

Surfactant Dosing Guidelines section under

Respiratory Problems in text.

Consult neonatologist for other possible uses such

as in congenital diaphragmatic hernia, persistent

pulmonary hypertension, or HMD in older

gestational age neonates.

Synagis

(Palivizumab)

15 mg/kg monthly IM during RSV

season.

See RSV Prophylaxis section under Infectious

Diseases in text for patient inclusion criteria. Must

be ordered on power plan with approval from NICU

pharmacist or PAS. Batch days are Monday and

Thursday with doses to be administered at 1400

Thorazine

See Chlorpromazine

Tobramycin

Same as under Gentamicin

TPA

(Alteplase)

Using a 5 mL syringe, gently and

slowly instill a volume of

1 mg/mL equal to or less than the

internal volume of the catheter.

Do not force the TPA into the

catheter. If device does not allow

infusion or aspiration, a gentle

repeated push-pull action can be

used to instill the TPA.

For clearing an occluded line.

Allow solution to dwell in line for 30-60 minutes;

then attempt to aspirate TPA from the catheter with

a 5 mL syringe. If unsuccessful, wait an additional

30 minutes before trying again to aspirate solution.

Once patency is restored, aspirate and discard 1-2

mL of blood. Replace this volume with normal

saline. For clot dissolution unrelated to occluded

lines, consult neonatologist.

Trifluridine 1% 1 drop in each eye every 2 hours For treatment of primary keratoconjunctivitis caused

by herpes simplex virus types 1 and 2.

Trimethoprim and

Polymyxin B

Ophthalmic

Solution

(Polytrim)

1-2 drops in each eye q4-6h For bacterial conjunctivitis.

Ursodiol

(Actigall)

25 - 30 mg/kg/day ÷ TID PO/OG

For cholestasis

Vancomycin Dose: 15 mg/kg IV

INTERVAL (based on PMA and

PNA):

< 2 weeks old:

- < 28 wks PMA: q24h

- 29 – 32 wks PMA: q18h - ≥33wks PMA: q12h

>2 weeks old:

o < 28 wks PMA: q18h

29 – 32 wks PMA: q12h

≥33wks PMA: q8h

Intravenous therapy reserved for species of

Staphylococcus and enterococcus resistant to other

agents. Levels not needed unless treatment to

continue past 3 days, there is renal impairment, or

patient received an unusually high dose.

Post/peak level should be 25-40 mCg/mL and

trough level 8-15 mCg/mL. Give less frequently in

infants with birth depression, congenital heart

disease, renal impairment, or on inotropic support.

Oxacillin is preferred drug if CONS is susceptible to

both vancomycin and oxacillin.

Vaponephrine 0.25-0.5 mL nebulized x 1

2.25% racemic epinephrine

Vecuronium

(Norcuron)

0.1 mg/kg/dose IV every 1-2 hours

as needed.

Monitor blood pressure and heart rate. Less likely to

cause hypertension and tachycardia than

pancuronium. Consider vecuronium when these side

effects become problematic. Drips available as 0.1

or 1 mg/mL.

Versed

See Midazolam

Vidarabine 3%

Ophthalmic

Ointment (Vira-A)

Apply ointment to lower

conjunctival sac every 2 hours

For treatment of primary keratoconjunctivitis caused

by herpes simplex virus.

Vira-A Ophthalmic

See Vidarabine Ophthalmic

Viroptic

Ophthalmic

See Trifluridine

Zantac

See Ranitidine

Zidovudine (AZT) Preterm:

< 30 weeks PMA:

IV: 1.5 mg/kg/dose q12h or

PO/OG: 2 mg/kg/dose q12h

for 4 weeks, then q8h

> 30 weeks PMA:

IV: 1.5 mg/kg/dose q12h or

PO/OG: 2 mg/kg/dose q12h

for 2 weeks, then q8h

Term:

PO/OG: 4 mg/kg/dose q12h or

IV: 1.5 mg/kg/dose q6h

Refer to HIV Exposed Infants section under

Infectious Diseases in text. Dosing to begin within

6-12 hours of birth and continue through 6 weeks.

Do not give IM. Monitor CBC with diff and

hemoglobin. IV infusion to be over 1 hour at < 4

mg/mL concentration in D5W.

Zosyn See Piperacillin/Tazobactam

neonatal formulary · aldactazide 2 - 4 mg/kg/day ÷ q12h po/og contains hydrochlorothiazide and...

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