neonatal drug formulary

Neonatal Drug Formulary

Neonatal Unit (NNU) Mbale Regional Referral Hospital

June 2017

Neonatal Drug Formulary Editors: Dr Kathy Burgoine Paediatrician Dr Alex Sande Pharmacist Contributors: Dr Alex Sande Pharmacist Dr Kathy Burgoine Paediatrician Sunny La Valle Neonatal Nurse Sara Talewoya Paediatric Nurse

The printing of this Neonatal Formulary is sponsored by Born on the Edge

ThisformularyisaimedformedicalandnursingstaffworkinginneonatalcareatMbaleRegionalReferralHospitalThedrugdosesarerelevantupto1monthcorrectedageThedrugdosesspecifiedinthisformularyareinaccordancewithourneonatalguidelinesThemainreferenceguideistheBNFforchildrenpublishedin2014

Neonatal Unit, Mbale Regional Referral Hospital, June 2017

Notes on neonatal medications:

If you are prescribing medications for neonates, the doses may be very small, so there is much more chance of an error occurring.

Please follow the Neonatal Drug Formulary carefully when prescribing and administering medications to neonates. This will help you to avoid errors.

Prescribe and administer medicines at a time when it is easy for staff. Avoid times of when there is a change of staff shifts as this may result in a delay in administration.

Document clearly on the front of the prescription chart

• patient’s name • hospital number • birth weight or highest weight

Always write the drug dosage and not the volume, e.g. “mg” not “ml” except for when prescribing Haemoforte and Grovit syrups.

UNITS

1 Kilogram (kg) = 1000 grams 1 gram (g) = 1000 milligrams 1 milligram (mg) = 1000 micrograms 1 microgram (mcg) = 1000 nanograms


Drug

Amikacin

Indication

Usedforthemanagementofneonatalsepsisontheadviceofaseniordoctorormicrobiologist

Presentation

Vial:500mg/2ml

Dose:

Term:15mg/kgperdoseoncedaily<2.5kg:10mg/kgperdoseoncedaily<1kg:7.5mg/kgperdoseoncedaily

Preparation:

Diluent:

• Waterforinjection• D5,5%dextrose• NS,0.9%saline

Drawup0.4ml(100mg)fromvialAdd9.6mlofdiluenttomakeatotalof10mlTotalamount=100mgin10mlFinalconcentration=10mg/mlExampledoseswhendilutedasdescribedabove:Dose 10mg 15mg 30mg 45mg 60mg 75mgVolume 1.0ml 1.5ml 3ml 4.5ml 6ml 7.5ml

Administration

Intravenous(IV):SlowIVinjectionover3-5minutesIntramuscular(IM)

Adverseeffects

HearinglossReducedrenalfunctionRenalFailure

Comments

UseAmikacinwithin24hoursofdilutingStoreinfridgeifpossibleFlushthecannulabeforeandafterwith0.5ml-1mlofNS


Drug

Aminophylline

Indication

Usedforthemanagementofapnoeaofprematurity

Presentation

Vial:250mgin10ml=25mg/ml

Dose:

Loadingdose:6mg/kgONCEONLYMaintenancedose:2mg/kg/doseTWICEDAILY.Startmaintentancedose12hoursafterloadingdose.Ifstillhavingapnoeaconsiderincreasingmaintenancedoseto3mg/kg/doseTWICEDAILY

Preparation:

Diluent:

• Waterforinjection• 0.9%SodiumChloride(NS)• 5%Dextrose(D5)

Drawup2mlAminophylline(50mg)Add8mltomakeatotalof10mlTotalamount=50mgin10mlFinalconcentration=5mg/mlExampledoseswhendilutedasdescribedabove:Dose 2mg 3mg 4mg 6mg 9mg 12mgVolume 0.4ml 0.6ml 0.8ml 1.2ml 1.8ml 2.4ml

Administration

Loadingdose:Intravenous(IV)over20minutesMaintenancedose:Intravenous(IV)slowIVpushororally

Adverseeffects

TachycardiaFeedingintoleranceJitterySeizures

Comments

UseAminophyllinewithin24hoursofdilutingFlushthecannulabeforeandafterwith0.5ml-1mlofNS


