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Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 1
Neonatal Guidelines
Chapter 15: Pharmacy related Version: 2017.1
Specialty: Neonatal Medicine Revised by: Katherine Wilson Edited by: Sujoy Banerjee Date Revised: 24th January 2017 Approved by: ABMU Joint Perinatal Forum Date Ratified: 6th February 2017 Date of implementation 1st March 2017 Date for Review: 1st March 2020
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 2
Directorate of Child Health
Checklist for Clinical Guidelines being submitted for Approval by
ABMU Joint Perinatal Forum
Title of Guideline: Chapter 15: Pharmacy related v2017.1
Name(s) of revision author: Katherine Willson; Edited :Sujoy Banerjee
Chair of Group or Committee supporting submission:
Neonatal Guideline Group – Sujoy Banerjee
Issue / Version No: Chapter 15: Pharmacy related v2017.1
Next Review / Guideline Expiry: Review date: 1st March 2020
Details of persons included in consultation process:
Neonatal Consultants, Neonatal junior doctors, Nursing Managers, Neonatal Pharmacist
Brief outline giving reasons for document being submitted for ratification
Routine Revision
Name of Pharmacist (mandatory if drugs involved):
Katherine Willson
Please list any policies/guidelines this document will supercede:
Chapter 15: Pharmacy related v 2014.11 – 29th September 2015
Keywords linked to document: Pharmacy, drugs, formulary, neonate
Date approved by ABMU Joint Perinatal Forum:
6th February 2015
File Name: Used to locate where file is stores on hard drive
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 3
Changes included in the latest revision v2017.1
New guidance on
1. Clonidine
2. Peripheral dopamine
3. Hydrocortisone for Chronic Lung Disease
Minor modification on
1. IV Midazolam
2. Dexamethasone
3. Dobutamine
4. Tazocin
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 4
CONTENTS Topics Page number Aciclovir 5 Adrenaline 6 Bicarbonate 7 Calcium gluconate 9 Clonazepam 10 Clonidine 11 Dexamethasone 12 (Dinoprostone)Prostaglandin E2 13 Dobutamine 14 Dopamine 16 Dopamine by peripheral route 17 Heparin 18 Hydrocortisone 19 Insulin 20 Liver medication for conjugated jaundice 21 Levetiracetam 22 Magnesium Sulphate 23 Midazolam 25 Morphine 26 Noradrenaline 28 Tazocin 29 THAM 30 Vecuronium 31
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 5
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
ACICLOVIR
USE:
Treatment and prophylaxis of herpes simplex and varicella zoster infection
DOSE:
10-20mg/kg iv every 8 hours Infusion given over 1 hour
PREPARATIONS:
Aciclovir infusion 250mg in 10ml
DILUTION:
Dilute to a concentration of at least 5mg in 1ml before administration
DILUENTS:
Glucose 5% Sodium chloride 0.9%
KNOWN COMPATIBILITY:
Cefotaxime, Ceftazidime,Fluconazole, Gentamicin, Heparin, Imepenem, Metronidazole, Potassium, Ranitidine, Vancomycin
KNOWN INCOMPATIBILITIES:
Dobutamine, Dopamine, Meropenem,Morphine, Tazocin
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Chapter 15: Pharmacy related v2017.1 6
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
ADRENALINE
USE:
Inotrope
DOSE:
VIA A CENTRAL LINE Initially 100-300nanograms /kg/minute up to a maximum of 1.5micrograms/kg/minute
PREPARATIONS:
Adrenaline 1mg in 1ml (1:1000) Adrenaline 100micrograms in 1ml (1:10,000)
DILUTION:
Weight in Kg x1.5= mg of adrenaline made up to 25ml with 10% dextrose 0.1ml /hour = 100nanogram/kg/minute
DILUENTS:
Dextrose 5%,Dextrose 10%, Sodium Chloride 0.9%
KNOWN COMPATIBILITY:
Calcium Salts, Dopamine,Dobutamine,Doxapram,Fentanyl,Frusemide, Heparin,Insulin,Midazolam,Milrinone,Morphine,Noradrenaline, Pancuronium,Potassium Chloride,Ranitidine,TPN, Vecuronium
KNOWN INCOMPATIBILITIES:
Lipid, Lignocaine, Sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 7
Sodium Bicarbonate
Half correction for Metabolic acidosis:
Base deficit (mmol/l) x body weight (Kg) x 0.3 = mmol of bicarbonate required
4.2% sodium bicarbonate contains 0.5 mmol bicarbonate / ml.
