KING EDWARD MEMORIAL HOSPITAL AND PRINCESS MARGARET HOSPITAL Neonatology Clinical Care Unit DRUG PROTOCOLS Part I ERYTHROPOIETIN A ACETYLCYSTEINE ACICLOVIR ADENOSINE ADRENALINE ALBUMIN (HUMAN) 20% ALBUMIN (HUMAN) 4% ALPROSTADIL (PROSTAGLANDIN E1) AMIKACIN AMOXYCILLIN AMOXYCILLIN & CLAVULANIC ACID (AUGMENTIN DUO 400 / CLAMOXYL DUO 400) AMPHOTERICIN (FUNGIZONE) AMPHOTERICIN LIPOSOMAL (AMBISOME) ATROPINE SULPHATE F FAT EMULSION 20% FERROUS SULPHATE FLECAINIDE FLUCLOXACILLIN FLUCONAZOLE FLUCYTOSINE FLUDROCORTISONE ACETATE FLUMAZENIL FLUTICASONE FOLIC ACID FRAMYCETIN EYE DROPS FRUSEMIDE FUSIDIC ACID B BCG (BACILLUS CALMETTE-GUÉRIN) VACCINE BENZYLPENICILLIN (PENICILLIN-G) G GANCICLOVIR GENTAMICIN GLUCAGON GLYCERYL TRINITRATE GLYCERYL TRINITRATE TOPICAL GLYCOPYROLLATE C CAFFEINE CALCITRIOL CALCIUM CARBONATE CALCIUM GLUCONATE CAPTOPRIL CARBAMAZEPINE CEFOTAXIME CEFTAZIDIME CEFTRIAXONE CEPHALEXIN CEPHALOTHIN CEPHAZOLIN CHLORAL HYDRATE CHLORAMPHENICOL OPHTHALMIC PREPARATIONS CIPROFLOXACIN CLINDAMYCIN CLONAZEPAM CO-TRIMOXAZOLE (Trimethoprim/Sulphamethoxazole) H HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE VACCINE HEPARIN SODIUM HEPATITIS B VACCINE HYALURONIDASE HYDRALAZINE HYDROCHLORIDE HYDROCHLOROTHIAZIDE HYDROCORTISONE HYDROXYCHLOROQUINE I INDOMETHACIN INSULIN HUMAN, NEUTRAL (ACTRAPID / HUMULIN-R) ISOPRENALINE D DEXAMETHASONE PHOSPHATE DIAZEPAM DIAZOXIDE DIGOXIN DILACAINE EYE DROPS – PMH FORMULATION DIPTHERIA-TETANUS-ACELLULAR PERTUSSIS (DTPa), HEPATITIS B AND INACTIVATED POLIO VACCINE (INFANRIX PENTA) DIPTHERIA-TETANUS-ACELLULAR PERTUSSIS (DTPa), HEPATITIS B, POLIOVIRUS AND HAEMOPHILUS INFLUENZAE TYPE B VACCINE (INFANRIX HEXA) DOBUTAMINE DOMPERIDONE DOPAMINE LIGNOCAINE L M MAGNESIUM SULPHATE MEDIUM CHAIN TRIGLYCERIDES OIL (MCT) MEROPENEM METHYLDOPA METHYLENE BLUE METRONIDAZOLE MICONAZOLE MIDAZOLAM MORPHINE SULPHATE MYLANTA E ERYTHROMYCIN FORMULAS 1) TO WORK OUT HOW MANY MG/KG/MIN OF GLUCOSE Rate x dext% x 1000 100 mg/hr wt mg/kg/hr 60 = = = mg/hr mg/kg/hr mg/kg/min Eg 4ml/hr – 1.5 kg baby – 5% glucose 4 x 5 x 1000 100 200 1.5 133.3 60 2) = = = 200 133.3 mg/kg/hr 2.2 mg/kg/min TO INCREASE GLUCOSE PERCENTAGE Vol x (req% - avail%) (add % - avail% = amount of additive glucose required To make 50ml of 13% glucose, using 50% glucose ampoules and 10% bags Eg 50 x (13-10) = (50-10) 50 x 3 = 40 15 4 = 3.75 mls 50% glucose and 46.25 mls of 10% glucose 3) TO DECREASE GLUCOSE PERCENTAGE Required strength x volume Stock strength = amount of stock glucose plus amount of H20 Eg decrease 5% - 3% to make a 50 ml syringe 3 x 50 30 mls 5% glucose and 20 mls of H20 5 METRIC CONVERSION 1 mg 0.1 mg 0.01 mg = = = 1000 microgram 100 microgram 10 microgram TO CONVERT mg TO MICROGRAM mg x 1000 eg 2.3 mg = = microgram 2.3 x 1000 = 2,300 microgram TO CONVERT MICROGRAM TO mg microgram 1000 eg 100 1000 = = mg 0.1 mg KING EDWARD MEMORIAL AND PRINCESS MARGARET HOSPITALS NEONATOLOGY CLINICAL CARE UNIT (NCCU) INJECTABLE DRUG GUIDELINES This table provides a guide to the compatibilities of drugs commonly infused in the NCCU. Drug compatibilities are concentration, temperature and light dependant. Do not use solutions where there is a visual change in the bag, or