Drug

Ampicillin

Indication

NeonatalinfectionscausedbysusceptibleorganismsProvidesgoodcoverforGroupBStreptococcusandListeria

Presentation

Vial:500mgpowderforinjectionVial:1000mg(1g)powderforinjection

Dose:

50mg/kg/doseIV100mg/kg/doseformeningitisPostnatal age Frequency Under 7 days 12 hourly / BD 7 to 21 days 8 hourly / TDS

21 to 28 days 6 hourly / QDS

Preparation:

Diluent:

• Waterforinjection• 0.9%sodiumchloride(NS)• 10%or5%Dextrose(D5orD10)

Ifusing500mgvial:Add5mlFinalconcentration=100mg/mlIfusing1000mgvial:Add10mlFinalconcentration=100mg/mlExampledoseswhendilutedasdescribedabove:Dose 50mg 75mg 100mg 125mg 150mg 200mgVolume 0.5ml 0.8ml 1.0ml 1.3ml 1.5ml 2.0ml

Administration

Intravenous(IV)Intramuscular(IM)

Adverseeffects

Comments

Usewithin2hoursofmixingFlushthecannulabeforeandafterwith0.5ml-1mlofNS,especiallybetweenAmpicillinandGentamicinDonotmixinthesamesyringeasGentamicinasthiscancauseinactivationofbothdrugsIncreasethedosageintervalifthereisrenalfailure


Drug

Benzylpenicillin(PenicillinG,Crystapen)

Indications

Neonatalinfectionscausedbysusceptibleorganisms

Presentation

Vial:600mgpowderforinjection

Dose:

25mg/kgperdoseIV50mg/kgperdoseformeningitisorsevereinfectionPostnatal age Frequency Under 7 days 12 hourly

7 to 28 days 8 hourly

Preparation:

Diluent:

• Waterforinjection• 5%Dextrose(D5)• 0.9%sodiumchloride(NS)

Add5.6mlOverallamount=600mgin6mlFinalconcentration=100mg/mlExampledoseswhendilutedasdescribedabove:Dose 30mg 60mg 90mg 120mg 150mg 180mgVolume 0.3ml 0.6ml 0.9ml 1.2ml 1.5ml 1.8ml

Administration

Intravenous(IV):GiveIVover3minutes

Adverseeffects

RashesAngioedemaAnaphylaxis

Comments

Usewithin1hourofmixingDonotmixwithotherdrugsFlushthecannulabeforeandafterwith0.5ml-1mlofNS


Drug

Cefotaxime(CefotaximeSodium,Claforan)

Indication

Sepsis,Meningitis.3rdgenerationcephalosporinofchoiceforuseinhospitalisedneonates.WhenreadilyavailableuseinpreferencetoCeftriaxoneforallneonatesIfsupplyislimiteduseforJAUNDICEneonatesandPRETERMneonates

Presentation

Vial:500mgpowderforinjectionVial:1000mgpowderforinjection

Dose

Formeningitisandsevereinfection50mg/kg/doseForcongenitalgonococcalconjunctivitis100mg/kg(max1g)ONCEONLYgivenIntramuscular(IM)

Frequency

Age FrequencyUnder7days 12hourly7-21days 8hourly21daysormore 6hourly

Preparation:

Diluent:

• Waterforinjection• 5%dextrose(D5)• 0.9%sodiumchloride(NS)

Ifusing500mgvial:Add5mldiluentOverallamount=500mg/5mlFinalconcentration=100mg/mlIfusing1000mgvial:Add10mldiluentOverallamount=1000mg/10mlFinalconcentration=100mg/mlExampledoseswhendilutedasdescribedabove:Dose 50mg 100mg 150mg 200mgVolume 0.5ml 1.0ml 1.5ml 2.0ml

Administration

Intravenous(IV):over3to5minutes

Adverseeffects

Vomiting,Diarrhoea,Rash

Comments

DONOTmixwithotherdrugs.Flushthecannulabeforeandafterwith0.5ml-1mlofNSReconstituteddrugisstablefor:

• 24hoursatroomtemperature• 48hoursinthefridge


Drug

Ceftriaxone(Rocephin)n.bPleaseuseCefotaximeifavailable

Indication

Sepsis,Meningitis

Presentation

Vial:500mgVial:1000mg(1g)

Dose:

Sepsis:50mg/kg/doseONCEDAILYMeningitis:100mg/kgloadingdoseTHEN80mg/kg/doseONCEDAILYGonococcalophthalmia:50mg/kg/dose

Preparation:

Diluent:

• Waterforinjection500mgvial:Add5ml=500mgin5ml=100mg/ml1000mgvial:Add10ml=1000mgin10ml=100mg/mlExampledoseswhendilutedasdescribedabove:Dose 50mg 80mg 100mg 150mg 160mg 200mgVolume 0.5ml 0.8ml 1.0ml 1.5ml 1.6ml 2.0ml

Administration

Intravenous(IV)Intramuscular(IM)

Adverseeffects

Comments

DONOTgivetoneonateswithJaundiceFlushthecannulabeforeandafterwith0.5ml-1mlofNS


Drug

Cloxacillin

Indication

StaphylococcalInfections

o Noteincreasingresistancetothisdrug

Presentation

Vial:2000mgofpowder

Dose:

25to50mg/kg/dose

• 0to7daysoflife–12hourly• 7to21daysoflife–8hourly• 21to28daysoflife–6hourly

Preparation:

Diluent:

• Waterforinjection• 5%Dextrose(D5)• 0.9%SodiumChloride(NS)

1stRECONSTITUTE:Add6.8mlWaterforinjectiontomake8mlOverallamount=2000mgin8mlConcentration=250mg/ml2ndDILUTE:Take2mlofthe250mg/mlsolution(i.e.500mg)Add8mlofwaterforinjectiontomake10mlOverallamount=500mgin10mlFinalconcentration=50mg/mlExampledoseswhendilutedasdescribedabove:Dose 25mg 50mg 75mg 100mg 125mg 150mgVolume 0.5ml 1.0ml 1.5ml 2.0ml 2.5ml 3.0ml

Administration

Intravenous(IV):Giveover3to5minutes

Adverseeffects

RashesAngioedemaAnaphylaxis

Comments

Usewithin3daysofreconstitutionFlushthecannulabeforeandaftergivingwith0.5ml-1mlofNS


Drug

Domperidone(Motilium®)

Indication

Gastro-oesophagealreflux

Presentation

Oralliquid:1mg/ml

Dose:

0.2ml/kg/doseGive4timesperdayBEFOREFEEDS

Preparation:

Nofurtherdilutionrequired

Administration

Oral:Givepriortofeeds

Adverseeffects

DrymouthHeadacheGalactorrhoeaRashTremor

Comments


Drug

Furosemide(Lasix)INTRAVENOUS

Indication

UsedinfluidoverloadtoproduceadiuresisManagementofPatentDuctusArteriosus(PDA)ManagementofCardiacFailureManagementofpulmonaryoedema

Presentation

Vial:1ml,2ml,4mlavailableAllare10mg/ml

Dose:

0.5-1mg/kgperdoseevery24hours

Preparation:

Diluent:

• NS,0.9%saline(preferred)• Waterforinjection• NOTWITHDEXTROSE

Drawup1ml(10mg)fromvial,add9mltomaketotal10mlOverallamount=10mgin10mlFinalconcentration=1mg/mlExampledoseswhendilutedasdescribedabove:Dose 1mg 1.5mg 2.0mg 2.5mg 3.0mgVolume 1ml 1.5ml 2.0ml 2.5ml 3.0ml

Administration

Intravenous(IV):slowlyideallyover5minutes

Adverseeffects

DehydrationHyponatraemiaHypokalaemiaRashOtotoxicityNephrotoxicity

Comments

DONOTmixwithotherdrugsFlushthecannulabeforeandafterwith0.5ml-1mlofNS


Drug

Furosemide(Lasix)ORAL

Indication

UsedinfluidoverloadtoproduceadiuresisManagementofPatentDuctusArteriosus(PDA)ManagementofCardiacFailureManagementofpulmonaryoedema