Always try to correct the underlying condition leading to metabolic acidosis. The correction if
necessary, should ideally be undertaken over several hours as a slow infusion. This
correction will always undercorrect the acidaemia but is usually sufficient.
THAM is an alternative base. It has the advantage of being sodium free and shouldn’t raise
the PaCO2. Therefore this may be preferred if the baby has very high sodium or PaCO2.
However it stops premature babies breathing so should only be used in babies who are
being ventilated.
1 ml of 7.2% THAM is approx equivalent to 1 mmol bicarbonate.
Bicarbonate infusion through arterial line in extremely premature babies
(<26 weeks gestation):
Extremely preterm neonates (<26/40 weeks) can be anticipated to develop a metabolic
acidosis. This can be due to renal tubular loss of bicarbonate accompanied by chloride
retention leading to a hyperchloremic metabolic acidosis.
In the short term, metabolic acidosis is associated with the following abnormalities:
Inhibition of surfactant production
Increases in pulmonary vascular resistance
Reduction in cardiac output
Abnormal EEGs (consequences unclear)
In the longer term, a pH <7.2 is associated with an abnormal neurodevelopmental outcome
in preterm neonates <1000g.
Metabolic acidosis is predominantly corrected by identifying its cause. Whether correction
of metabolic acidosis improves outcome has not been studied in a randomised trial.
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Chapter 15: Pharmacy related v2017.1 8
However, if bicarbonate treatment is given, it is best administered slowly. Twenty-four hour
intravenous infusions are associated with decreased mortality, whereas rapid infusions are
associated with an increased incidence of IVH.5
Hence, prophylactic arterial infusion of low dose bicarbonate in this high risk population is
established clinical management in many UK neonatal units.
Route: Bicarbonate should be infused through a UA or peripheral arterial line.
Dose: 0.54mmols of NaHCO3 administered per 24-hours (or about 1mmol/kg/day
for a 500g neonate).
Preparation:
3mls of 4.2% NaHCO3 (=1.5mmol)
16mls of sterile water for injection
1ml of hepsaline equivalent to 10 iu of heparin
Total volume 20 mls with heparin conc. of 0.5 i.u/ml
Infusion rate: Run solution at 0.3ml/hr
Use a three way tap in between the baby and the transducer to infuse continuous
bicarbonate solution as above through the side arm (Transducer set in a normal way with
0.45% hepsaline attached but not infusing from the syringe). During sampling stop
bicarbonate infusion, sample in the usual way and flush with hepsaline from the syringe.
Once flushed restart bicarbonate solution.
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Chapter 15: Pharmacy related v2017.1 9
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG: CALCIUM GLUCONATE USE: Hypocalcaemia DOSE: Urgent IV Correction
200mg/kg calcium gluconate 2ml/kg calcium gluconate 10%
Maintenance
0.5mmol/kg/24hours calcium 2.5ml/kg/24hours calcium gluconate10%
PREPARATIONS: Calcium Gluconate 10%
100mg calcium gluconate in 1ml 0.22mmol calcium in 1ml
DILUTION: Urgent Correction
Slow IV injection over 5-10minutes
Continuous infusion
Dilute dose required 10 fold Maximum administration rate 22micromol/kg/hour
DILUENTS: Dextrose 5%
Dextrose 10% Sodium Chloride 0.9%
KNOWN COMPATIBILITY: Adrenaline, Heparin, Midazolam,
Noradrenaline, Potassium Chloride
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Chapter 15: Pharmacy related v2017.1 10
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
CLONAZEPAM
USE:
Anticonvulsant
DOSE:
IV Bolus 100microgram/kg/day over 30mins IV Infusion Initially 50microgram/kg THEN 10microgram/kg/hour adjustedaccording to response (Max 60microgram/kg/hour)
PREPARATIONS:
Clonazepam 1mg in 1ml supplied with a further 1ml ampoule water for injection. Mix immediately before use
DILUTION:
IV BOLUS
Dilute dose to 100microgram in 1ml
IV INFUSION (Weight in grams x0.5)=micrograms of clonazepam made up to 50ml with 5% dextrose 1ml/hr=10micrograms/kg/hour Administer in NON PVC containers Expiry 12 hours
DILUENTS:
Dextrose 5% Dextrose 10% Sodium chloride 0.9%
KNOWN COMPATIBILITY:
None
KNOWN INCOMPATIBILITIES: Sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 11
SINGLETON HOSPITAL - NEONATAL UNIT
Drug: Clonidine Use: Sedation/Opiate withdrawal Dosage: Orally 3 microgram/kg/dose three times daily,
can be increased upto 5 microgram/kg/dose TDS
Weaning: Can be stopped immediately if used for < 2 weeks.
