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Neonatal Intensive Care Drug Manual

Canberra Hospital

Contents: INTRODUCTION............................................................................................................................ 7

DRUG NAME.................................................................................................................................. 8

ACETYLCYSTEINE (INHALATION THERAPY).......................................................................9

ACETYLCYSTEINE (MUCOMYST)...........................................................................................10

ACICLOVIR.................................................................................................................................. 11

ADENOSINE.................................................................................................................................. 12

ADRENALINE (RESUSCITATION)............................................................................................13

ADRENALINE (INFUSION, INHALATION)..............................................................................14

ALBUMIN...................................................................................................................................... 15

AMLODIPINE............................................................................................................................... 16

AMPICILLIN................................................................................................................................. 17

AMPHOTERICIN B...................................................................................................................... 18

AMPHOTERICIN B (LIPID COMPLEX)...................................................................................19

ASPIRIN......................................................................................................................................... 20

ATENOLOL................................................................................................................................... 21

ATROPINE.................................................................................................................................... 22

AZITHROMYCIN......................................................................................................................... 23

BUCCAL GLUCOSE GEL 40%...................................................................................................24

BUDESONIDE............................................................................................................................... 25

CAFFEINE BASE.......................................................................................................................... 26

CALCIUM GLUCONATE............................................................................................................ 27

CALCIUM CARBONATE SUSPENSION....................................................................................28

CALCITRIOL................................................................................................................................ 29

CAPTOPRIL.................................................................................................................................. 30

CEFOTAXIME.............................................................................................................................. 31

CEFTAZIDIME PENTHYDRATE...............................................................................................32

CEPHAZOLIN............................................................................................................................... 33

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register1


Canberra HospitalCHLORAL HYDRATE................................................................................................................. 35

CHLORAMPHENICOL................................................................................................................ 36

CIPROFLOXACIN........................................................................................................................ 37

CLINOLEIC LIPID EMULSION.................................................................................................38

CLONAZEPAM............................................................................................................................. 39

CLOTRIMAZOLE........................................................................................................................ 40

CO-TRIMOXAZOLE.................................................................................................................... 41

CRYOPRECIPITATE................................................................................................................... 42

CUROSURF: PORACTANT ALFA..............................................................................................43

CYCLOPENTOLATE HYDROCHLORIDE EYE DROPS (0.25%)...........................................44

DEXAMETHASONE..................................................................................................................... 46

DIAZEPAM.................................................................................................................................... 48

DIAZOXIDE.................................................................................................................................. 49

DIGOXIN....................................................................................................................................... 50

DOBUTAMINE.............................................................................................................................. 51

DOPAMINE................................................................................................................................... 52

EPOPROSTENOL......................................................................................................................... 53

ERYTHROMYCIN........................................................................................................................ 54

ERYTHROPOIETIN..................................................................................................................... 55

FENTANYL................................................................................................................................... 56

FERROUS SULFATE (FERRO-LIQUID)....................................................................................57

FLECAINIDE................................................................................................................................ 58

FLUCLOXACILLIN...................................................................................................................... 59

FLUCONAZOLE........................................................................................................................... 60

FLUMAZENIL............................................................................................................................... 61

FLUTICASONE (FLIXOTIDE)....................................................................................................62

FOLIC ACID.................................................................................................................................. 63

FRUSEMIDE................................................................................................................................. 64

GANCICLOVIR............................................................................................................................. 65



Canberra HospitalGAVISCON (ALGINIC ACID).....................................................................................................66

G-CSF (GRANULOCYTE-COLONY STIMULATING FACTOR.............................................67

GENTAMICIN............................................................................................................................... 68

GLUCAGON.................................................................................................................................. 69

HEPARIN....................................................................................................................................... 70

HEPARIN CVC LOCK.................................................................................................................71

HEPATITIS B IMMUNOGLOBULIN.........................................................................................72

HEPATITIS B VACCINE............................................................................................................. 73

HYDRALAZINE............................................................................................................................ 74

HYDROCHLOROTHIAZIDE......................................................................................................75

HYDROCORTISONE................................................................................................................... 76

IBUPROFEN.................................................................................................................................. 77

INDOMETHACIN......................................................................................................................... 79

IMIPENEM/CILASTATIN........................................................................................................... 80

IMMUNOGLOBULIN IV (INTRAGRAM®P): DRAFT..............................................................82

INDOMETHACIN......................................................................................................................... 84

INFANRIX HEXA......................................................................................................................... 86

INFLORAN®................................................................................................................................. 87

INSULIN (ACTRAPID – FOR HYPERGLYCAEMIA)...............................................................89

INSULIN (FOR HYPERKALAEMIA).........................................................................................90

IPRATROPIUM BROMIDE.........................................................................................................92

ISOPRENALINE........................................................................................................................... 93

ISOVUE.......................................................................................................................................... 94

LABETALOL................................................................................................................................. 95

LACTULOSE................................................................................................................................. 96

LEVETIRACETAM (KEPPRA)...................................................................................................97

LIGNOCAINE FOR SEIZURES...................................................................................................98

LIGNOCAINE FOR LOCAL ANAESTHETIC, CARDIAC ARRHYTHMIA..........................100

MAGNESIUM SULPHATE........................................................................................................ 101



Canberra HospitalMAGNESIUM ASPARTATE......................................................................................................103

MEROPENEM............................................................................................................................. 104

METOCLOPRAMIDE................................................................................................................ 105

METOPROLOL........................................................................................................................... 106

METRONIDAZOLE.................................................................................................................... 107

MICONAZOLE (TOPICAL GEL)..............................................................................................108

MIDAZOLAM............................................................................................................................. 109

MILRINONE................................................................................................................................ 110

MORPHINE IV............................................................................................................................ 111

MORPHINE ORAL..................................................................................................................... 112

MYLANTA................................................................................................................................... 113

NALOXONE................................................................................................................................ 114

NEOSTIGMINE........................................................................................................................... 115

NORADRENALINE..................................................................................................................... 116

NYSTATIN (ORAL).................................................................................................................... 117

NYSTATIN (TOPICAL).............................................................................................................. 118

OCTREOTIDE............................................................................................................................. 119

OMEGAVEN 10% LIPID EMULSION......................................................................................120

OMEPRAZOLE........................................................................................................................... 122

PANCREATIC ENZYMES/CREON...........................................................................................124

PANCURONIUM......................................................................................................................... 125

PANTOPRAZOLE....................................................................................................................... 126

PARACETAMOL (DRAFT)........................................................................................................127

PENICILLIN, BENZYL (PENICILLIN G)................................................................................130

PENTAVITE (MULTIVITAMIN PREP)....................................................................................132

PHENOBARBITONE.................................................................................................................. 133

PHENYLEPHRINE HYDROCHLORIDE EYE DROPS (2.5%)...............................................134

PHENYTOIN............................................................................................................................... 135

PHOSPHATE SUPPLEMENT....................................................................................................137



Canberra HospitalPOTASSIUM CHLORIDE.......................................................................................................... 139

POVIDONE-IODINE (BETADINE)...........................................................................................140

PREDNISOLONE........................................................................................................................ 141

PREVENAR 13............................................................................................................................. 142

PROPOFOL................................................................................................................................. 143

PROPANOLOL........................................................................................................................... 144

PROSTAGLANDIN E1(ALPROSTADIL)..................................................................................145

PROSTACYCLIN PGI2(EPOPROSTENOL).............................................................................146

PYRIDOXINE.............................................................................................................................. 147

RANITIDINE............................................................................................................................... 148

RECOMBINANT FACTOR VIIA...............................................................................................149

RESONIUM A.............................................................................................................................. 150

RIFAMPICIN............................................................................................................................... 151

ROTAVIRUS VACCINE............................................................................................................. 152

SALBUTAMOL - FOR I.V. ADMINISTRATION.....................................................................153

SALBUTAMOL (NEBULISED)..................................................................................................154

SANDOGLOBULIN (NORMAL HUMAN IMMUNOGLOBULIN).........................................155

SILDENAFIL............................................................................................................................... 156

SODIUM BICARBONATE..........................................................................................................159

SODIUM CHLORIDE 20% (NACL)..........................................................................................160

SOTALOL.................................................................................................................................... 162

SPIRONOLACTONE.................................................................................................................. 163

STREPTOKINASE...................................................................................................................... 164

SUCROSE.................................................................................................................................... 165

SURVANTA: BERACTANT.......................................................................................................166

SUXAMETHONIUM CHLORIDE (SCOLINE).........................................................................167

TEICOPLANIN............................................................................................................................ 168

THEOPHYLLINE....................................................................................................................... 169

THYROXINE............................................................................................................................... 170



Canberra HospitalTICARCILLIN/CLAVULANIC ACID........................................................................................171

TOBRAMYCIN............................................................................................................................ 172

URSODEOXYCHOLIC ACID (URSO)......................................................................................173

VALPROATE............................................................................................................................... 174

VANCOMYCIN........................................................................................................................... 175

VECURONIUM........................................................................................................................... 176

VIGABATRIN.............................................................................................................................. 177

VITAMIN A (RETINOL)............................................................................................................ 178

VITAMIN E (ALPHA-TOCOPHEROL)....................................................................................179

VITAMIN K................................................................................................................................. 180

ZIDOVUDINE.............................................................................................................................. 181

ZOSTER IMMUNOGLOBULIN................................................................................................183



Canberra Hospital

IntroductionRevision Date : 20 February 2015 Approved : Department of Neonatology

The following list is a compilation of drugs commonly and not so commonly used in Neonatal Care. The list has developed over a period of years and is based on experiences within this unit or on data collected from published reports in recent perinatal literature.