tubing. Contact your pharmacist for further information. Amphotericin Dobutamine Sodium bicarbonate Calcium Gluconate Dopamine Morphine Sodium Chloride No Yes Yes Yes Yes Yes Yes Amphotericin Calcium Gluconate Dobutamine Dopamine Morphine Sodium Bicarbonate TPN * • No No No No Yes No No No Yes No Yes Yes No Yes Yes Yes Yes No No No No No Yes Yes Yes Yes No Use Buffered\ Solution • Yes Yes Yes No Yes • Yes Yes No Yes • Yes No Yes • No Yes • No • TPN is the amino acid/glucose solution only. It does not include Fat Emulsion. Glucose Yes Yes Yes Yes Yes Yes TPN * CALCULATION OF THE COMPOSITION OF DRUG INFUSIONS (50mL SYRINGE PUMP) 1. 2. 3. SELECT DESIRED DRUG DOSAGE TO BE DELIVERED IN microgram/kg/min. SELECT INFUSION RATE OF SYRINGE PUMP IN mL/HOUR (FROM CENTRE OF TABLE). CALCULATE NUMBER OF MILLIGRAMS OF DRUG TO BE MIXED IN 50mL SYRINGE. 0.1-0.2 microgram/kg/min, Infusion rate 1-2mL/hr PUT 0.3 milligram/kg (3 milligram) IN 50mL. EG: 10kg CHILD, mg= milligram Infusion rate required Microgram/ kg/min 0.05 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.5 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 12.0 14.0 15.0 20.0 25.0 30.0 40.0 50.0 100.0 150.0 200.0 0.15mg/kg in 50mL mL/hr 1 2 4 6 8 10 12 14 16 18 20 0.3mg/kg in 50mL mL/hr 1 2 3 4 5 6 7 8 9 10 15 20 0.6mg/kg in 50mL 1.5mg/kg in 50mL 3mg/kg in 50mL 6mg/kg in 50mL 15mg/kg in 50mL 30mg/kg in 50mL 60mg/kg in 50mL Suggested doses for commencement of treatment Adrenaline, Noradrenaline infusions: 0.1-0.2 microgram/kg/min Increase to a maximum of 1.5 microgram/kg/min Isoprenaline infusion: 0.1 microgram /kg/min mL/hr 1 1.5 2 3 4 5 10 20 mL/hr 1 Midazolam, Vecuronium infusions: 1-2 microgram/kg/min 2 3 4 6 8 10 12 14 16 18 20 mL/hr 1 1.5 2 3 4 5 6 7 8 9 10 12 14 15 20 mL/hr 1 1.5 2 Dopamine, Dobutamine infusions: 5-10 microgram/kg/min Increase to a maximum of 20 microgram/kg/min mL/hr 1 3 4 5 6 7 10 15 20 2 3 4 5 6 8 10 20 mL/hr 1 1.5 2 3 4 5 10 15 20 mL/hr 1 1.5 2 5 10 DRUG: PRESENTATION: ACETYLCYSTEINE Ampoule: 200mg/mL Solution for direct application, instillation or nebulisation. ACTION & INDICATION: DOSE: Mucolytic for use in bronchopulmonary disease 0.5mL twice daily ADMINISTRATION: To be diluted with 0.5mL or required amount of 0.9% sodium chloride injection and nebulised via CPAP, ETT or mask. (See instruction sheet) Do not use in infants with renal or liver impairment COMMENTS: REFERENCES: DATE: June 2008 DRUG: PRESENTATION: ACTION & INDICATION: ACICLOVIR Vial: 250mg / 10mL, or 250mg (powder for reconstitution) Tablets: 200mg dispersible tablets Antiviral agent active against Herpes simplex type I and II, and varicella virus by inhibiting viral replication. Used for the prophylaxis or treatment of herpes infection, and varicella infection. IV: 32 nd DOSE: weeks: weeks: weeks: 20mg/kg/dose 24 hourly 20mg/kg/dose 18 hourly 20mg/kg/dose 12 hourly 20mg/kg/dose 8 hourly First week of life: 2 to 12 week of life: Oral: Consult Microbiologist PREPARATION: th IV: Use solution prepared by Pharmacy if available. Vial contains 250mg in 10mL. However if 250mg powder for reconstitution is supplied, add 10mL of 0.9% sodium chloride to vial (to give 250mg/10mL) . Further dilute