If used for > 2 weeks, reduce daily over 5 days by 1 microgram/kg/dose (i.e. 5,4,3,2,1) tds then stop
Preparation : Clonidine Hydrochloride ( 10 microgram in 1 ml) oral
Solution
Note : Close cardiovascular monitoring especially baby’s
blood pressure ( hourly for first 6 hours, 2 hourly over next 6 hours, then 4 hourly over next 12 hours.)
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Chapter 15: Pharmacy related v2017.1 12
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
DEXAMETHASONE
USE:
Treatment of chronic lung disease
DOSE:
60mcg/kg bd day1-3 40mcg/kg bd day4-6 20mcg/kg bd day7-8 8mcg/kg bd day 9-10 Doses given are as dexamethasone base
PREPARATIONS:
DEXAMETHASONE 3.3mg in 1ml (Hameln) This is 3.3mg/ml dexamethasone base
DILUTION:
Take 0.3ml and dilute to 10ml with 5% dextrose to give a solution containing 100microgram/ml dexamethasone base. Give as infusion over minimum of 5-10mins
DILUENTS:
Dextrose 5% Sodium Chloride 0.9%
KNOWN COMPATIBILITY:
Aciclovir, Heparin, Morphine, Potassium, Ranitidine,
KNOWN INCOMPATIBILITIES:
Ciprofloxacin, Midazolam, Vancomycin
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Chapter 15: Pharmacy related v2017.1 13
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
DINOPROSTONE (Prostagandin E2)
USE:
Maintain patency of ductus arteriosus
DOSE:
Initially 5nanograms/kg/minute up to a maximum of 40nanogram/kg/minute
PREPARATIONS:
0.75ml ampoule containing 1mg in 1ml
DILUTION:
For 5nanogram/kg/minute Add 0.5ml(500microgram) to 500ml of 10% glucose to give a solution of 1microgram in 1ml. Infuse at 0.3ml/kg/hour
DILUENTS:
Dextrose 5% Dextrose 10%
KNOWN COMPATIBILITY:
None
KNOWN INCOMPATIBILITIES:
VERY UNSTABLE – do not use with any other drugs
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Chapter 15: Pharmacy related v2017.1 14
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
DOBUTAMINE
USE:
Inotrope
DOSE:
5-20micrograms/kg/minute by continuous infusion Concentrations above 5mg in 1ml must be given centrally
PREPARATIONS:
Dobutamine 250mg in 20ml (12.5mg in 1ml)
DILUTION:
SINGLE STRENGTH (Weight in Kgx30)=mg dobutamine made up to 50ml with 5% or 10% dextrose 0.2-2ml/hour=2-20microgram/kg/minute DOUBLE STRENGTH (Weight in Kg x30)=mg dobutamine made up to 25ml with 5% or 10% dextrose 0.1-1ml/hour =2-20microgram/kg/minute QUADRUPLE STRENGTH (Weight in Kg x30)=mg dobutamine made up to 12.5ml with 5% or 10% dextrose 0.1-0.5ml/hour=4-20microgram/kg/minute
DILUENTS: Dextrose5%, Dextose10%
Sodium chloride 0.9% KNOWN COMPATIBILITY: Adrenaline, amiodarone, dopamine,
fentanyl, lignocaine, morphine, noradrenaline, pancuronium, potassium,
ranitidine
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Chapter 15: Pharmacy related v2017.1 15
KNOWN INCOMPATIBILITIES: Aciclovir, calcium gluconate, digoxin, frusemide, heparin, indomethacin, magnesium sulphate, phenytoin, sodium bicarbonate, Tazocin
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Chapter 15: Pharmacy related v2017.1 16
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
DOPAMINE
USE:
Inotrope
DOSE:
2-20micrograms/kg/minute by continuous iv infusion
PREPARATIONS:
Dopamine Hydrochloride 200mg in 5ml
DILUTION:
SINGLE STRENGTH (Weight in Kg x30) = mg dopamine made up to 50ml with 5% or 10% dextrose 0.2-2ml/hour = 2-20 microgram/kg/minute DOUBLE STRENGTH (Weight in Kg x30) = mg dopamine made up to 25ml with 5% or 10% dextrose 0.1-1ml/hour= 2-20 microgram/kg/minute QUADRUPLE STRENGTH (Weight in kg x30) = mg dopamine made up to 12.5ml with 5% or 10% dextrose 0.1-0.5ml/hour= 4-20 microgram/kg/minute