The current revision includes data concerning drug compatibilities which have been previously considered a problem but now which have been shown to be safe and effective.

Some methods of administration may be considered new or novel but should not be avoided for this reason. In general, recommendations are made on the best available evidence. Should there be any discrepancies these should be brought to our attention. Suggestions for change are welcome.

Entries in this manual should not be annotated or marked without the approval of the Consultant in Charge as this will only serve to confuse and may lead to mistakes or errors in administration.

Note that the following abreviations are used throughout this document:

WFI = Water for injection.D5W = 5% Dextrose WaterD10W = 10% Dextrose WaterNS= 0.9% Normal Saline

This manual is constantly updated by the Dept of Neonatology and Pharmacy. Thank you for your continued efforts in keeping this document up to date with the latest evidence.

Professor Alison Kent and Dr Tejasvi Chaudhari,Department of Neonatology



Canberra Hospital

Drug NameRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : A brief description of the uses for the chosen drug

Dose : Single Dose amount

Interval : Dosage interval or number of doses per day

Route : Oral, intravenous, intra-arterial or other routes available

Total Daily Dose : Maximum recommended daily dosage

Comments : Description of action, precautions, side effects etc.

Supplied as : Company or trade name is not usually recorded and should not be used in prescriptions. Amount usually found in supplied units.

Dilution : Instructions for appropriate dilution. May differ from that recommended by suppliers because has been adjusted for use in small babies.

Stability : Refers to how long drug can be used after being reconstituted or diluted.

Storage : Usual method and place of storage - cupboard, fridge, freezer etc.

Incompatibility : Drug and diluent incompatibilities, comments on whether can be given mixed with other drugs or solutions.

Serum Levels : Therapeutic range - if known



Canberra Hospital

Acetylcysteine (Inhalation Therapy)Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : A mucolytic agent used as adjuvant therapy in patients with thick or viscid bronchial secretions and mucous obstruction.

Dose : 1-2 ml of 100mg/mL or 200mg/mL solution

Interval : 1- 4 hourly as necessary

Route : Intratracheal via Endotracheal tube

Total Daily Dose : Use with care in small babies where fluids are restricted.

Comments : May be mixed with bronchodilators without loss off of effect. Generally it is used on its own, and bronchodilators are given pre mucomyst, so that the mucomyst can penetrate further into the bronchioles.Not for Injection

Supplied as : Acetylcysteine, 200mg/mL solution, 10 mL vial.Trade name Mucomyst®

Dilution : Not required or can be diluted with an equal volume of Water For Injection to make a 100mg/mL solution

Stability : Open vials may be stored in a refrigerator for up to 96 hrs. Use diluted solution within an hour and discard any unused diluted solution

Storage : Store at room temperature until vial is accessed, then in refrigerator. Label vial as to the time of the first access.

Incompatibility : Not applicable

Serum Levels : Nil



Canberra Hospital

Acetylcysteine (Mucomyst) Revision Date : 18 June 2012 Approved : AK, JD

Indication : Cystic fibrosis, meconium plug syndrome related to IUGR

Dose : Order dose in terms of mLs of 50mg/mL solutionRectal enema: 2-10 mL (max of 10mL/kg) of 50mg/mL solutionRetention time of 30-45 minutes, but max effect if retained for 6 hours.

Interval : Daily, up to 6/24

Route : PR or via fistula/stoma

Total Daily Dose :

Comments : Give enema in a slow steady manner to avoid over distension and observe abdomen for signs of distension.Thought to act by disrupting disulphide linkages of mucoproteins i.e. it breaks up the protein matrix and lowers the viscosity of meconium.Not for Injection

Supplied as : 200 mg/mL vial. Trade name Mucomyst®

Dilution : Dilute with water to make 50 mg/mL - take 1mL of solution (200mg) from the vial and add 3 mL of Water For Injection to make 200mg/4mL.

Stability : Prepare fresh solution for each dose and discard any unused diluted portion. The vial can be reused for up to 96 hours.

Storage : Vials: protect from light. Store below 25°C

Compatibility : Not applicable

Incompatibility :

Serum Levels : Not required

Taken from RCH Paediatric Pharmacopoeia, SHPA Injectable Drugs Handbook



Canberra Hospital

AciclovirRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : An antiviral agent active against Herpes Simplex (types 1 and 2), varicella zoster. Disease should be treated quickly even if clinical signs are minimal or superficial.

Dose : 20 mg/kg< 30 weeks daily30-32 weeks 18/24 1st week of life32 - 37 weeks 12/24> 37 weeks 8/24

2-12 weeks of life 8/24Interval : 8 hourlyRoute : Intravenous infuse over 1 hour

Total Daily Dose : 30-60 mg/kgComments : Aciclovir triphosphate acts as an inhibitor of and substrate for herpes

DNA polymerase preventing further DNA synthesis. Must be infused over 1 hour. If infused too rapidly may cause renal failure by precipitation of crystals in the kidney and transient renal dysfunction. Give adequate hydration to prevent precipitation of crystals in the renal tubules. Monitor urine output and creatinine carefully. Monitor IV site for phlebitis (has a pH of 10). If phlebitis occurs, then make the solution more dilute. Treatment should continue for at least 10 days. 21 days may be needed for CNS disease.

Supplied as : Zovirax (and other brand names) 250 mg and 500mg vials of powder for reconstitution. 250mg/10 ml vials of solution.

Dilution : 250mg and 500mg vials of powder are reconstituted with 10 ml and 20ml of WFI to give a solution of 25mg/ml. 1 ml of this solution or of the ready prepared solution can be further diluted with NS to a total of 5 ml to make a solution of 5mg/ml. Discard remainder of vial.

Stability : Solution stable for 24 hours at room temperature. Do not put solution in refrigerator as crystals will develop and not re-dissolve at room temperature.

Storage : Store at room temperature. 3 yr. shelf life. DO NOT refrigerate.

Compatibility Compatible with Cefotaxime, 5% Dextrose, gentamicin, lorazepam, potassium chloride, NS, metronidazole, fluconazole, ampicillin, vancomycin.

Incompatibility : Do not give with TPN solutions, Dopamine, Dobutamine.



Canberra HospitalSerum Levels : Reduce dose in renal failure and hepatic failure.

Adenosine

Revision Date: 09/01/2014 14:40:00 Approved : AK, JD

Indication : Rapid conversion of paroxysmal tachycardias to normal sinus rhythm, and as an aid to the diagnosis of supraventricular tachycardias.

Dose : Initial dose 0.1mg/kg, increasing by 0.05mg/kg to a maximum of 0.35 mg/kg/dose

Interval : Every 1-2 minutes until termination of arrythmia

Route : Rapid bolus IV, over 1-2 seconds directly into a vein or at the most proximal port available. Follow rapidly with a saline flush.

Total Daily Dose : Not Applicable.

Comments : The half-life of adenosine is less than 10 seconds, thus adverse effects are generally self-limiting. May produce heart block and bronchospasm and may induce pulmonary hypertension. Methylxanthines are competitive antagonists of adenosine. Larger doses of adenosine may be required when these drugs are used concurrently. Dipyridamole enhances and prolongs the effect. Contraindicated in adenosine deaminase deficiency. Side effects include flushing, headache and nausea. Rarely may produce apnoea.