as follows: Diluent: 0.9% Sodium chloride or Water for Injections Withdraw 1mL from vial and dilute to 5mL = 5mg/mL Oral: Disperse one tablet in 20mL of water = 200mg/20mL ADMINISTRATION: ADVERSE EFFECTS : Intravenous: Infuse over 60 minutes via syringe pump. Renal damage with increasing urea and creatinine – risk increased by dehydration, bolus injection or other nephrotoxic drugs. Ensure adequate hydration prior to and during therapy to avoid drug crystallisation in renal tubules. Monitor urine output, creatinine and U & E's twice weekly during therapy. Inflammation at injection site. Blood dyscrasias. Monitor Full Blood Count twice weekly COMMENTS: Administer for 2 weeks for cutaneous/visceral neonatal herpes and for 3 weeks for neonatal CNS infection Do not refrigerate – drug may precipitate from solution. Discard reconstituted vial after 24 hours Discard dispersed tablet after 24 hours REFERENCES: DATE: Neonatal Pharmacopoeia 2nd Ed 2005 Pharmacy Department, The Royal Women’s Hospital Melbourne Therapeutic Guidelines. Antibiotic 13th Ed 2006 June 2008 DRUG: PRESENTATION: ACTION & INDICATION : ADENOSINE Vial: 6mg/2mL Supraventricular tachycardia Slows AV node conduction and atrial automaticity. No effect on atrial flutter or fibrillation. No effect on ventricular muscle. DOSE : Initial dose: 100 microgram/kg Increase dose in 50 microgram/kg increments every 2 minutes until return of sinus rhythm. Maximum dose: 300 microgram/kg/dose PREPARATION: For doses less than 0.2mL (600 microgram) solution may be diluted. Diluent: 0.9% Sodium chloride Take 1mL and dilute to 10mL = 300 microgram / 1mL ADMINISTRATION: Rapid IV bolus over 1 to 2 seconds Follow with rapid sodium chloride 0.9% flush ADVERSE EFFECTS : Flushing, dyspnoea, irritability, transient arrhythmias, bradycardia, bronchial constriction. Contraindicated in 2nd or 3rd degree AV block or sick sinus syndrome. COMMENTS: Monitor, and obtain ECG strip during administration. Effect diminished by interaction with caffeine. Refrigerate opened vial. Discard after 24 hours. REFERENCES: DATE: BNF for Children 2007 Pediatric Dosage Handbook 2007 June 2008 DRUG: PRESENTATION: ACTION & INDICATION: DOSE : ADRENALINE Ampoule: 1 in 10,000, (1mg/10mL) 10mL Ampoule: 1 in 1,000, (1mg/mL) 1mL Respirator Solution : 1% 15mL Sympathomimetic agent. For cardiac arrest, severe bradycardia, acute hypotension, bronchospasm. Low cardiac output Intravenous: USE 1 IN 10,000 AMPOULE ONLY 0.1 - 0.3mL/kg/dose Intravenous infusion: USE 1 in 1000 AMPOULE ONLY To be further diluted (see Preparation section) Initially 0.1microgram/kg/minute, increasing to a maximum of 1microgram/kg/min Endotracheal tube: USE 1 IN 10,000 AMPOULE ONLY 0.1 – 0.3mL/kg/dose For ease of calculation in an acute resuscitation a dose of 1mL may be given in a term infant and 0.5mL in a preterm infant. Repeated doses may be required. Nebulisation: Using Respirator Solution 0.05mL/kg/dose Using 1 in 1000 ampoule only 0.5mL/kg/dose Dilute to 2-4mL with saline. PREPARATION: Use solution prepared in Pharmacy if available. To give a dose of 0.1 microgram/kg/min when infused at 1mL/hr: Take 0.3mg of adrenaline (ie 0.3mL of 1:1000) per kilogram