DILUENTS:
Dextrose 5% Dextrose 10% Sodium chloride 0.9%
KNOWN COMPATIBILITY:
Adrenaline, amiodarone, dobutamine, fentanyl Gentamicin, heparin, midazolam, morphine, noradrenaline, pancuronium, potassium chloride, ranitidine, vecuronium
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Chapter 15: Pharmacy related v2017.1 17
KNOWN INCOMPATIBILITIES:
Alkaline solutions, aciclovir, amphotericin, ampicillin, benzylpenicillin, indomethacin, insulin, metronidazole, sodium bicarbonate, tolazoline, TPN
SINGLETON HOSPITAL - NEONATAL UNIT DOPAMINE INFUSION VIA PERIPHERAL IV LINE
Preparation: 40mg of Dopamine to be diluted to 25 ml of preferred
diluent Infusion: 5 microgram/kg/minute at a rate of 0.19 ml/kg/hr
10 microgram/kg/minute at a rate of 0.38 ml/kg/hr 15 microgram/kg/minute at a rate of 0.57 ml/kg/hr 20 microgram/kg/minute at a rate of 0.76 ml/kg/hr
Diluent: Dextrose 5%, Dextrose 10%, 0.9% normal saline Please note:
1. Dopamine should only be given peripherally in exceptional circumstances.
2. Maximum infusion concentration should not
exceed 1.6 mg/ml via peripheral line.
3. For babies less than 1.3 kg, our current single and double strength dilutions are using dopamine less
than 1.6 mg/ml limit.
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Chapter 15: Pharmacy related v2017.1 18
SINGLETON HOSPITAL - NEONATAL UNIT
I.V. INFUSION GUIDE DRUG:
HEPARIN solution
USE:
For arterial lines
DOSE:
0.5units/hour =0.5ml/hour (made up as below)
PREPARATIONS:
Pre-filled syringes 50units heparin in 50ml of 0.45% sodium chloride
DILUTION:
To make on the unit - if pre-filled syringe not available Add 5ml (50units) of Hepsal to 45ml Sodium chloride 0.45% to give 50units in 50ml (1unit /ml) NB 0.45% sodium chloride @0.5mls/hr administers 0.9mmol of Na / 24 hours. This with 0.18mmol from heparin means baby gets 1mmol of Na /24 hrs by this route
DILUENTS:
Sodium chloride 0.45% Dextrose 5% Dextrose 10%
KNOWN COMPATIBILITY:
Aciclovir, adrenaline, benzylpenicillin, calcium gluconate, dopamine, fentanyl, frusemide, insulin, lipid, magnesium sulphate, metronidazole, morphine, noradrenaline, pancuronium, ranitidine, sodium bicarbonate, TPN, vecuronium
KNOWN INCOMPATIBILITIES:
Erythromycin, gentamicin, vancomycin
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Chapter 15: Pharmacy related v2017.1 19
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
Hydrocortisone
USE: DOSE:
Hypotension in pre-term neonates. To reduce CLD and facilitate extubation Hypotension 1-2mg/kg bd for 3 days Facilitate extubation 1.25mg/kg qds for 7 days 0.9mg/kg qds for 5 days 0.6mg/kg qds for 5 days 0.3mg/kg qds for 5days Give as iv bolus over 3-5mins
PREPARATIONS:
Hydrocortisone sodium succinate 100mg Hydrocortisone in 2ml
DILUTION:
Reconstitute 100mg with diluents (water for injection) provided to give 100mg in 2ml.Further dilute 1ml to 10mlto give 5mg in 1ml
DILUENTS:
Sodium Chloride 0.9% Glucose 5%
KNOWN COMPATIBILITIES: Dopamine, Frusemide, Morphine KNOWN INCOMPATIBILITIES: Midazolam, Phenytoin
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Chapter 15: Pharmacy related v2017.1 20
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE -- INSULIN
Plastic tubing used for infusion should be flushed with at least 20mls of insulin solution and
primed by for at least 20 minutes before use because insulin binds to the tubing resulting in
decreased availability to the baby. It is extremely important that any replacement set is also
fully primed.