Supplied as : Vials (Adenocor) containing 6mg adenosine in 2 ml Normal saline

Dilution : Use 1 ml with 9 ml of Normal Saline to make up a solution with a final concentration of 0.3 mg/ml.

Stability : Single use only. Discard immediately after use.

Storage : Do not refrigerate. Keep at room temperature below 25’C

Incompatibility : No data


Green AP, Giattina KH. Adenosine administration in neonatal SVT. Neonatal Network1993;12:15-18.Paret et al. Adenosine for the treatment of Paroxysmal SVT in full term and preterm infants. Am J Perinatol 1996 13:343-346



Canberra Hospital

Adrenaline (Resuscitation)Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Cardiac resuscitation

Dose : IV = 0.01-0.03 mg/kg = 0.1-0.3 mls/kg of 1:10,000 solutionETT = 0.05 – 0.10 mg/kg = 0.5-1.0 mls/kg of 1:10,000 solution

Interval : Stat. repeat if necessary

Route : IV, ETT

Dose used for resuscitation :

0.1-0.3 ml of 1:10,000 solution/kg body weight for IV administration. May be repeated every 1-3 minutes. 0.5-1.0ml/kg of 1:10,000 solution/kg body weight for ETT administration.

Comments : Of value in cardiac arrest because of alpha-adrenergic properties. Beta-mimetic use uncertain in resuscitation conditions. May cause cardiac arrythmias, hypertension, tachycardia.

Supplied as : Adrenaline 1 in 10,000 (1 mg in 10 ml)

Dilution : Undiluted in resuscitation

Stability : Use immediately. Discard after opening.

Storage : Room temperature. Shield from light. Do not use if solution is brown or turbid.

Compatibility: May be co-infused with TPN, amikacin, calcium gluconate, cimetidine, dopamine, hydrocortisone, morphine, vecuronium, dobutamine, heparin.

Incompatibility : Do not give with aminophylline, sodium bicarbonate, phenobarbitone.

Serum Levels : Nil



Canberra Hospital

Adrenaline (Infusion, Inhalation)Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Inotropic support where alpha-adrenergic properties are desirable.Croup or post-extubation stridor

Dose : IV infusion - 0.1-1 microg/kg/min by continuous infusionInhalation - 4 mls of 1:1000

Interval : InfusionsInhalation – repeat if required

Route : IV, Inhaled

Comments : May cause cardiac arrythmias, hypertension, tachycardia.Use in croup and post extubation stridor is for emergency, transient (1-2 hrs) relief of partial obstruction. ECG monitoring & continuous medical supervision is indicated. Not a substitute for intubation, if intubation is indicated.

Supplied as : Adrenaline 1 in 1,000 (1 mg in 1 ml)

Dilution : Infusion - Add 1.5 mg per Kg of Adrenaline 1:1,000 to a syringe and make up to 25 ml with D5W, D10W or NS.Using this resulting concentration:

0.1 ml/ hr = 0.1 microg/kg/ minInhalation - use 1:1,000 ampoules undiluted.

Stability : Use immediately. Discard after opening. Continuous infusion must be shielded from light.

Storage : Room temperature. Shield from light. Do not use if solution is brown or turbid.

Compatibility: May be co-infused with TPN, amikacin, calcium gluconate, cimetidine, dopamine, hydrocortisone, morphine, vecuronium, dobutamine, heparin.

Incompatibility : Do not give with aminophylline, sodium bicarbonate, phenobarbitone.

Serum Levels : Nil



Canberra Hospital

AlbuminRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Intravenous albumin infusion is used in preterm and term infants as a fluid bolus or to treat hypoalbuminaemia

Dose : 1] Fluid bolus - 4% albumin – 10 ml/kg2] Hypoalbuminaemia - 20% albumin – 5-10 ml/kg (1-2g/kg)

Interval : 1] May be repeated depending upon response2] Daily depending upon response

Route : 1] Intravenous – infuse over 30 minutes2] Intravenous – infuse over 4 hours, generally followed by frusemide

Total Daily Dose :

Comments : Adverse effects may include circulatory overload, hypotension, rigors and sodium overload.

Supplied as : 1] Human albumin 4% 4 g/dL2] Human albumin 20% 2g/dL

Dilution : Nil required

Stability : Discard after use

Storage : Refrigerate – if not used must be returned to transfusion.Protect from light

Compatibility : 5% Dextrose, 10% Dextrose, 0.9% Sodium chloride

Incompatibility : Cefotaxime, Ceftriaxone, Clindamycin, Dobutamine, Adrenaline, Insulin, Penicillin, Phenytoin, Midazolam, Vancomycin

Serum Levels : Nil



Canberra Hospital

AmlodipineRevision Date : 24 June 2013 Approved : AK, JD

Indication : Antihypertensive agent.

Dose : 0.1-0.4 mg/kg

Interval : Daily

Route : Oral

Total Daily Dose : Maximum dose 0.4 mg/kg/day

Comments : Amlodipine is a long acting dihydropyridine calcium channel antagonist with resultant antihypertensive activity related to smooth muscle relaxation. Adverse effects may include hypotension, feed intolerance and alteration of liver function tests, flushing, peripheral oedema and palpitations. Caution when used in combination with other antihypertensives. Caution when used with other medications metabolised via CYP3A4 (eg erythromycin, antifungals).

Supplied as : 5 mg tablet1mg/mL Suspension (made in pharmacy)

Dilution : Pharmacy will prepare a 1mg/mL suspension during normal hours. For doses after hours, crush and disperse a 5mg tablet in 5mL of sterile water to make a 1mg/mL mixture. Shake for even drug distribution immediately prior to drawing up dose and discard remainder. Use immediately as amlodipine is very sensitive to light.

Stability :

Storage : Store below 25 degrees Celsius (tablets and mixture).Protect from light.

Incompatibility :

Serum Levels :



Canberra Hospital

AmpicillinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Neonatal sepsis, meningitis and other infections.

Dose : 25 mg/kg for septicaemia50 mg/kg for meningitis, GBS Sepsis.

Interval : 12 hourly <7 days after birth 8 hourly >7 days after birth 6 hourly > 4 weeks of age

Route : IV or IM.

Total Daily Dose : According to maturity

Comments : Slow intravenous infusion over not more than 100 mg/ minute

Supplied as : Ampicyn 500 mg

Dilution : Add 4.7 ml sterile water to vial (= 5 ml at 100 mg/ml). For use dilute to 10 ml with Normal Saline (50 mg/ml) and draw up required dose. Infuse slowly over 15 minutes.

Stability : Discard after reconstitution. Ampicillin is unstable in concentrated solutions and should be used as soon as practical.

Compatibility: May be co-infused with Calcium in saline, cimetidine, chloramphenicol, heparin, morphine, sodium bicarbonate, tolazoline, vancomycin.

Storage : At room temperature

Incompatibility : Do not give with Calcium and dextrose solutions, dopamine, adrenaline, fluconazole, gentamicin or hydralazine. Not compatible with TPN.

Serum Levels : Not required.



Canberra Hospital

Amphotericin BRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Fungal sepsis

This is a RED ANTIMICROBIAL and requires approval from the Infectious Disease Team as per AMS SOP.

Dose : Candida species: 0.5-0.7 mg/kgAspergillus species: 1-1.5 mg/kgZygomyces species: 1.5 mg/kgProlonged febrile neutropenia: 1 mg/kg

Interval : 24 hourly

Route : IV only infuse over 4-6 hours

Total Daily Dose : 0.5-1.5 mg/kg

Comments : Amphotericin is derived from streptomyces nodosus. In its crystalline form it is insoluble in water and is suspended in a colloidal dispersion for IV administration. The drug is toxic and causes renal impairment - notably hypokalaemia(by increasing renal potassium loss), renal tubular acidosis. Leucopenia and thrombocytopenia are less common and maybe due to the primary infection. Monitor serum creatinine, electrolytes, FBC. Test doses unnecessary in children and may delay therapy. If in-line filters are used, the mean pore diameter should not be less than 1 micron.

Supplied as : Fungizone Intravenous 50 mg powder for reconstitution.

Dilution : Single dose preparation from pharmacy. Reconstitute with 10 ml sterile water and shake until solution is clear. Dilute with 5% dextrose by adding 0.2 ml to 9.8 ml giving a solution with 0.1 mg/ml. Administer infusion over 4-6 hours. Protect entire line from light.

Stability : Vial for single use only. Discard remainder.

Storage : Refrigerate. Protect from light.

Compatibility: 5%, 10%, 20% Dextrose, Heparin, Hydrocortisone, Sodium bicarbonate and Zidovudine.