of baby’s weight and dilute to 50mL with glucose or glucose / saline solutions. If a different concentration is required, refer to the Calculation of Drug Infusion table. ADMINISTRATION: Intravenous injection Intravenous infusion Umbilical arterial/venous injection Nebulisation Tachycardia, dysrhythmias, hypertension, tremor, cold extremities, agitation. ADVERSE EFFECTS : COMMENTS: REFERENCES: Incompatible with sodium bicarbonate If possible correct acidosis prior to adrenaline administration The Northern Neonatal Network Formulary 10th Ed Neofax 2006 Neonatal Pharmacopoeia 2nd Ed 2005 Royal Women’s Hospital; Melbourne DATE: June 2008 DRUG: PRESENTATION: ALBUMIN (HUMAN) 4% Vial: 40mg/mL (4%) 50mL ACTION & INDICATION: DOSE : Maintains plasma colloid oncotic pressure. Used as a plasma volume expander in hypovolaemia. Usual dose: 0.5-1g/kg (12.5-25mL/kg) ADMINISTRATION: Intravenous infusion over 30- 60 minutes, or as ordered by Consultant Neonatologist. ADVERSE EFFECTS : Too rapid infusion: Hypertension, vascular overload causing pulmonary oedema, cardiac failure, Intraventricular haemorrhage. Allergic reactions: anaphylaxis. Chills, fever, vomiting, urticaria, COMMENTS: Compatible with: 0.9% Sodium chloride, 5% Glucose, Glucose and saline solutions. Albumin (human) 20% also available (see protocol). As this is a blood product, parents are to be notified before use. REFERENCES: DATE: Gomella T. Neonatology 5th Ed June 2008 DRUG: PRESENTATION: ALBUMIN (HUMAN) 20% Vial: 200mg/mL (20%) 10mL, 100mL ACTION & INDICATION: DOSE : ADMINISTRATION: Hypoproteinaemia. Usual dose: 1-2g/kg (5-10mL/kg) Intravenous infusion over 30- 60 minutes, or as ordered by Consultant Neonatologist. ADVERSE EFFECTS : Too rapid infusion: Hypertension, vascular overload causing pulmonary oedema, cardiac failure. Intraventricular haemorrhage. Allergic reactions: anaphylaxis. Chills, fever, vomiting, urticaria, COMMENTS: Compatible with: 0.9% Sodium chloride, 5% Glucose, Glucose and saline solutions. Albumin (human) 4% also available (see protocol). As this is a blood product, parents are to be notified before use. REFERENCES DATE: Gomella T. Neonatology 5th Ed. June 2008 DRUG: PRESENTATION: ACTION & INDICATION: ALPROSTADIL (PROSTAGLANDIN E1) Ampoule: 500 microgram/mL Promotes dilatation of all arterioles. Used to maintain patency of ductus arteriosus in neonates with congenital heart defects dependent on ductal shunting for oxygenation and perfusion until corrective surgery can be performed. (Cyanotic heart disease, duct dependant lesions) Initially: 0.05 microgram/kg/minute (50 nanograms/kg/min) If effective within 30 minutes reduce to 0.025 microgram/kg/minute. DOSE : Maintenance dose : May be as low as 0.01microgram/kg/minute PREPARATION: Use solution prepared by Pharmacy if available. Diluent: 5% Glucose, sodium chloride 0.9% To prepare an infusion solution to deliver 0.05 microgram/kg/minute (ie 50 nanograms/kg/minute) at a rate of 1mL/hr. Volume of diluent required (mL) = 167 Baby's weight (kg) Add 500 micrograms alprostadil to this volume. The infusion solution may be further diluted if required . ADMINISTRATION: ADVERSE EFFECTS: For continuous intravenous/arterial