Do not use the line to give any other medications e.g. antibiotics as this will result in a
bolus of insulin with potentially significant hypoglycaemia. If there is only one peripheral
cannula other infusions should be administered at the hub of the cannula.
Insulin infusion – Add 25 units/kg of insulin to 50 ml of i.v. solution, then infuse at 0.2 ml/hr
(which equates to 0.1 units/kg/hr). Infuse at 0.05 – 0.1units/kg/hr. The following sliding scale
is a recommendation, but may need adjusting to suit individual requirements.
Blood Glucose Rate of infusion of solution
>20 mmol/l 0.2ml/hr (0.1 units/kg/hr)
8 – 20 mmol/l 0.1 ml/hr (0.05 unit/kg/hr)
< 8 mmol/l Stop insulin infusion
If fluids are restricted a double strength infusion can be prepared by diluting 50 units/kg to 50 ml
i.v. solution where 0.1 ml/hour = 0.1 unit/kg/hour. No more than 0.5 units/kg/hr is usually needed.
Some growth retarded and very pre-term babies can be very sensitive to the effects of insulin so
monitor blood glucose very frequently at the start of the infusion.
Diluents: Sodium chloride (0.45% and 0.9%) and Dextrose 5% and 10%. The infusion should be
freshly prepared every 24 hours. Vials of insulin should be stored in a refrigerator at 2 – 8o C. Do not
use if the solution appears hazy or coloured.
Known compatibilities: Can be added (terminally) to a line containing: Dobutamine, Heparin,
Midazolam, Milrinone, Morphine, Potassium, TPN (Aqueous), Vancomycin
Known incompatibilities: Aminophylline, Phenytoin, Phenobarbitone, Dopamine,
sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 21
Liver medication for babies with conjugated jaundice
Babies with neonatal cholestasis where the conjugated bilirubin fraction is greater than 50
umol/l will need additional supplements of fat soluble vitamins. This recommendation is
adapted from the King’s college, London guidelines 2009 for neonatal cholestatsis.
Option 1:
Dalavit 0.3 mls BD OR Abidec 0.3mls BD orally
Vitamin E 10mg/Kg OD orally
Vitamin K 1mg OD orally / intravenously
Ursodeoxycholic acid 5-10mg/Kg TDS orally
Option 2 (If medications in option 1 are not available):
Ketovite liquid 5mls OD orally
Ketovite tablet 3tab crushed along with Ketovite liquid
Vitamin K 1mg OD orally / intravenously
Ursodeoxycholic acid 5-10mg/Kg TDS orally
In addition, for both options, you may consider Alfacalcidol 5-10nanogram/kg/day if you
have confirmed evidence of Vitamin D deficiency. You will need close monitoring of serum
calcium and phosphate levels.
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Chapter 15: Pharmacy related v2017.1 22
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG: LEVETIRACETAM USE: Treatment of seizures DOSE: GIVE ONLY BY IV INFUSION OVER 15 MINS.
*Loading dose of 30mg/kg iv followed after 12 hours by a maintenance dose of 10mg/kg iv/po bd.