Canberra HospitalIncompatibility : Do not mix with 0.9% NaCl, CaCl2, KCl, dopamine,

penicillin. Not compatible with TPN, give through separate line. Calcium gluconate, gentamicin, ranitidine.

Serum Levels : Nil

Amphotericin B (Lipid Complex) Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Fungal sepsis. Restricted to patients with or at risk of developing renal failure, or in patients with infections resistant to conventional amphotericin B.This is a RED ANTIMICROBIAL and requires approval from the Infectious Disease Team as per AMS SOP.

Dose : 2.5-5 mg/kg. Test dose unnecessary in children and may delay treatment.


Route : IV only infuse over 1-2 hours. Infuse each 2.5 mg/kg over 1 hour.

Total Daily Dose : Up to 5 mg/kg

Comments : Amphotericin B is complexed to phospholipids. Decreases overall toxicity and side effects of Amphotericin. A greater concentration of Amphotericin is transported to the site of infection. Higher doses are tolerated without side effects. Monitor serum creatinine, electrolytes and FBC. Treat for at least 14 days.

Supplied as : Abelcet 5 mg/ml vial.

Dilution : Normally made by pharmacy. Shake vial gently to ensure no yellow sediment at bottom of vial. Using 5 ml syringe and 17 or 19 G needle withdraw 5 ml from vial. Replace needle with 5 micron high flow filter needle provided with each vial. Adjust volume to 1.25 ml (25 mg) and transfer it into a 25 ml syringe. Draw the 25 mg up to 25 ml with 5%D. Final concentration = 1mg/ml. If the syringe is not used immediately hold in refrigerator and shake vigorously prior to use.

Stability : Single use vial. Discard any remaining solution.

Storage : In refrigerator. Protect from light.

Incompatibility : Not compatible with NS or TPN. Infuse through a separate line. Flush with 5% D before and after dose.



Canberra HospitalSerum Levels : Nil

Compatibility: 5%D ONLY

*Available only as SAS drug from TGA. Can be used in Level 3 units only.



Canberra Hospital

AspirinRevision Date : 24 June 2013 Approved : AK, JD

Indication : Antiplatelet agent for use in neonates with cardiac shunts e.g. Blalock-Taussig shunt

Dose : 1 - 5mg/kg/dose1

Interval : Once Daily

Route : Oral

Total Daily Dose : Maximum dose 5mg/kg/day

Comments : Aspirin may cause gastrointestinal irritation with GI bleed. If this occurs discussion should occur with the Cardiology team managing the patient as to whether aspirin can be ceased or addition of a H2 antagonist or proton pump inhibitor is required.Give with feeds to reduce gastric irritation.May cause bronchospasm.Solprin® and Disprin® brands - contain no sodium. Aspro Clear® 300mg soluble tablets contain 6.5 mmoles sodium per tablet – caution mother not to use Aspro Clear® brand after discharge.G6PD deficient patients are at risk of haemolysis.Not used as an analgesic or antipyretic in neonates, infants or children.

Supplied as : 300mg dispersible tablet

Dilution : Disperse a 300mg tablet in about 8mL of water for injection. Wait for bubbles to subside and make up to a final volume of 10mL with extra WFI. Makes a 30mg/mL solution.Give dose immediately and discard remaining solution.

Stability : Aspirin breaks down rapidly when exposed to moisture – use immediately after removal from packaging2

Storage : Store tablets below 25 degrees Celsius

Incompatibility : Caution with NSAIDs and anticoagulants – increased risk of bleeding

Serum Levels : Not applicable



Canberra Hospital

AtenololRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Hypertension, Beta-1-adrenergic blocking agent.

Dose : IV 0.02-0.05 mg/kg/dose every 5 minutes until response (max 4 doses), then 0.1-0.2 mg/kg/dose 12 hourly if necessary.Oral 1-2 mg/kg/dose once daily (twice daily in severe cases).

Interval : 12-24 hourly

Route : IV, Oral

Total Daily Dose :

Comments : May exacerbate asthma, cardiac failure and heart block. Monitor for hypoglycaemia when commencing therapy.

Supplied as : Ampoules: 5mg in 10 ml (0.5 mg/ml)Tablets: 50 mg

Dilution : Dose can be given undiluted as a slow bolus over 5 minutes or diluted with NS to a suitable volume and given as an infusion over 20 minutes.

Stability : Discard any unused solution.

Storage : Ampoules and tablets store at less than 30 degrees Celsius. Diluted IV solutions protect from light.

Incompatibility : Amphotericin.

Compatibility: NS, 5%D, Y-site compatible with morphine, meropenem.Serum Levels : Nil



Canberra Hospital

AtropineRevision Date : 23 April 2014 Approved : TC, LZ, JD

Indication : 1. Sinus bradycardia, premedication to reduce secretions during operative procedures or intubation.2. Cardiac resuscitation

Dose : 1. 0.01 mg/kg (10 microg/kg) stat= 0.1 mL/kg of diluted solution (see below)2. 20 microg/kg stat= 0.2 mL/kg of diluted solution (see below)

Interval : Dose can be repeated every 10-15min to achieve desired effect

Route : IV, IM, SC

Total Daily Dose : Upto 40 microg/kg

Comments : May cause dry mouth, dilated pupils, increased intra-ocular pressure, flushed, dry skin, bradycardia leading to tachyarrhythmias, constipation.Overdose may cause tachycardia, tachypnoea, hyperpyrexia, restlessness. If massive, overdose will cause hypertension, circulatory failure and respiratory depression.Duration of action is 6 hours.

Supplied as : Atropine 0.6 mg/mL (600microg/1mL)

Dilution : Add 1mL of solution (600microg/1mL ampoule) to 5mL of Normal SalineMakes 600microg/6mL = 10 microg/0.1 mLDose = 10-20 microg/kg = 0.1-0.2 mL/kg

Stability : Discard after dilution

Storage : Room temperature, protect from light

Compatibility: Compatible for co-infusion with dobutamine, fentanyl, morphine, KCl, ranitidine.

Incompatibility : Bromides, iodides, Na Bicarbonate, noradrenaline, pentobarbitone.

Serum Levels : Nil



Canberra Hospital

AzithromycinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Azithromycin is macrolide subclass antibiotic used for the treatment of community acquired pneumonias and ureaplasma pneumonia. Use outside these indications may require an ID approval code.

Dose : 5-10 mg/kg/dayInterval : DailyRoute : OralTotal Daily Dose : 5-10 mg/kg

10mg/kg/dose daily for 7 days followed by 5mg/kg/dose for another 7 days (total 14 day course) for ureaplasma infection *

Comments : May cause gastrointestinal upset, raised LFT’s and renal dysfunction. Can also cause candidal infection and ototoxicity. May be associated with prolonged QT interval, use with caution with other drugs that prolong QT interval1.Give mixture on an empty stomach and separate dose from antacids2.

Supplied as : Zithromax Powder for oral suspension 40mg/mL, 15mL

Dilution : Reconstituted in pharmacy to make a 40mg/mL oral suspension.

Stability : Discard solution 10 days after preparation

Storage : Once reconstituted store below 30 degrees Celsius

Serum Levels : Nil

References: * Limited evidence, dose and duration to be reviewed once further evidence published. (Use of azithromycin for the prevention of bronchopulmonary dysplasia in preterm infants: a randomized, double blind, placebo controlled trial. Paediatric Pulmonology Ballard et al., 2011 46(2):111-8)1. Australians Medicines Handbook 2013Macrolides – Azithromycin2. Paediatric Pharmacopoeia Royal Childrens Hospital Melbourne 13th edition



Canberra Hospital

Buccal Glucose Gel 40% Revision Date : Jan 2017 DTC Approved: 27/02/2017

Indication : Hypoglycaemia in the newborn population

Dose : 0.5mL/kg/dose

Interval : As required

Route : Buccal

Total Daily Dose : Can be repeated up to 4 times in a 48 hour period

Comments : -to be used in newborns if glucose if <2.6-repeat BGL after ½ hour. If remains <2.6 repeat dose of glucose gel can be given.-Treatment Failure: If the BGL remains <2.6 after 2 doses of Glucose gel, alternative treatment needs to be given.-Recurrent Hypoglycaemia: If there is treatment response and recurrent episode of hypoglycaemia (BGL <2.6) glucose gel can be repeated. (Maximum 4 doses in a 24 hour period).