infusion via syringe pump. May cause apnoea in infants especially in the first hour of infusion. Consider intubation and ventilation when using on WANTS transports Flushing, bradycardia, tachycardia, hypotension, apnoea, fever, seizures, hypothermia. Avoid in HMD/RDS Contraindicated in infants with PFC (persistent foetal circulation) or anomalous pulmonary venous return. Neonates receiving alprostadil for more than 120 hours, or maintained on high doses, should be closely monitored for evidence of antral hyperplasia, gastric outlet obstruction and cortical hyperostosis (eg widening fontanelles). COMMENTS: REFERENCES: DATE: Maximum effectiveness within 96 hours of birth No evidence of incompatibility with heparin Infusion solution stable for 24 hours BNF for Children 2007 Neofax 2006 June 2008 DRUG: PRESENTATION: ACTION & INDICATION: DOSE : AMIKACIN Vial: 500mg/2mL Semi-synthetic aminoglycoside for treatment of serious infection due to susceptible strains of gram negative bacilli. Single daily dose: < 30 weeks 30-36 weeks Term: 1st week of life 2nd week of life onwards 7.5 mg/kg/dose 10 mg/kg/dose 15 mg/kg/dose 22.5mg/kg/dose 24 hourly 24 hourly 24 hourly 24 hourly PREPARATION: Use solution prepared in Pharmacy if available. Diluent: Water for Injections, Glucose 5%, sodium chloride 0.9% Draw up contents of vial, make up to 50mL = 500mg in 50mL = 10mg/mL Intramuscular Intravenous: Infuse over 20 to 30 minutes ADMINISTRATION: ADVERSE EFFECTS : Hearing loss, reduced renal function, renal failure, vertigo, anaemia, arthralgia. Toxicity may be enhanced by concurrent administration of diuretic. COMMENTS: DRUG LEVELS: Discard vial after use Trough: < 5mg/L Sample immediately prior to 4th dose and every 3 to 5 days thereafter Peak: Not required REFERENCES: DATE: Paediatric Pharmacopoeia 13th Ed Royal Children’s Hospital Melbourne June 2008 DRUG: PRESENTATION: AMOXYCILLIN Vial: 500mg 250mg/5mL 100mg/mL (KEMH only) Oral Suspension: ACTION & INDICATION : Broad spectrum penicillin antibiotic. For treatment of sensitive organisms including Listeria monocytogenes and group B Streptococci < 34 weeks ≥ 34 weeks All infants < 7 days < 7 days ≥ 7 days 50mg/kg/dose 12 hourly 50mg/kg/dose 8 hourly 50mg/kg/dose 6-8 hourly DOSE : PREPARATION: Diluent: Water for Injections Intravenous: Add 4.6mL Water for Injections to 500mg vial = 100mg/mL Intramuscular: Add 1.6mL diluent to vial = 250mg/mL Oral 250mg/5mL: Add 80mL of Water for Irrigation to the powder for suspension in the bottle. Oral 100mg/mL: Add 13mL of Water for Irrigation to the powder for suspension in the bottle Intravenous: Infuse over 3-5 minutes. ADMINISTRATION: Intramuscular: Site as per NCCU policy Oral: May be given at any time with regard to feeds. ADVERSE EFFECTS: Vomiting, diarrhoea Urticaria Anaemia Phlebitis Thrombocytopenia purpura Discard reconstituted vial immediately after use. Store reconstituted oral suspension in refrigerator. Discard after 14 days. COMMENTS: REFERENCES: DATE: Paediatric Pharmacopoeia 13th Ed Royal Children’s Hospital Melbourne June 2008 DRUG: PRESENTATION: ACTION & INDICATION : AMOXYCILLIN & CLAVULANIC ACID (AUGMENTIN DUO 400 / CLAMOXYL DUO 400) Oral