Presentation

Tablet:40mg

Dose:

1mg/kgperdoseevery24hoursOR0.5mg/kgperdoseevery12hours

Preparation:

Diluent:

• Breastmilk• Drinkingwater

Break40mgtabletinto4quartersPut¼tablet(10mg)in5mldiluentandmixwellOverallamount=10mgin5mlFinalconcentration=2mg/mlExampledoseswhendilutedasdescribedabove:Dose 1mg 1.5mg 2.0mg 2.5mg 3.0mgVolume 0.5ml 0.8ml 1ml 1.3ml 1.5ml

Administration

Orally(PO):givebyNGTororally

Adverseeffects

DehydrationHyponatraemiaHypokalaemiaRashOtotoxicityNephrotoxicity

Comments


Drug

Gentamicin

Indication

FirstlineantibioticforneonatalsepsisAminoglycosideantibioticfortreatmentofinfectionscausedbygramnegativeorganismsincludingE.Coli,Pseudomonas,Klebsiella

Presentation

Vial:80mg/2ml

Dose:

Dosesshouldbe24hoursapartTerm:5mg/kg/doseoncedaily(EVERY24hoursonly)Preterm:3mg/kgdoseoncedaily(EVERY24hoursonly)

Preparation:

Diluent:

• Waterforinjection• NS,0.9%saline

In5mlsyringe:Drawup1ml(40mg)fromvial,add3mltomakeatotalof4mlOverallamount=40mgin4mlFinalconcentration=10mg/mlIn10mlsyringe:Drawup2ml(80mg)fromvial,add6mltomakeatotalof8mlOverallamount=80mgin8mlFinalconcentration=10mg/mlExampledoseswhendilutedasdescribedabove:Dose 3mg 4mg 6mg 12mg 15mgVolume 0.3ml 0.4ml 0.6ml 1.2ml 1.5ml

Administration

Intravenous(IV):ByslowIVinjectionover3-5minutes

Adverseeffects

HearinglossReducedrenalfunctionRenalFailure

Comments

Usewithin24hoursofmixingDonotmixinthesamesyringeasAmpicillinasthiscancauseinactivationofbothdrugsFlushthecannulabeforeandafterwith0.5ml-1mlofNSESPECIALLYbetweengivingAmpicillinandGentamicin


Drug

Ibuprofen

Indication

Usedforclosureofpatentductusarteriosus(PDA)

Presentation

Oralsuspension:100mg/5ml

Dose:

Initialdose:10mg/kg(0.5ml/kg)Seconddoseafter24hours:5mg/kg(0.25ml/kg)Thirddose48hoursafterfirst:5mg/kg(0.25ml/kg)Dosesshouldbe24hoursapart

Preparation:


Administration

Orallyorbynasogastrictube(NGT)

Adverseeffects

ReducedurineoutputPlateletdysfunction

Comments

Givethedosesat24hourintervalsMonitorforthepersistenceofthePDADONOTGIVEinneonateswith:

o bleedingorplatelet<60o poorurineoutputo SignsofNecrotisingEnterocolitis

Reference

ArchDisChildFetalNeonatalEd.2012Jul;97(4):F279-83.


Drug

Iron

Indication

ProphylaxisforirondeficiencyanaemiainLBWinfantsGiventoallinfantswithbirthweight<1.800kgfrom14-28daysofage

Presentation

Haemofortesyrup=FerricammoniumCitrate1000mg/100ml=ElementalIron2mgperml

Dose:

2mg/kg/dayofelementaliron=1ml/kgperdayofhaemoforteuptomaximum2.5ml

Preparation:


Administration

Orallyoncedaily

Adverseeffects

Gastrointestinaldisturbances,darkstools,haemolysis

Comments


Drug

KetamineHydrochloride(KetamineHCl)

Indication

Analgesiaduringpainfulproceduressuchasincisionanddrainage,siloplacementforgastroschisisONLYTOBEGIVENBYNEONATOLOGISTORNEONATALCLINICIAN.PATIENTMUSTHAVECONTINUOUSPULSEOXIMETRYMONITORINGDURINGPROCEDURE