PREPARATIONS: Levetiracetam 500mg in 5ml infusion DILUTION: Dilute 1ml to 10ml to give a concentration of
10mg in 1ml before administering. DILUENTS: Glucose 5%
Sodium chloride 0.9%
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Chapter 15: Pharmacy related v2017.1 23
SINGLETON HOSPITAL-NEONATAL UNIT I.V. INFUSION GUIDE
DRUG: MAGNESIUM SULPHATE USE: Hypocalcaemia Hypomagnesaemia Persistent Pulmonary Hypertension DOSE: Hypocalcaemia/Hypomagnesaemia
100mg/kg by iv infusion This dose can be repeated every 12 hours as necessary for 2-3 doses Maximum infusion rate 10mg/kg/min Persistent Pulmonary Hypertension
Loading dose 200mg/kg over 20-30mins,if response occurs then by continuous infusion of 20-75mg/kg/hour to maintain plasma magnesium concentration between 3.5-5.5mmol/litre for 2-5days PREPARATIONS: Magnesium Sulphate 50% 10ml ampoule (contains 5g in 10ml) DILUTION: * Dilute to 100mg in 1ml before administration as follows* Draw up 2ml Magnesium Sulphate 50% and
make up to 10ml with diluent to give a solution containing 100mg in 1ml
Give required dose as infusion over 20-30minutes. For continuous infusion 20mg/kg/hour=0.2ml/kg/hour
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Chapter 15: Pharmacy related v2017.1 24
DILUENTS: Dextrose 5% , sodium Chloride 0.9% KNOWN COMPATIBILITY: Insulin, morphine, TPN, Vancomycin KNOWN INCOMPATIBILITIES: Ambisome,dobutamine, metronidazole,
salbutamol and sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 25
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
Midazolam
USE:
Anticonvulsant
DOSE:
Initially 100-200microgram/kg over 5minutes followed by a continuous infusion of 30-300microgram/kg/hour
PREPARATIONS:
Many different concentrations and ampoule sizes. CHECK CAREFULLY
DILUTION: DILUENTS:
Dilute 15mg/kg body-weight to 50ml Infuse at 0.1ml/hour to give 30microgram/kg/hour Dextrose 5% Dextrose10% Sodium Chloride 0.9%
KNOWN COMPATIBILITY:
Adrenaline,Calcium Gluconate,Dopamine,Fentanyl, Heparin,Morphine,Noradrenaline,Pancuronium. Potassium chloride,TPN
KNOWN INCOMPATIBILITY: Furosemide, Sodium bicarbonate,Ranitidine
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Chapter 15: Pharmacy related v2017.1 26
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
MORPHINE SULPHATE
USE:
Sedation during ventilation
DOSE:
IV Infusion 5-20micrograms/kg/hour Pre-intubation dose=50microgram/kg
PREPARATIONS:
Morphine suphate 500microgram in 10 ml Dextrose 5%
DILUTION:
See attached nomogram
DILUENTS:
Dextrose 5% Dextrose 10% Sodium chloride 0.9%
KNOWN COMPATIBILITY:
Adrenaline, Amiodarone, Dobutamine, Dopamine, Magnesium sulphate, Midazolam, Noradrenaline,Pancuronium, Potassium chloride, Ranitidine
KNOWN INCOMPATIBILITIES:
Alkaline solutions, Aciclovir, Frusemide,Heparin, Sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 27