Suspension: 400mg/5mL (as amoxycillin) Broad spectrum penicillin antibiotic in combination with a β-lactamase inhibitor. For treatment of bacterial infections caused by sensitive organisms. DOSE: 22.5mg/kg/dose 12 hourly (The dose is calculated with regard to the amoxycillin content) PREPARATION: Oral 400mg/5mL: Add 55mL of Water for Irrigation to the powder for suspension in the bottle. ADMINISTRATION: ADVERSE EFFECTS: Oral: Should be given immediately prior to feeds. Vomiting, diarrhoea Urticaria Anaemia Phlebitis Cholestatic jaundice Thrombocytopenia purpura Store reconstituted oral suspension in refrigerator. Discard after 7 days. Paediatric Pharmacopoeia 13th Ed Royal Children’s Hospital Melbourne June 2008 COMMENTS: REFERENCES: DATE: DRUG: PRESENTATION: AMPHOTERICIN LIPOSOMAL (AMBISOME) Do not confuse with amphotericin infusion (Fungizone) Infusion solution from Pharmacy Vial: 50mg Antifungal agent used to treat systemic fungal infections ACTION & INDICATION: DOSE: Initially 1mg/kg/day up to 5mg/kg/day Doses up to 10mg/kg/day may be used with Specialist consultation Use solution supplied by Pharmacy OR To dilute vial: Add 12mL water for injection to vial =4mg/mL Shake for 15 seconds. Take 5mL and dilute up to 10mL with Glucose 5%. Filter through 5micron filter supplied before dilution. =2mg/mL Intravenous solution: Infuse over 30-60 minutes If line requires flushing use glucose solutions only Do not use solutions containing sodium chloride Nephrotoxicity- monitor renal function Fever, rigors, Nausea, vomiting Hypokalaemia, Rash Refrigerate infusion solution, discard after 24 hours Refrigerate reconstituted vial. Discard after 72 hours Protect from light Paediatric Pharmacopoeia 13th Ed. Royal Children’s Hospital Melbourne June 2008 PREPARATION: ADMINISTRATION: ADVERSE EFFECTS: COMMENTS: REFERENCES: DATE: DRUG: PRESENTATION: AMPHOTERICIN (FUNGIZONE) Do not confuse with liposomal amphotericin Infusion solution from Pharmacy Vial: 50mg Antifungal agent used to treat systemic fungal infections. 0.5-1mg/kg/dose 24 hourly Use solution supplied by pharmacy OR Use kit in fridge if needed after Pharmacy hours. To dilute vial: 1.Add 10mL water for injection = 5mg/mL 2.Prepare buffered glucose solution. Add 0.6mL from potassium dihydrogen phosphate and dipotassium hydrogen phosphate concentrated injection to Glucose 5% 100mL bag. 3.Withdraw 10mL from glucose bag and discard . 4.Add 2mL from diluted amphotericin vial to bag = 1mg /10 mL Solution can be heparinised (0.5 units/mL). If line requires flushing use glucose solutions only. Do not use solutions containing Sodium chloride. ACTION & INDICATION: DOSE : PREPARATION: ADMINISTRATION: ADVERSE EFFECTS: Intravenous infusion: Infuse over 6 hours. Nephrotoxicity – monitor renal function Mild anaemia Hypokalaemia Ensure baby is well hydrated Chills, fever Vomiting, diarrhoea Do not filter Protect from light Refrigerate infusion solution, discard after 24 hours COMMENTS: REFERENCES: Paediatric Pharmacopoeia 13th Ed. Royal Children’s Hospital Melbourne BNF for Children 2007 June 2008 DATE: DRUG: PRESENTATION: ACTION & INDICATION: ATROPINE SULPHATE Ampoule: 400 microgram/mL Anticholinergic