Neonatal Guidelines - wisdom.wales.nhs.uk 15... · Neonatal Guidelines Valid until 1st March 2020...

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



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



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



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



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




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%


Calcium Salts, Dopamine,Dobutamine,Doxapram,Fentanyl,Frusemide, Heparin,Insulin,Midazolam,Milrinone,Morphine,Noradrenaline, Pancuronium,Potassium Chloride,Ranitidine,TPN, Vecuronium


Lipid, Lignocaine, Sodium bicarbonate



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.



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.




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




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%


None

KNOWN INCOMPATIBILITIES: Sodium bicarbonate



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.)




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%


Aciclovir, Heparin, Morphine, Potassium, Ranitidine,


Ciprofloxacin, Midazolam, Vancomycin




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%


None


VERY UNSTABLE – do not use with any other drugs




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



KNOWN INCOMPATIBILITIES: Aciclovir, calcium gluconate, digoxin, frusemide, heparin, indomethacin, magnesium sulphate, phenytoin, sodium bicarbonate, Tazocin




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:



Adrenaline, amiodarone, dobutamine, fentanyl Gentamicin, heparin, midazolam, morphine, noradrenaline, pancuronium, potassium chloride, ranitidine, vecuronium




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.




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%


Aciclovir, adrenaline, benzylpenicillin, calcium gluconate, dopamine, fentanyl, frusemide, insulin, lipid, magnesium sulphate, metronidazole, morphine, noradrenaline, pancuronium, ranitidine, sodium bicarbonate, TPN, vecuronium


Erythromycin, gentamicin, vancomycin




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



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



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.




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%



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



DILUENTS: Dextrose 5% , sodium Chloride 0.9% KNOWN COMPATIBILITY: Insulin, morphine, TPN, Vancomycin KNOWN INCOMPATIBILITIES: Ambisome,dobutamine, metronidazole,

salbutamol and sodium bicarbonate




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%


Adrenaline,Calcium Gluconate,Dopamine,Fentanyl, Heparin,Morphine,Noradrenaline,Pancuronium. Potassium chloride,TPN

KNOWN INCOMPATIBILITY: Furosemide, Sodium bicarbonate,Ranitidine




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:



Adrenaline, Amiodarone, Dobutamine, Dopamine, Magnesium sulphate, Midazolam, Noradrenaline,Pancuronium, Potassium chloride, Ranitidine


Alkaline solutions, Aciclovir, Frusemide,Heparin, Sodium bicarbonate



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




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%


Adrenaline, calcium gluconate, dobutamine dopamine, fentanyl , heparin, magnesium sulphate, midazolam, morphine,potassium chloride, TPN

KNOWN INCOMPATIBILITIES: Insulin, lignocaine, sodium bicarbonate




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




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




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




Adrenaline,Aminophylline, Dopamine,, Dobutamine, Fentanyl, Heparin, Hydrocortisone, Midazolam, Morphine,Noradrenaline, Ranitidine, Vancomycin


Diazepam, Frusemide, Sodium bicarbonate

Checked by Katherine Willson: Neonatal Pharmacist, January 2017

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