MORPHINE SYRINGES – 50 MICROGRAMS PER 1ML DEXTROSE 5%
Baby’s
Weight
5 mcg/kg/hr
10 mcg/kg/hr
20 mcg/kg/hr
0.5 kg
-
0.1ml/hr
0.2ml/hr
0.75 kg
0.1 ml/hr
0.15ml/hr
0.3ml/hr
1.0 kg
0.1ml/hr
0.2ml/hr
0.4ml/hr
1.25 kg
0.12 ml/hr
0.25ml/hr
0.5ml/hr
1.5 kg
0.15 ml/hr
0.3ml/hr
0.6ml/hr
1.75 kg
0.17ml/hr
0.35ml/hr
0.7ml/hr
2.0 kg
0.2ml/hr
0.4ml/hr
0.8ml/hr
2.25 kg
0.22ml/hr
0.45ml/hr
0.9ml/hr
2.5 kg
0.25ml/hr
0.5ml/hr
1.0ml/hr
2.75 kg
0.27ml/hr
0.55ml/hr
1.1ml/hr
3.0 kg
0.3ml/hr
0.6ml/hr
1.2ml/hr
3.25 kg
0.32ml/hr
0.65ml/hr
1.3ml/hr
3.5 kg
0.35ml/hr
0.7ml/hr
1.4ml/hr
3.75 kg
0.37ml/hr
0.75ml/hr
1.5ml/hr
4.0 kg
0.4ml/hr
0.8ml/hr
1.6ml/hr
**For intermediate weights - round up or down to the nearest specified weight in the table.
PRE-INTUBATION DOSE: (ONLY FOR ELECTIVE INTUBATION)
50 micrograms/kg BOLUS (1 ml/kg) NOTE : Syringes are unable to infuse at rates < 0.1 ml/hr
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Chapter 15: Pharmacy related v2017.1 28
SINGLETON HOSPITAL - NEONATAL UNIT
I.V. INFUSION GUIDE DRUG:
NORADRENLINE
USE:
Vasoconstrictor to treat hypotension
DOSE:
VIA A CENTRAL LINE 20-100nanograms/kg/min noradrenaline base adjusted according to response. Max 1.5microgram/kg/minute
PREPARATIONS:
Noradrenaline acid tartrate 2mg in 1ml equivalent to Noradrenaline BASE 1mg in 1ml
DILUTION:
Weight in kg x 1.5 = mg noradrenaline base made up to 25ml with dextrose 10% 0.1ml/hour=100nanogram/kg/minute Protect infusion from light Discard solution if brown colour develops
DILUENTS: Dextrose 5% Dextrose 10%
KNOWN COMPATIBILITY:
Adrenaline, calcium gluconate, dobutamine dopamine, fentanyl , heparin, magnesium sulphate, midazolam, morphine,potassium chloride, TPN
KNOWN INCOMPATIBILITIES: Insulin, lignocaine, sodium bicarbonate
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Chapter 15: Pharmacy related v2017.1 29
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
TAZOCIN (Piperacillin with tazobactam)
USE:
Broad spectrum antibiotic
DOSE:
See Neonatal Formulary AS IV Bolus over 3-5mins or infusion over 30mins
PREPARATIONS:
Injection 2.25g vial NB 1g contains 2mmol Na (Tazocin) Manufacturers; Sandoz,Pfizer Wockhardt Actavis,Noridem Fresenius Kabi
DILUTION:
Displacement value 2.25g=1.58ml Add 8.4ml Water for Injection or Sodium chloride 0.9% to 2.25g vial to give a concentration of 225mg in 1ml For infusion further dilute above solution to at least 90mg in 1ml and give over 30mins Piperacillin/Tazobactam (Bowmed,Stragen) Displacement value 2.25g=1.7ml Add 8.3ml Water for Injection or Sodium chloride 0.9% to 2.25g vial to give a concentration of 225mg in 1ml For infusion further dilute above solution To at least 90mg in 1ml and give over 30mins
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 30
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
THAM (tris-hydroxymethyl aminomethane/ trometamol, tromethamine)
USE:
Metabolic acidosis when sodium bicarbonate inappropriate
DOSE:
Calculate total no. of mmol of bicarbonate required for half correction 0.3 × base deficit (mmol/litre) × weight (Kg) 1mmol of bicarbonate = 1ml of 7.2% THAM = 1 ml of 8.4% sodium bicarbonate Give over 30 minutes or longer
PREPARATIONS:
5mL ampoule containing THAM 7.2%
DILUTION:
Dilute THAM 7.2% to 3.6% Concentration using an equal volume of dextrose 5% or water for injection If necessary, fluid restricted patients may be given THAM 7.2% undiluted via a long line or central line
DILUENTS:
Dextrose 5% Water for injection
KNOWN INCOMPATIBILITIES: Benzylpenicillin
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 31
SINGLETON HOSPITAL - NEONATAL UNIT I.V. INFUSION GUIDE
DRUG:
VECURONIUM
USE:
Non depolarising muscle relaxant used in ventilation
DOSE:
IV BOLUS Initially 80-100microgram/kg then 30-50microgram/kg adjusted according to response, usually every 2-4hours IV INFUSION 50-80microgram/kg/hour
PREPARATIONS:
10mg vecuronium powder with 5ml water for injection to give a solution of 2mg in 1ml
DILUTION:
SINGLE STRENGTH (Weight in Kg x5) =mg of vecuronium made up to 50ml with 5% dextrose 0.5-1ml/hr=50-100microgram/kg/hr DOUBLE STRENGTH (Weight in Kg x10)=mg of vecuronium made up to 50ml with 5% dextrose 0.25-0.5ml/hr=50-100microgram/kg/hr QUADRUPLE STRENGTH (Weight in Kg x20)=mg of vecuronium made up to 50 ml with 5% dextrose 0.125-0.25ml/hr=50-100microgram/kg/hour
DILUENTS:
5% dextrose 10% dextrose 0.9% sodium chloride 0.45% sodium chloride
Neonatal Guidelines Valid until 1st March 2020
Chapter 15: Pharmacy related v2017.1 32
KNOWN COMPATIBILITY:
Adrenaline,Aminophylline, Dopamine,, Dobutamine, Fentanyl, Heparin, Hydrocortisone, Midazolam, Morphine,Noradrenaline, Ranitidine, Vancomycin
KNOWN INCOMPATIBILITIES:
Diazepam, Frusemide, Sodium bicarbonate
Checked by Katherine Willson: Neonatal Pharmacist, January 2017