agent used for: • Pre-anaesthetic medication to inhibit excessive salivary and bronchial secretions and to diminish the risk of vagal inhibition of the heart. Sinus bradycardia, AV block. • DOSE : Premedication IM: 10 - 20 microgram/kg/dose IV: 10 - 30 microgram/kg/dose Oral: 40 microgram/kg/dose two hours before induction. Bradycardia IV or IM: 10 – 30 microgram/kg/dose Intramuscular: Site as per NCCU policy Intravenous : Over 1 minute Dose may be repeated every 10 - 15 minutes to achieve desired effect. Maximum total dose 40 microgram/kg ADMINISTRATION: ADVERSE EFFECTS: Oral Arrhythmias, tachycardia Hyperthermia Urinary retention Do not give to febrile infant - risk of provoking hyperthermia. COMMENTS: REFERENCES: Reserve use of atropine for patients unresponsive to improved oxygenation and adrenaline BNF for Children 2007 Pediatric Dosage Handbook 14th Ed Neofax 2006 DATE: June 2008 DRUG: PRESENTATION: ACTION & INDICATION: DOSE : BCG (BACILLUS CALMETTE-GUÉRIN) VACCINE Multidose vial plus diluent. Suspension of living organisms of an attenuated strain of Mycobacterium bovis (Bacillus Calmette-Guérin). For immunisation against tuberculosis. For infants under 6 months; 0.05mL Reconstitute powder in vial with 1.5mL of accompanying phosphate buffered saline diluent. PREPARATION: ADMINISTRATION: INTRADERMAL INJECTION : Administer above the insertion of the deltoid muscle of the right arm To be given by appropriately trained and certified health care providers only. Infants may be referred to the Perth Chest Clinic for vaccination if trained staff are not available. Avoid inhalation of dried vaccine. If alcohol is used to swab skin, or the rubber bung of vial, it must be allowed to evaporate before proceeding. COMMENTS: Refrigerate reconstituted solution. Discard 8 hours after reconstitution. Discard contents into "sharps" container after use REFERENCES: DATE: NH&MRC The Australian Immunisation Handbook 8th Ed June 2008 DRUG: PRESENTATION: ACTION & INDICATION: DOSE : BENZYLPENICILLIN (PENICILLIN-G) Vial: 600mg Antibiotic for treatment of susceptible organisms including Group B Streptococci, non-β lactamase – producing Staphyloccocci and congenital syphilis. < 7 days ≥ 7 days 50 mg/kg/dose 50mg/kg/dose 12 hourly 8 hourly For GBS septicaemia, meningitis < 7 days 50mg/kg/dose ≥ 7 days 50mg/kg/dose Congenital syphilis: 50mg/kg/dose 12 hourly Asymptomatic and normal CSF - 10 days therapy. Symptomatic - 14 days therapy. PREPARATION: Diluent: Water for Injections 12 hourly 6 hourly Intravenous : Add 5.6mL diluent to vial = 100mg/mL Intramuscular : Add 1.6mL diluent to vial = 300mg/mL ADMINISTRATION: Intramuscular Intravenous : Infuse over 3-5 minutes ADVERSE EFFECTS: Hypersensitivity, rash Diarrhoea Seizures with high doses Haemolytic anaemia Refrigerate reconstituted solution. Discard after 24 hours. BNF for Children 2007 Neofax 2006 Dr T Keil KEMH Microbiology DATE: June 2008 COMMENTS: REFERENCES: DRUG: PRESENTATION: ACTION & INDICATION: CAFFEINE Oral solution:10 mg/mL (caffeine base) Ampoule: 50 mg/5 mL(caffeine base) Stimulates central inspiratory drive and increases sensitivity of the medullary centre to CO2. Used for prevention or treatment