Presentation

Bottle:500mg/10ml

Dose:

0.25mg/kguptothreetimesmaximumGiven5minutesapartminimum

Preparation:

Diluent:

• Waterforinjection• NS,0.9%saline

In10mlsyringe:Drawup0.2ml(10mg)fromvial,add9.8mltomakeatotalof10mlOverallamount=10mgin10mlFinalconcentration=1mg/mlExampledoseswhendilutedasdescribedabove:Dose 0.3mg 0.4mg 0.5mg 0.8mg 1mgVolume 0.3ml 0.4ml 0.5ml 0.8ml 1.0ml

Administration

Intravenous(IV)Ensurecontinuousmonitoringwithpulseoximeterthroughoutadministrationandfor30minutesafterwards

Adverseeffects

SecretionsTachycardiaRespiratorydepressionLossofairwayreflexes

Comments

ONLYTOBEGIVENBYNEONATOLOGISTORNEONATALCLINICIAN.


Drug

Metronidazole(Flagyl,Metrogyl)

Indication

SuspectedorprovenanaerobicinfectionNecrotisingEnterocolitis(NEC)

Presentation

Bottle:500mg/100ml

Dose:

7.5mg/kgperdosetwicedaily

Preparation:

NofurtherdilutionrequiredOverallamount=500mg/100mlConcentration=5mg/mlExampledoseswhendilutedasdescribedabove:Dose 7.5mg 11mg 15mg 18mg 22.5mgVolume 1.5ml 2.2ml 3.0ml 3.6ml 4.5ml

Administration

Intravenous(IV)slowlyover30minutes

Adverseeffects

GastrointestinaldisturbancePeripheralneuropathyifprolongeduseNeutropaenia

Comments

IrritatingtoveinsFlushlinewith1mlNSbeforeandafteradministrationOnceopenednotsuitableforstorage


Drug

Nystatin(Mycostatin)

Indication

Oralcandidiasis

Presentation

Syrup

Dose:

1ml(100,000units)every4-6hoursContinuefor2-3daysaftersymptomsresolve

Preparation:


Administration

Orallyonaffectedareaafterfeeds

Adverseeffects

Comments

NotsuitableforsystemicfungalinfectionsConsidertopicalapplicationtomother’snipplewheninfanthasoralthursh


Drug

ParacetamolINTRAVENOUS

Indication

Analgesiawhenpatientnilperos(NPO)ornottoleratingoralfeedsNOTtobegivenroutinelyforfever

Presentation

Bottle:500mg/100ml

Dose:

<1.5kg:7.5mg/kgthreetimesaday>1.5kg:7.5mg/kgfourtimesaday

Preparation:

NofurtherdilutionrequiredOverallamount=500mg/100mlConcentration=5mg/mlExampledoseswhendilutedasdescribedabove:Dose 7.5mg 11mg 15mg 18mg 22.5mgVolume 1.5ml 2.2ml 3.0ml 3.6ml 4.5ml

Administration

Loadingdose:Intravenous(IV)slowlyover10to15minutesMaintenancedose:IVorIMbeginning12to24hoursaftertheloadingdose

Adverseeffects

Painatinjectionsite,hypotonia,nauseaandvomiting,fever

Comments

DonotgivetoextremepretermsUsewithcautioninotherpreterms


Drug

ParacetamolORAL

Indication

Secondlineforclosureofpatentductusarteriosus(PDA)Considergivingwhentreatmentwithibuprofenhasfailedoribuprofeniscontraindicatedi.e.renalfailure,bleeding,NECNOTtobegivenroutinelyforfever

Presentation

Syrupinabottle:120mgin5ml

Dose:

15mg/kgQDSforTHREEdays(total12doses)

Preparation:

NofurtherdilutionrequiredConcentration=120mgin5ml(24mg/ml)Exampledoses:Dose 15mg 23mg 30mg 38mg 45mgVolume 0.6ml 1.0ml 1.3ml 1.6ml 1.9ml

Administration

Giveonedosesafterevery6hoursforatotalof12doses

Adverseeffects

Comments

Resultsoftrialsshowsimilarefficacytoibuprofenwithlesssideeffects,howeverdataonlongtermoutcomesareneededbeforeparacetamolcanberecommendedasfirstlineforPDA

Reference

OhlssonA,ShahPS.Paracetamol(acetaminophen)forpatentductusarteriosusinpretermorlow-birth-weightinfants.CochraneDatabaseofSystematicReviews2015,Issue3.


