Common drugs and infusions

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CHAPTER 12 Common drugs and infusions

Mark Davies, David Cartwright

Common drug doses

• Aminophylline (IV) or theophylline (oral/NG)

— loading……5 mg/kg
— maintenance…2 mg/kg/dose…every 8 hours

• Ampicillin (IV)…50 mg/kg/dose…every 12 hours
• Caffeine citrate (IV/oral/NG)

— loading…20 mg/kg
— maintenance…5–10 mg/kg/dose…daily

• Cefotaxime (IV)…50 mg/kg/dose…every 12 hours
• Chloral hydrate (oral/NG)

— hypnotic…50 mg/kg/dose…STAT
— sedation…6 mg/kg/dose…every 6 hours

• Dexamethasone…see pages 86–8
• Iron (oral/NG)…see page 76
• Flucloxacillin (IV)…50 mg/kg/dose

— first week of life…every 12 hours
— 2–4 weeks old…every 8 hours
— >4 weeks old…every 6 hours

• Frusemide (IV/oral/NG)…1–2 mg/kg/dose…every 12 hours
• Gentamicin (IV)…2.5 mg/kg/dose

— <30 weeks…every 36 hours
— ≥30 weeks…daily
— trough level, prior to third dose, <2 mg/L is OK

• Hydrocortisone (IV)…1–2.5 mg/kg…every 4–6 hours initially
• Indomethacin (IV) — a number of regimens exist:

— prophylaxis…0.1 mg/kg/dose…daily for 3 days
— treatment #1 (usual)…0.1 mg/kg/dose…daily for 6 days
— treatment #2…0.2 mg/kg/dose…every 12 hours for 3 doses
— treatment #3…0.2 mg/kg STAT…then 2 doses of 0.1 mg/kg…every 12 hours
— treatment #4…0.2 mg/kg/dose every 12 hours for 3 doses…then 0.1 mg/kg/dose daily for 4 or 5 days

• Midazolam (IV)…50–100 μg/kg/dose (i.e. 0.05–0.1 mg/kg)
• Morphine (IV)…50–100 μg/kg/dose (i.e. 0.05–0.1 mg/kg)
• Penicillin (IV)…60 mg/kg/dose… every 12 hours
• Phenobarbitone (IV/oral/NG)

— loading…20–30 mg/kg/dose
— further bolus…10 mg/kg/dose
— maintenance…2.5 mg/kg/dose…every 12 hours

• Phosphate (NG)…see page 76
• Ranitidine (oral/NG)…3–6 mg/kg/dose…every 8 hours
• Spironolactone (oral/NG)…1–2 mg/kg/dose…every 12 hours
• Theophylline see aminophylline
• Vancomycin (IV)…15 mg/kg/dose

— <1200 g…every 24 hours
— ≤7 days old, ≥1200 g…every 12 hours
— >7 days old, 1200–2000 g…every 12 hours
— >7 days old, >2000 g…every 8 hours
— (trough level, prior to third dose, 10–15 mg/L is OK)

Standard infusions

Note: Nsaline is Normal saline, 0.9%.

Dopamine

A powerful vasopressor agent used for elevating blood pressure (BP). At low doses it also increases urine output in adults. The ‘renal dose’ for neonates is not well documented, but is probably somewhat lower than that usually quoted for adults (0.5–2 μg/kg/min in neonates vs 3–5 μg/kg/min in adults). Dopamine stimulates dopamine receptors, is an alpha and beta agonist, and a serotonin agonist with varying effects at different doses.

Dose of dopamine

• Doses are:

— For ‘renal’ purposes usually use 4 μg/kg/min, or less.
— For BP, start at 10 μg/kg/min, but may be effective at 5 μg/kg/min, particularly in very immature infants.

• For both purposes, mix in Nsaline, 5% or 10% dextrose in a ‘low-stiction’ syringe, e.g. Braun or IVAC: 30 mg/kg of dopamine in 50 mL of fluid. This gives a solution of dopamine 600 μg/kg/mL. If run at 1 mL/hr, this is 10 μg/kg/min.

This may be doubled in strength if fluid management is a problem.

• Dopamine may be given in parenteral nutrition lines, before the filter. Never give into any arterial line.
• Dopamine is usually given via a peripheral venous line or a central venous line (CVL). It needs to be a line that is not having bolus drugs given through it. It is compatible with morphine/midazolam solution, and with parenteral nutrition solutions.

Dobutamine

An agent used to improve myocardial contractility (heart rate and strength of contraction — a beta agonist). Also has some pulmonary vasodilating effects, at least theoretically. Not as good as dopamine for elevating blood pressure, unless the cause of low BP is poor myocardial performance.

Dose of dobutamine

• Usually start at 10 μg/kg/min.
• Mix in Nsaline, 5% or 10% dextrose, in a ‘low-stiction’ syringe, e.g. Braun or IVAC: 30 mg/kg of dobutamine in 50 mL of fluid. This gives a solution of dobutamine 600 μg/kg/mL. If run at 1 mL/hr, this is 10 μg/kg/min.
• May be given in parenteral nutrition lines, before the filter. Never give into any arterial line.

Insulin

For control of hyperglycaemia (sometimes seen in infants on IV dextrose, parenteral nutrition or dexamethasone).