of apnoea of prematurity or apnoeas associated with respiratory infection or anaesthesia. To aid extubation of ventilated babies. Loading dose: 20 mg/kg Maintenance dose: 5 mg/kg/day commencing at least 24 hours after loading dose. DOSE : PREPARATION: Diluent: 0.9% Sodium chloride, Water for Injections Loading dose: does not require dilution If maintenance dose requires dilution: Dilute 50 mg/5 mL ampoule with 5mL of diluent = 50 mg/ 10 mL ADMINISTRATION: For intravenous, umbilical arterial / venous infusion. Infuse over 30 minutes. Oral: Give dose with feeds. ADVERSE EFFECTS : Nausea, vomiting, gastric irritation Agitation Tachycardia Diuresis Overdose – arrhythmias, seizures. Sampling time: Therapeutic: Toxic: Drug levels All infants: First level to be taken one week after commencing drug, then weekly only if baby symptomatic. If Infant < 30 weeks at commencement: Check level after four weeks, or prior to late extubation. Midway between doses 5 - 30 mg/L > 50 mg/L DRUG MONITORING: REFERENCES: BNF for Children 2007 Neofax 2006 Acta Paediatr Scand 1989;78:786-788 (for dosing) DATE: June 2008 DRUG: PRESENTATION: CALCITRIOL Oral Solution : 0.05 microgram/mL (prepared in pharmacy) Oral Solution : 1 microgram/mL (SAS authority required) ACTION & INDICATION: Calcitriol is 1,25-dihydrocholecalciferol, an activated form of Vitamin D3. This active hormone increases calcium and phosphorus absorption and with parathyroid hormone, increases bone resorption, maintaining calcium and phosphorous at blood levels which permit mineralisation of bone matrix. Used to treat hypocalcaemia, hypoparathyroidism, neonatal rickets. DOSE : Starting dose: 0.02-0.25 microgram/dose/day Dose to be individualised depending on indication, and response. ADMINISTRATION: Oral: If dose is ≥ 0.05 microgram, use 1 microgram/mL strength oral solution. Protect solution from light. Monitor: Serum alkaline phosphatase, calcium, phosphorus, creatinine BNF for Children 2007 Paediatric Pharmacopoeia 13th Ed Royal Children’s Hospital Melbourne ADVERSE EFFECTS & COMMENTS: REFERENCES: DATE: June 2008 DRUG: PRESENTATION: CALCIUM CARBONATE Oral Suspension : Calcium Carbonate Contains: 40mg (1 mmol) Calcium per mL ACTION & INDICATION: Hypocalcemia Calcium supplement for infants not receiving premature formula / fortified breast milk. Calcium Supplement: Infants BW < 1.2 kg Start on day 10, when on full feeds and continue until the baby’s weight is at least 2kg. Dose: 1mL/kg/dose 8hrly (120mg/kg/day or 3mmol/kg/day). DOSE : ADMINISTRATION: ADVERSE EFFECTS COMMENTS: Oral Flatulence, constipation Gastric hypersecretion, acid rebound with prolonged use Given in conjunction with Sodium Phosphate mixture DO NOT MIX WITH SODIUM PHOSPHATE MIXTURE Monitor serum calcium concentrations. Use with caution in neonates who are currently receiving frusemide. IF INTRAVENOUS CALCIUM THERAPY IS REQUIRED, REFER TO CALCIUM GLUCONATE PROFILE. REFERENCES: DATE: Neofax 2006 June 2008 DRUG: PRESENTATION: CALCIUM GLUCONATE Ampoule: 1g in 10mL, (10%). (contains 0.22mmol Calcium per mL) ACTION & INDICATION: Intravenous electrolyte for the treatment of hypocalcaemia. Ionized calcium less than 0.65mmol/l (