Supplied as : 37.5g tube15g glucose in 37.5g oral gel

Dilution : Not required

Stability :

Storage : Room temperature

Incompatibility : Saliva- swab mouth with gauze before applying

Serum Levels : N/A

Compiled: November 2015 Review: November 2019

References:1. Dextrose Gel for treating neonatal hypoglycaemia: a Randomised Placebo-Controlled Trial

(The Sugar Babies Study), Harris D, Weston P, Harding JE; Lancet 2013, published September 25

2. Outcome at 2 years after Dextrose Gel treatment for neonatal hypoglycaemia: Follow up of a Randomised Trial. Harris D, Alsweiler JM, Ansell JM et al; J Pediatr Mar, 2016; 170: 54-59.e2

3. Hypoglycaemia- Infant Management, The Royal Women’s Hospital, Melbourne4. Hypoglycaemia in a neonate, Royal hospital For Women, Sydney. 5. Incidence of neonatal hypoglycaemia in babies identified as being at risk, Harris D, Weston

P, Harding J; Journal of Paediatrics 2012:787-91



Canberra Hospital6. Neofax on line accessed 21/12/16

BudesonideRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Inhaled corticosteroid used in the treatment of chronic lung disease of prematurity.

Dose : Nebuliser 250-500 micrograms 12 hourly


Route : Inhaled via nebuliser

Total Daily Dose : Nebuliser 500-1000 microgram

Comments : Avoid contact with eyes during nebulisation. Wash entire face after use. Rinse mouth after use either by feeding or with a moistened swab stick. Titrate to give effective control with the lowest possible dose. Risk of systemic effects with higher doses.

Supplied as : Budesonide nebuliser solution 500mcg/2 ml and 1000 mcg/2 ml

Dilution : Nil. If using a small volume, the dose can be diluted to an appropriate volume (eg 2 mls) with normal saline.

Stability : Keep at room temperature

Storage : Store at room temperature

Incompatibility :




Canberra Hospital

Caffeine BaseRevision Date: 09/01/2014 14:40:00 Approved : AK, JD

Indication: Apnoea of prematurity, either for prophylaxis or active treatment.

Dose Loading Dose: 10 mg/kg of Caffeine BaseMaintenance dose: 2.5 mg/kg/dose If indicated, can be increased up to 5 mg/kg/dose. Higher doses may be considered but must be approved by a Consultant.

Interval: Daily

Route: 1) Intravenous dose may be given as a slow push over 3-5 minutes2) Intravenous dose may be given as an infusion by syringe pump over 30 minutes.3) Oral medication must be given with feeds.

Total Daily Dose: 2.5 mg/kg/day after the loading dose.Oral maintenance doses given at 10:00am each morning

Comments: Maintenance dose should be started 24 hours after the loading dose. When transferring from IV to oral dosing please remember that the oral dose is given at 10.00am. Adverse effects include restlessness, vomiting and tachycardia. Consider withholding the dose if heart rate >180/min. Bronchodilator and CNS stimulant. Metabolised via liver by Cytochrome P450 and so interacts with drugs which share the same metabolic pathway (eg phenytoin, phenobarbitone, erythromycin, ciprofloxacin, ketoconazole and others) Interconversion between theophylline and caffeine can occur in premature neonates.Caffeine Base 10mg/ml is equivalent to Caffeine Citrate 20mg/ml.

Supplied as: Caffeine Base solution 10mg/mlCaffeine Base vial 10mg/ml

Dilution: Nil. Use directly.

Stability: Stable until expiry date

Storage: At room temperature

Compatibility: Compatible with: D5W, D50W NS, 20% Intralipid, Dopamine, Calcium Gluconate, Heparin, Fentanyl, Potassium.

Incompatibility No information available

Serum Levels: Caffeine levels to be done if toxicity suspected or if doses higher than those recommended are being considered for persistent apnoeas. Trough (just prior to next dose) Therapeutic levels 100-205 μmol/L (20-40 mg/L); Toxic levels > 250 μmol/L (> 50 mg/L)



Canberra Hospital

Calcium GluconateRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : 1] Resuscitation2] Seizures due to hypocalcaemia3] Hypocalcaemia4] Daily maintenance

Dose : 1] 0.5 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)2] 2.0 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)3] 900 mg/kg/day (double daily maintenance)4] continuous infusion over 24 hours. (10 ml of 1g/10 mL solution added to 500 ml of maintenance fluids)

Interval : 1] stat, repeat if necessary, administer over 3-5 minutes2] stat, repeat if necessary, administer over 15 minutes3] continuous infusion over 24 hours.4] continuous infusion over 24 hours.

Route : I.V.

Total Daily Dose :

Comments : May cause bradycardia, hypokalaemia, and/or hypotension if infusion given too rapidly. Tissue necrosis and sloughing of tissue may occur if extravasation occurs. Care is required when there is extra Vitamin D intake.

Supplied as : 1g/10 mL solution (2.2 mMol/10 mL)

Dilution : 1] < 1 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with sterile water to a total of 2 mls. 1-2 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with sterile water to a total of 2.5 mls. 2-3kg – dilute 0.5 ml/kg of 1 g/10mL solution with sterile water to a total of 3 mls. > 3kg – dilute 0.5 ml/kg of 1 g/10mL solution with sterile water to a total of 4 mls.2] < 1 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with sterile water to a total of 4 mls. 1-2 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with sterile water to a total of 5 mls. 2-3kg – dilute 2.0 ml/kg of 1 g/10mL solution with sterile water to a total of 6 mls. > 3kg – dilute 2.0 ml/kg of 1 g/10mL solution with sterile water to a total of 8 mls.3] & 4] In peripheral I.V. infusion keep concentration 2 ml of 1g/10 mL solution to 100 ml of maintenance to prevent tissue burns.

Stability : Discard ampoules and unused portions after initial use.


Compatibility: Compatible with aminophylline, Adrenaline, Dobutamine, Lignocaine, vancomycin.

Incompatibility : Sodium bicarbonate, Magnesium sulphate, cephalothin, streptomycin, prednisolone. Contraindicated with digoxin except with extreme caution.

Serum Levels : Measure serum calcium as indicated.



Canberra Hospital

Calcium Carbonate Suspension Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Calcium deficient states needing supplementation.

Dose : 50 mg per dose

Interval : 6 hourly.

Route : Oral – not to be given with feeds or with oral phosphate.

Total Daily Dose : 5 mls

Comments : Use in early hypocalcaemic states associated with deficient intake during periods of rapid growth. Use in chronic renal failure must be monitored closely as hypercalcaemia may occur. Concomitant administration with Vitamin D may cause toxicity.

Supplied as : 40 mg/mL elemental calcium = 100 mg/mL of calcium carbonate i.e. 50 mg of elemental calcium = 1.25 mL

Dilution : 200 mL bottle – please shake bottle well prior to extracting dose

Stability : Preservative hydroxybenzoates.

Storage : Room temperature.

Incompatibility : Give at separate times to oral phosphate to prevent precipitation and malabsorption.

Serum Levels : Monitor serum calcium.



Canberra Hospital

CalcitriolRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Vitamin D deficiency - due to end organ unresponsiveness either as a primary problem or secondary to chronic renal failure.

Dose : 0.02 microg/kg/day

Interval : Daily dose increasing every 4-8 weeks by 0.02 mcg/kg depending on response.

Route : Oral/ Sublingual.

Total Daily Dose : N/A

Comments : The most active form of Vitamin D. Hypercalcaemia is a danger and the dosage should be adjusted to avoid intoxication. Regular monitoring of serum calcium, phosphate and ALP is necessary. Symptoms of overdose include lethargy, weakness, ectopic calcification, etc.

Supplied as : Capsules : 0.25 microg calcitriol/ capsuleLiquid: 1microg/mL available on SAS (Special Access Scheme)

Dilution : Not required. Remove fluid from capsule with syringe and administer orally.

Stability : Use immediately.

Storage : Protect from heat and light.

Incompatibility : Not Applicable.

Serum Levels : N/A.



Canberra Hospital

CaptoprilRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : HypertensionCardiac Failure

Dose : Starting dose is 0.1 mg/kg, increasing in 0.1 mg/kg increments until desired blood pressure achieved or cardiac failure controlled.

Interval : 8 hourly for infants 1500 g12 hourly for infants < 1500 g

Route : Oral

Total Daily Dose : Not known for newborns. May require up to 0.4-4 mg/kg/day in larger infants.