Drug

Phenytoin(PhenytoinSodium)

Indication

NeonatalseizuresNOTrespondingtophenobarbitonealone

Presentation

Vial:250mgin5ml(Clearsolution,50mg/mL)

Dose:

Loadingdose:20mg/kgonceNofurtherloadingdosesshouldbegivenMaintenance:2.5mg/kgtwiceaday

Preparation:

Diluent:

• NS,0.9%salineDrawup2mlphenytoininto10mlsyringe.Add8mlofNStomakeupto10mlOverallamount=100mgin10mlTotalconcentration=10mg/mlMixwellbeforedrawingupdose.Exampledoseswhendilutedasdescribedabove:Dose 5mg 10mg 15mg 20mg 40mg 60mgVolume 0.5ml 1.0ml 1.5ml 2.0ml 4.0ml 6.0ml

Administration

DONOTGIVEINTRAMUSCULAR(IM)Loadingdose:Intravenous(IV)slowlyover10to15minutesMaintenancedose:SlowIVbeginning12to24hoursaftertheloadingdose

Adverseeffects

IrritationatinjectionsiteNausea,Vomiting,constipationOverdoseorrapidadministrationmaycausehypotension,coma,respiratorydepression

Comments

PhenytoininduceshepaticmetabolismandthereforeinteractswithmanydrugsFlushthecannulabeforeandafterwith0.5ml-1mlofNSIrritatingtoveins,ensureitisdilutedasaboveUsecautiouslyinneonateswithrespiratoryfailure/apnoea


Drug

PhenobarbitoneINTRAVENOUS

Indication

Firstlinedrugtocontrolseizuresinneonates

Presentation

Vial:200mgin1ml(Thickclearsolution)Vial:200mgin2ml(Thinclearsolution)

Dose:

Loadingdose:20mg/kgonceIfseizuresnotcontrolledcangiveadditional5-10mg/kgdosesuptoatotalof40mg/kgmaximumloadingdoseMaintenance:3-5mg/kgoncedaily

Preparation:

Diluent:

• WaterforinjectionIfusing200mgin1ml:Drawup1mlphenobarbitoneinto10mlsyringe.Add9mlofwaterforinjectiontomakeupto10mlIfusing200mgin2ml:Drawup2mlphenobarbitoneinto10mlsyringe.Add8mlofwaterforinjectiontomakeupto10mlOverallamount=200mgin10mlTotalconcentration=20mg/mlMixwellbeforedrawingupdoseExampledoseswhendilutedasdescribedabove:Dose 5mg 10mg 15mg 20mg 40mg 60mgVolume 0.25ml 0.5ml 0.75ml 1.0ml 2.0ml 3.0ml

Administration

Loadingdose:Intravenous(IV)slowlyover10to15minutesMaintenancedose:IVorIMbeginning12to24hoursaftertheloadingdose

Adverseeffects

Sedation,lethargy,drowsyRespiratorydepression

Comments

PhenobarbitoneinduceshepaticmetabolismandthereforeinteractswithmanydrugsFlushthecannulabeforeandafterwith0.5ml-1mlofNSIrritatingtoveins,ensureitisdilutedasaboveUsecautiouslyinneonateswithrespiratoryfailure


Drug

PhenobarbitoneORAL

Indication

FirstlinedrugtocontrolseizuresinneonatesOralphenobarbitonecanbegivenforlongertermmanagement

Presentation

Tablet:30mgpertablet(whitetablet)

Dose:

5mg/kgoncedaily

Preparation:

Diluent:

• Water• Breastmilk

Exampledoseswhendilutedasdescribedabove:Dose 8mg 15mg 23mg 30mgVolume ¼tab ½tab ¾tab 1tab