Dose of insulin

• 0.05–0.2 units/kg/hr.
• Mix in Nsaline: 25 units/kg insulin in 50 mL of Nsaline. If run at 0.1 mL/hr, this is 0.05 units/kg/hr.

Midazolam

Used for sedation or for seizures. Use with caution in unintubated, non-ventilated infants.

Dose of midazolam

• Infusion: the standard infusion rate is 6–10 μg/kg/hr (0.3–0.5 mL/hr).
• Single dose: for elective intubation, a bolus of 50–100 μg/kg (0.05–0.1 mg/kg) should be given prior to intubation.

This can be given as a one-off injection, or as a bolus of 2.5–5 mL of the standard solution below (if the baby’s clinical status can tolerate that much fluid), or intranasally (at double the dose).

• For both infusion and single dose, mix in Nsaline, 5% or 10% dextrose: 1 mg/kg in 50 mL of fluid. This solution contains 20 μg/kg/mL.

If run at 1 mL/hr, this is 20 μg/kg/hr.

Morphine

Used for sedation and/or pain relief — for ventilated infants only. Do not give to unintubated infants.

Dose of morphine

• Infusion: the standard infusion rate is 6–10 μg/kg/hr (0.3–0.5 mL/hr).
• Single dose: for elective intubation, a bolus of 50–100 μg/kg (0.05–0.1 mg/kg) should be given prior to intubation. Give as a one-off injection, or as a bolus of 2.5–5 mL of the standard solution below (if the baby’s clinical status can tolerate that much fluid). (It is safer to give as standard solution to avoid accidental overdose.)
• For both infusion and single dose, mix in Nsaline, 5% or 10% dextrose: 1 mg/kg in 50 mL of fluid. This solution contains 20 μg/kg/mL.

If run at 1 mL/hr, this is 20 μg/kg/hr.

Morphine and midazolam can both be put in the same syringe. 1 mL/hr gives 20 μg/kg/hr of each drug.

Prostaglandin — PGE1

PGE1 (Alprostadil) is used to open, or maintain open, the ductus arteriosus. It is a generalised vasodilator and has also been used in the management of pulmonary hypertension (with bigger doses).

Dose of PGE1

• The usual starting dose is 0.005 μg/kg/min.
• Mix in Nsaline: 30 μg/kg in 50 mL of Nsaline. If run at 1 mL/hr, this is 0.01 μg/kg/min.

Therefore the starting infusion rate is 0.5 mL/hr.

• The solution may be made stronger (e.g. double concentration) for very small babies, to reduce the total amount of fluids given.

Beware of apnoea as a side effect. During retrievals ventilate the baby in case apnoea occurs in transit. Fever and flushing of the skin also occur. The fever is presumed to be a central effect.

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CHAPTER 12 Common drugs and infusions

Mark Davies, David Cartwright

Common drug doses

• Aminophylline (IV) or theophylline (oral/NG)

— loading……5 mg/kg
— maintenance…2 mg/kg/dose…every 8 hours

• Ampicillin (IV)…50 mg/kg/dose…every 12 hours
• Caffeine citrate (IV/oral/NG)

— loading…20 mg/kg
— maintenance…5–10 mg/kg/dose…daily

• Cefotaxime (IV)…50 mg/kg/dose…every 12 hours
• Chloral hydrate (oral/NG)

— hypnotic…50 mg/kg/dose…STAT
— sedation…6 mg/kg/dose…every 6 hours

• Dexamethasone…see pages 86–8
• Iron (oral/NG)…see page 76
• Flucloxacillin (IV)…50 mg/kg/dose

— first week of life…every 12 hours
— 2–4 weeks old…every 8 hours
— >4 weeks old…every 6 hours

• Frusemide (IV/oral/NG)…1–2 mg/kg/dose…every 12 hours
• Gentamicin (IV)…2.5 mg/kg/dose

— <30 weeks…every 36 hours
— ≥30 weeks…daily
— trough level, prior to third dose, <2 mg/L is OK

• Hydrocortisone (IV)…1–2.5 mg/kg…every 4–6 hours initially
• Indomethacin (IV) — a number of regimens exist:

— prophylaxis…0.1 mg/kg/dose…daily for 3 days
— treatment #1 (usual)…0.1 mg/kg/dose…daily for 6 days
— treatment #2…0.2 mg/kg/dose…every 12 hours for 3 doses
— treatment #3…0.2 mg/kg STAT…then 2 doses of 0.1 mg/kg…every 12 hours
— treatment #4…0.2 mg/kg/dose every 12 hours for 3 doses…then 0.1 mg/kg/dose daily for 4 or 5 days

• Midazolam (IV)…50–100 μg/kg/dose (i.e. 0.05–0.1 mg/kg)
• Morphine (IV)…50–100 μg/kg/dose (i.e. 0.05–0.1 mg/kg)
• Penicillin (IV)…60 mg/kg/dose… every 12 hours
• Phenobarbitone (IV/oral/NG)

— loading…20–30 mg/kg/dose
— further bolus…10 mg/kg/dose
— maintenance…2.5 mg/kg/dose…every 12 hours

• Phosphate (NG)…see page 76
• Ranitidine (oral/NG)…3–6 mg/kg/dose…every 8 hours
• Spironolactone (oral/NG)…1–2 mg/kg/dose…every 12 hours
• Theophylline see aminophylline
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