Comments : ACE inhibitor functions in cases of presumed hyper-reninaemia. May cause hyperkalaemia particularly if used in conjunction with potassium sparing diuretics or potassium supplements. Can cause cough

Supplied as : A clear, colourless, plum flavoured syrup containing 5 mg/ml of solution.When syrup is unavailable, disperse one tablet in water to make a 1mg/mL mixture. Discard unused portion immediately after preparation.

Dilution : Dilute 1 ml of syrup with 4 ml of water to make 1 mg/ml solution. Administer immediately and discard remainder after use.

Stability : may be kept up to 28 days after opening.

Storage :


Serum Levels : Not Applicable.



Canberra Hospital

CefotaximeRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Septicaemia and Meningitis caused by susceptible organisms.This is a restricted ORANGE ANTIMICROBIAL but does not require approval if used in paediatrics when used for the same indications as Ceftriaxone that are listed in the AMS SOP.

Dose : 50 mg/kg

Interval : 12 hourly for infants < 1 week. 8 hourly for infants 1-4 weeks..

Route : I.V.

Total Daily Dose : 100 - 200 mg/kg/day.

Comments : Should be used with caution with aminoglycosides. May cause a rash. CSF/Serum ratio 0.4-0.6. 35% protein bound.

Supplied as : 1 gram vials.

Dilution : Dilute with WFI. Add 3.6 ml to vial to give a solution of 250 mg/ml.

Stability : Discard after reconstitution.

Storage : Up to 2 years prior to reconstitution.

Compatibility: Compatible with Aciclovir, morphine, metronidazole, and TPN.

Incompatibility : Aminophylline, Fluconazole, Sodium bicarbonate and Vancomycin.




Canberra Hospital

Ceftazidime penthydrateRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Gram negative and Gram positive infections. Specific for Pseudomonal infections. Not MRSE, MRSA, Strep faecalis, or other enterococci, Listeria or clostridia.This is a restricted ORANGE ANTIMICROBIAL and can only be used for the indications outlined in the AMS SOP unless otherwise specified by the Infectious Disease team.

Dose : 30 mg/kgSevere infection: 50 mg/kg

Interval : Age < 1 week: 12 hrlyAge 1 week: 8 hrly

Route : I.V.

Total Daily Dose : max 90 mg/kg

Comments : Beta-lactam antibiotic. Some renal toxicity noted. May cause eosinophilia, transient rises in liver enzymes. Not metabolised and is excreted unchanged in the urine. Reduce dose in renal failure.

Supplied as : 1 or 2 gram vials.

Dilution : Usually made up in pharmacy. Single dose use. Use 1 gram vial. Dilute in 10 ml water to give concentration of 100 mg/ml. Shake to dissolve. Bubbles of CO2 may be disregarded.

Stability : Discard after use.

Storage : Room temperature before reconstitution.

Compatibility: TPN, Saline, Dextrose, Aciclovir, Aminophylline, Heparin, Morphine, Sodium bicarbonate, Vancomycin.

Incompatibility : Fluconazole, Midazolam.

Serum Levels : Should not exceed 40 microg/ml. Not routinely measured.



Canberra Hospital

Cephazolin Revision Date : 15 May 2015 DTC Approved: May 2015

Indication : For use in susceptible staphylococcal and streptococcal infections, and UTI’s due to susceptible bacteria.1

Dose : 25 mg/kg/dose2

Interval2 : Corrected gestational age

(weeks)

Post Natal age(days old)

Dosage Interval(hours)

≤29 0 to 28>28

128

30 to 36 0 to 14>14

128

37 to 44 0 to 7>7

128

≥45 ALL 6

Route : I.V. – infusion over 15 minutes2,3

Total Daily Dose :

Comments : May be nephrotoxic in high doses or if concomitant renal impairment, in which case the dose should be reduced. Caution when used with other nephrotoxic drugs.Each 1gram of cephazolin contains 2.1mmol of sodium (48.3 mg).4

Supplied as : Vials containing 1g of cephazolin sodium.

Dilution : Reconstitute each 1g vial of cephazolin with WFI to make total volume of 10mL (100mg/mL). Take 1mL of this solution and further dilute to a total volume of 10mL with normal saline (10mg/mL).2,3

Stability : Discard remainder after use.

Storage : Room temperature.4

Compatibility3,5: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, Dextrose-NS combinationsAciclovir, hydrocortisone, insulin, midazolam, morphine, sodium bicarbonate

Incompatibility3,5 : Ampicillin, dopamine, dobutamine, benzylpenicillin, calcium chloride, gentamicin, vancomycinNote: incomplete list of compatibilities/incompatibilities, contact pharmacy if any concerns.



Canberra HospitalSerum Levels : Nil

Compiled: May 2015 Review: May 2019

References: 1. Australians Medicines Handbook 2015 Cephalosporins – Cephazolin2. Neofax, accessed 3/3/20153. Australian Injectables Drugs Handbook, 6th Edition4. Product Information, Kefzol, TGA approved 18/02/20105. Micromedex IV compatibility, accessed 3/3/2015



Canberra Hospital

Chloral HydrateRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Sedative and hypnotic agent.

Dose : Sedative: 8 mg/kg, Hypnotic, Premedication: 25-100 mg/kg

Interval : Sedative: 6-8 hourly; Hypnotic, Premedication: single dose

Route : Oral or rectal

Total Daily Dose : Maximum dose 100 mg/kg/day

Comments : Chloral hydrate and its active metabolites have very long half lives in neonates, more so in premature infants (up to 40 hours). Any baby who receives more than 50 mg/kg should be closely monitored for adverse effects, in particular for respiratory depression. Infants on regular sedative dosing may experience accumulation. Side effects: respiratory depression, gastric irritation, headache, ketonuria, hyperactivity occurs in 1-2% of patients.

Supplied as : 500 mg/5 mL.

Dilution : For premedication give the dose undiluted 30 minutes prior to the procedure followed by a feed to assist in sleep. For other indications, oral irritation is reduced by diluting the dose with water or milk. May be given rectally – dilute the dose with an equal volume of olive oil.

Stability : Stable in room temperature until the expiry date indicated on the bottle.

Storage : Keep in drugs of dependence cupboard.

Incompatibility :

Serum Levels :



Canberra Hospital

ChloramphenicolRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Septicaemia, Meningitis

Dose : 25 mg/kg/dose

Interval 24 hourly for all infants 0-14 days and 15-30 days when < 2000 grams.12 hourly for infants > 2000 grams and 0-14 days.12 hourly for infants < 2000 grams and 2-4 weeks.

Route : I.V. infuse over 15-30 minutes.OralDo not give I.M.

Total Daily Dose : 25 mg/kg/day < 2000 grams at any age.25 mg/kg/day > 2000 grams and 0-2 weeks.50 mg/kg/day > 2000 grams and 2-4 weeks.

Comments : Use with reference to microbiology department. Adjust dosage when used with anticonvulsants and penicillin. The grey baby syndrome occurs after 3-4 days - abdominal distension, vomiting, pallid cyanosis, vasomotor collapse, irregular breathing, and death within hours. Occurs with blood levels > 90 mg/ml. Oral suspension is restricted to use by Director of Neonatology. SAS drug only

Supplied as : Chloromycetin sodium succinate 1.2 gram vials or oral suspension of chloromycetin 30 mg/ml.

Dilution : Usually made up by pharmacy. Add 11.0 ml of sterile water to vial, giving solution of 100 mg/ml for I.V. use only.

Stability : Discard remainder after use.


Incompatibility : Erythromycin, penicillin, cephalothin, gentamicin, aminophylline, phenytoin, heparin, ampicillin. Compatible with TPN.

Serum Levels : 10-25gm/ml.



Canberra Hospital

CiprofloxacinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : A synthetic carboxyquinolone derivative with broad-spectrum antimicrobial activity. Only to be prescribed on the direction of the consulting Neonatologist.This is a restricted ORANGE ANTIMICROBIAL and can only be used for the indications outlined in the AMS SOP unless otherwise specified by the Infectious Disease team.

Dose : 5 - 10 mg/kg


Route : Oral, IV.

Total Daily Dose : 10 - 20 mg/kg

Comments : Bacterial action appears to result from interference with the enzyme DNA gyrase. Not recommended in children under 12 years as causes defects in cartilagenous growth in rats. May cause theophylline and caffeine toxicity.Ciprofloxacin solution should be administered iv as a slow infusion over a period of 60 minutes.

Supplied as : Ciprofloxacin minibags, 100mg/50mL or 200mg/100mL

Dilution : Not required. 2mg/mL minibag is ready to infuse.

Stability : Stable at room temperature.