Crushandmixrequiredtabletwellwithdiluentandgiveorally

Administration

GivenafterintravenousloadingdoseorestablishedintravenoustherapyGiveeitherorallyorviaanasogastrictubedependingonthepatientCrushandmixthetabletwithasmallamountofbreastmilkorwaterbeforegivingIfgivinglongtermgivewithfolicacid500microgramsonceaweek

Adverseeffects

Sedation,lethargy,drowsyRespiratorydepressionFolatedeficiency

Comments

Phenobarbitoneinduceshepaticmetabolismandthereforeinteractswithmanydrugs


Drug

Ranitidine

Indication

UsedfortreatmentofGIhaemorrhage

Presentation

Vial:50mgin2ml(25mg/ml)Oral:syrup15mg/ml

Dose

IV:

• Term1.5mg/kgperdose8hourlyslowly• Preterm:0.5mg/kgperdose12hourlyslowly

PO:

• 2mg/kgperdose8hourly

PreparationforIV

Diluent:

• NS,0.9%salineDrawup0.2ml(5mg)fromvial,add4.8mlofNStomakeatotalof5mlOverallamount=5mgin5mlFinalconcentration=1mg/mlExampledoseswhendilutedasdescribedabove:Dose 0.5mg 1.0mg 1.5mg 2.0mg 3.0mgVolume 0.5ml 1.0ml 1.5ml 2.0ml 3.0ml

Administration

Intravenous(IV)asslowpushOrally(PO)–doesnotmatterabouttimingoffeeds

Adverseeffects

RarelybradycardiaorarrhythmiasRarelyhepatitisRarelydiarrhoea

Comments

DonotuseprophylacticallyinpreterminfantsasitcanincreasetheriskofNECandmortalityInsevererenalimpairmentusehalfthenormaldose


Drug

Vancomycin

Indication

UsedforvancomycinsensitiveinfectionsconfirmedbybloodcultureShouldbeusedontheadviceofmicrobiologyorseniordoctoronly

Presentation

Vial:500mg

Dose

IV:

• Neonateslessthan1kg-15mg/kgONCEDAILY• Neonates1.0-2.0kg-15mg/kgTWICEDAILY• Neonatesover2.0kg-15mg/kgTHREETIMESDAILY

PreparationforIV

Diluent:

• NS,0.9%saline• D5,5%Dextrose• Sterilewaterforinjection

For500mgvialadd10mlofdiluenttothevialOverallamount=500mgin10mlFinalconcentration=50mg/mlExampledoseswhendilutedasdescribedabove:Dose 15mg 20mg 30mg 40mg 50mgVolume 0.3ml 0.4ml 0.6ml 0.8ml 1.0ml

ADDDOSECALCULATEDABOVETOABURETTECONTAININGPATIENT’SMAINTENANCEFLUIDDONOTGIVEASABOLUSIFPATIENTNOTONIVFLUID,PUTIN20MLOFNNFANDGIVEOVER1HOUR(20DROPSPERMINUTE)

Administration

Intravenous(IV)overatleast1hourinburretteofmaintenancefluidDONOTGIVEINTRAMUSCULARLY

Adverseeffects

RenalimpairmentHearinglossAnaphylaxis“RedManSyndrome”–flushingofupperbody+/-paniinchestRashHypotension,palpitations,tachycardiaifgiventooquickly

Comments

DonotusewithamikacinorgentamicinIfpossiblemonitorplasmaconcentration:pre-doseconcentrationshouldbe10-15mg/l


Drug

VitaminK(Konakion,Phytomenadione)

Indication

ForALLbabiestopreventHaemorrhagicDiseaseofNewborn

Presentation

Vial:10mg/1ml

Dose:

Infants>1.5kg:1mg(1ml)onceInfants<1.5kg:0.5mg(0.5ml)once

Preparation:

Diluent:

• WaterforinjectionDrawup1ml(10mg)ofVitaminKfromvial,makeupto10mlwith9mlwaterforinjectionOverallamount=10mgin10mlFinalconcentration=1mg/ml

Administration

Intramuscular(IM)

Adverseeffects

Comments

UseVitaminKwithin24hoursofdiluting

neonatal drug formulary

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