Storage :

Incompatibility : Oral dose not absorbed if given with antacids.No data available on incompatibility.




Canberra Hospital

Clinoleic Lipid EmulsionRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Sterile fat emulsion for IV infusion for infants on TPN.

Dose : Day 1: 1 g/kg/dayDay 2: 2 g/kg/dayDay 3 onwards: 3-3.5 g/kg/day

Interval : Daily

Route : IV infusion over 24 hours

Total Daily Dose :

Comments : Isotonic fat emulsion providing 9 kJ/ml. Needs to be administered to NBM patients at least once weekly to prevent essential fatty acid deficiency (EFAD). Particle size is less than 1 micron. Must not be used with in-line filters less than 5 microns. Caution using in infants with sepsis. Long-term use – monitor platelets, LFT’s, serum triglycerides.

Supplied as : Clinoleic 20% 100mL and 250mL bags.The 20% fat emulsion is an isotonic emulsion of approximately 80% olive oil and 20% soya oil. This combination provides a ratio of 15% Saturated fatty acids, 65% Mono-unsaturated fatty acids and 20% Essential Polyunsaturated fatty acids.

Dilution : Pharmacy will prepare a syringe for doses up to 50 mls (with a 10 ml overage) and bags for doses over 50 mls (with a 25 ml overage). The dose will also be loaded with “Vitalipid N” (fat soluble vitamins) 1 ml/kg and Soluvit N (water soluble vitamins) 1 ml/kg. The total volume to be infused per day:1 g/kg/day = 5 ml/kg/day2 g/kg/day = 10 ml/kg/day3 g/kg/day = 15 ml/kg/day 3.5/kg/day = 17.5 ml/kg/day

Stability : 24 hours once prepared

Storage : Unopened bottles room temperature.Syringes/minibags – keep in refrigerator until ready to use.Protect from light.

Incompatibility :

Compatibility:

Serum Levels :



Canberra Hospital

ClonazepamRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Seizures unresponsive to phenobarbitone and phenytoin.

Dose : Loading dose 50-100 microg/kgMaintenance 15- 50 microg/kgContinuous infusion- Loading dose of 100 microg/kg, followed by an infusion of 10-30 microg/kg/hr. Once control is achieved, convert to a daily dose.


Route : Loading dose IVMaintenance orally.

Total Daily Dose : 0.1 mg/day (Tolerance may develop requiring higher dosing).

Comments : Half-life varies, as for elimination maturity and plasma levels are not helpful in determining effect. Oral route of administration is preferred for maintenance. Hyper-secretion of saliva and/or bronchial glands is a possible side effect. Note that benzodiazepines tend to limit spread of electrical activity rather than completely suppress a focus entirely. Concurrent treatment with phenobarbitone or phenytoin has been shown to cause increased serum phenytoin levels and reduced clonazepam levels. Drug tolerance occurs if treatment is continued for any extended period of time. Dose must be gradually reduced when the drug is withdrawn to reduce the risk of rebound seizures.

Supplied as : Parenteral Prep. vial 1 mg/ml.Oral drops 2.5 mg/ml.

Dilution : For loading doses and maintenance doses use water for injection and dilute to 2 ml for administration (500 microg/ml).For infusion take the baby’s weight in mls (3.0kg = 3ml) of Clonazepam solution (1000 microg/ml=1mg/ml) and make upto 25 ml with 5 % Dextrose or saline.1 ml/hr.= 40 microg/kg/hr.

Stability : As per pharmacy.


Compatibility: Dextrose 2.5 %, 5% and 10 %. Sodium chloride 0.45 % and 0.9 %.

Incompatibility : Do not mix with any other drugs or TPN

Serum Levels : 60-150 nmol/l. (Not very well defined). Not routinely performed.



Canberra Hospital

ClotrimazoleRevision Date : 09/01/2014 14:40:00 Approved AK, JD

Indication : Fungal infection of the skin.

Dose : Thin smear, rubbed in gently.

Interval : With each diaper change.

Route : Topical.

Total Daily Dose :

Comments : Used in treatment of perineal candidiasis where Nystatin has failed.Should be used with caution in babies under phototherapy as it can cause burns.

Supplied as : Clotrimazole 1%. May be combined with Hydrocortisone to produce a lotion/cream with faster action in soothing more aggressive rashes.

Dilution :

Stability :



Serum Levels :



Canberra Hospital

Co-trimoxazoleRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Pneumonia, UTI's, skin and wound infections. Coliform meningitis, infections unresponsive to other regimes. UTI prophylaxis. Pneumocystis Carinii Pneumonia (PCP)

Dose : Avoid in infants < 7 days.Infection treatment – Oral 4 mg/kg/dose 12 hourly (0.5 ml/kg/dose)General prophylaxis – 2 mg/kg/dose each night (0.25 ml/kg/dose)PCP Infection – IV/Oral 5 mg/kg 6 hourlyPCP prophylaxis – 5 mg/kg/dose on 3 nights per week – Monday, Wednesday, Friday


Route : Oral or I.V.

Total Daily Dose : 30 mg/kg/day sulphamethoxazole + 6 mg/kg/day trimethoprim.

Comments : Risk of jaundice in first week of life. Doses expressed in terms of trimethoprim content. Risk of kernicterus if used in frist 4 weeks of life. Contraindicated in G6PD. Give with feeds.

Supplied as : Oral Syrup – 1 ml contains 40 mg/8 mg sulpha/trimethoprim respectively.I.V. vial 5 ml contains 400 mg/80 mg sulpha/trimeth respectively. Single dose preparation by pharmacy.

Dilution : Mix only with dextrose or dextrose-saline solutions. Mix 5 ml vial to 125 ml of solution (3 mg/ml and 0.6 mg/ml of sulpha/trimeth). Give required dose over 10 minutes by slow infusion.

Stability : Discard after single usage.

Storage : 8-25oC. Do not refrigerate. Discard if precipitation occurs.

Incompatibility : Usual precautions apply. No specific data.




Canberra Hospital

CryoprecipitateRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Cryoprecipitate is a concentrated preparation containing all of the factor VIII, fibrinogen, fibronectin, factor XIII, and von Willebrand factor found in Fresh Frozen Plasma.

Dose : 5-10mL/kg, starting at no more than 5mL/min10mL/kg per infusion every 6 hours as needed

Interval : As required

Route : IV over half an hour

Total Daily Dose :

Comments : Use a new blood administration set with a 170-200micron filter – do not piggy back onto other lines. Change administration set every 12 hours for continuous infusions. At completion of a transfusion, flush the line to ensure the patient receives the entire dose.

Supplied as : Cryoprecipitate is issued thawed; there may be a delay of 20 to 30 minutes from the time of request until supply due to thawing.

Dilution : Do not add any medication to the cryoprecipitate or to the giving set.

Stability : There may be 2 expiry dates on the pack, one from the time of freezing and the other from the time of thawing – use expiry from time of thawing. Do not refreeze or refrigerate once thawed.

Storage : Commence immediately or contact the transfusion service provider for storage advice. Do not refrigerate once thawed. Each cryoprecipitate pack should be completed within 4 hours of removal from controlled storage or before the expiry time of the pack or Tranfusion Compatibility Report (whichever is sooner)

Incompatibility : Do not infuse with or through a line that has previously contained calcium (such as Hartman’s solution) as it may cause clotting of the infusion line. Cryoprecipitate should preferably be ABO compatible.

Compatibility: 0.9% sodium chloride

Serum Levels : Repeat coagulation studies 4-8 hours post transfusion



Canberra Hospital

Curosurf: Poractant alfaRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Respiratory distress due to definite surfactant deficiency and hyaline membrane disease. Surfactant deficiency also occurs in pulmonary hypoplasia and congenital diaphragmatic hernia. Restricted to babies less than 28 weeks gestation, and infants of any gestational age with severe meconium aspiration.

Dose : Curosurf: Treatment dose: 200mg/kg/dose (2.5ml/kg/dose). Up to two repeat doses of 100mg/kg/dose (1.25ml/kg/dose) may be administered 6-12 hourly. Max total cumulative dose is 400mg/kg (5ml/kg).Prophylactic dose: 100mg/kg/dose (1.25ml/kg/dose). Repeat doses of 100mg/kg (1.25ml/kg) may be given 6-12 hourly after the first dose, with max total cumulative dose of 400mg/kg (5ml/kg)

Interval : Curosurf: 6-12 hourly

Route : Endotracheal tube.

Comments : Poractant alfa is a sterile non-pyrogenic pulmonary surfactant obtained from porcine lung surfactant. It contains no preservatives. Infants less than 30 weeks gestation are usually given prophylactic surfactant at the time of birth, preferably before the institution of the first mechanical breath. Infants > 30 weeks gestation are administered surfactant if they require IMV or are on CPAP and 50% oxygen with the diagnosis of HMD on CXR.Given with a size 5 infant feeding tube directly down the ETT or via the suction port of the Trach-care device.

Supplied as : Curosurf: 80mg/ml of poractant alfa. 1.5ml and 3ml vials.

Dilution : Curosurf: Nil required.Should be given by experienced person (Neonatologist) or under supervision of Neonatologist. Ventilator settings may need adjustment during administration. Beware of blockage of ETT. If possible avoid suctioning for 2 hours post dose administration.

Stability : Single vial often good for several administrations. Do not warm whole vial. Draw up dose in syringe and warm slowly to room temperature, refrigerate remaining preparation for next dose. Do not shake the vial.

Storage : Curosurf: Refrigerate. Protect from light. Do not shake the vial.

Incompatibility : Do not mix with anything.



Canberra Hospital

Cyclopentolate hydrochloride eye drops (0.25%)Revision Date : 18 May, 2023 DTC Approved: October 2016

Indication : Used in conjunction with phenyelphrine hydrochloride to dilate the pupil for:1] ROP examination.2] Intraocular surgery

Dose : 1 drop of cyclopentolate 0.25% w/v in each eye, both 30mins and 15mins prior to examination

Apply pressure to the lacrimal sac during and for 1-2 minutes after instillation to minimise systemic absorption1,2

Interval : Every 15 mins

Route : Topical (Eyes)

Total Daily Dose : NA

Comments : -Used in conjuction with phenyephrine-Eye specialist on call will telephone the Unit and give phone instructions for eye drops to be given prior to his arrival in the unit-Maximal effect 30-60 mins, duration 2-4 hours-Systemic effects are those of anticholinergic drugs: Fever, tachycardia, vasodilatation, dry mouth, restlessness, delayed gastric emptying and decreased gastrointestinal motility, and urinary retention2

- Consider withholding feeds for 4 hours post administration2, 3

- Binds to melanin in the pupil; brown eyes may be less responsive to action and require a greater dose

Supplied as : Minims® Cyclopentolate hydrochloride 0.5% w/v. Will be diluted to cyclopentolate 0.25% in pharmacy

Dilution : Cyclopentolate 0.5% solution will be diluted with water for injection to 0.25% with addition of citrate buffer in the extemp area followed by sterilisation by filtration in aseptic suitePrepared solution will be transported and stored in NICU

Stability : For single use only. Discard any unused portion.

Storage : Refrigerate (2-8 degrees) for upto 28 days post manufacture. Do not freeze.

Compatibility: NA (Not applicable)

Incompatibility : NA

Serum Levels : NA



Canberra HospitalCompiled: October 2016

Review: October 2020

References:1. RPA and KEMH neonatal guidelines-online, 0.25% cyclopentolate, accessed

21/10/152. Neofax online. Accessed 21/10/153. Ozgun U1, Demet T1, Ozge KA1, Zafer D2, Murat S3, Mehmet Y1, Nilgun

K1. Fatal necrotising enterocolitis due to mydriatic eye drops. J Coll Physicians Surg Pak. 2014 May;24 Suppl 2:S147-9



Canberra Hospital

DexamethasoneRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Treatment of early or established chronic lung disease. To be ordered by Consultant Neonatologist only.

Dose : For CLD:0.2-0.3 mg/kg/day in two divided doses, then reduced every 48-72 hours by 0.1mg/kg/day.Further dosing schedule to be determined by infant response and requirements.


Route : I.V. or oral.

Total Daily Dose : According to protocol.

Comments : For CLD: Effects maximal after 36 hours of treatment. Massive diuresis, dehydration and shock have been described. Close check on fluid balance and electrolytes essential. GI haemorrhage documented. Hyperglycaemia and hypertension more common side effects. Watch urine for gylcosuria. Potentiates rickets of prematurity. May mask infection. Causes raised WCC generally without a toxic film. Use of this regime is potentially dangerous and should be under consultant supervision.Increased risk of systemic candidiasis. Infants on Dexamethasone should be treated with nystatin prophylaxis.

Supplied as : 4 mg/ml as dexamethasone sodium phosphate

Dilution : Add 3 ml NS or Dextrose to 1 ml dexamethasone( 1 ml = 1 mg). Infuse over 1-2 minutes.



Compatibility: TPN, Dextrose, Normal Saline, Aciclovir, Amikacin, Aminophylline, Fluconazole, Frusemide, Heparin, Hydrocortisone, Morphine, Sodium bicarbonate.

Incompatibility : Vancomycin, Midazolam.




Canberra Hospital

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

Dextrose - Increasing Dextrose Content of IV Bags Revision Date : 29 October, 2010 Approved : AK, ZK

Starting Concentration

Finished Concentration

Volume to be Removed From 500 mL Bag

Volume of 50% Dextrose to be added to 500 mL bag

5% Dextrose 7.5% 28 mL 28 mL

10% Dextrose 12.5% 31 mL 31 mL

10% Dextrose 15% 62 mL 62 mL

10% Dextrose 20% 125 mL 125 mL

N/4 3.75% Dextrose

5% 13.5 mL 13.5 mL

N/4 3.75% Dextrose 7.5% 40.5 mL 40.5 mL

N/4 3.75% Dextrose

10% 67.5 mL 67.5 mL

N/2 2.5% Dextrose 5% 27 mL 27 mL

N/2 2.5% Dextrose 7.5% 52.5 mL 52.5 mL

N/2 2.5% Dextrose 10% 79 mL 79 mL

Example: To make a 500 mL bag of 12.5% Dextrose, you need a total of 62.5 g of dextrose in 500 mL. 469 mL of 10% Dextrose contains 46.9 g of Dextrose. 31 mL of 50% Dextrose contains 15.5 g of Dextrose. When the 31 mL of 50% Dextrose is added to the bag, there is a total of 46.9 + 15.5 = 62.4 g which = 12.48% Dextrose. Calculations: Volume of 50% = Volume of IV solution (500 mL bag) x the required increase in percentage Dextrose required 50% Dextrose – the percentage of the base solution (i.e. 5 or 10%) E.g. – Increase 500 mL 10% bag to 12.5% Volume of 50% = 500 mL x 2.5% 50% - 10% = 1250 40 = 31.25 mL (rounded down to 31 mL) of 50% Dextrose

48


Canberra Hospital

DiazepamRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : 1] Control of convulsions (Not recommended for neonates)2] Sedation

Dose : 1] 0.2 mg I.V. up to 2 mg.2] 0.1-0.8 mg/kg/24 hours

Interval : 1] Stat; repeat if necessary.2] 0.1-0.8 mg/kg/24 hours

Route : I.M.I.V. Slowly, not more than 2 mg/minute.

Total Daily Dose : Not more than 2 mg/kg.

Comments : May cause hypotension, jaundice, hiccoughs, and lethargy. Caution when used with anaesthetic agents and alcohol. Contraindicated in severe jaundice i.e. SBR > 150 mmol/L, causes severe respiratory depression and prolonged hypotonia.

Supplied as : 10 mg/2 ml ampoules.

Dilution : Should not be diluted with any substance as it will precipitate. Administer over 5 minutes.

Stability : Discard unused portion.

Storage : Room temperature, protect from light.

Incompatibility : All other drugs in solution, including D5W and NS.




Canberra Hospital

DiazoxideRevision Date : 5th March 2009 Approved : AK, JD

Indication : Hyperinsulinaemic hypoglycaemia of the newborn.

Dose : 2-5 mg/kg/dose

Interval : 8/24

Route : Oral

Total Daily Dose : 6-15 mg/kg

Comments : Treatment of persistent or severe hypoglycaemia due to hyperinsulinism. Positive responses are usually seen within 48 to 72 hours and occur in approx 50% of neonates. Sodium and fluid retention is common, concurrent administration of hydrochlorothiazide is recommended.

Supplied as : 25mg capsules. Capsules are only available under the SAS scheme.An ‘SAS Category A Form’ needs to be given to pharmacy before supply can occur. See:http://www.tga.health.gov.au/docs/pdf/unapproved/sascata.pdf

Dilution : Pharmacy will make a 10mg/mL mixture.

Stability : Mixture is stable for 30 days.

Storage : Capsules and mixture: room temperature, protect from light.

Incompatibility : n.a.

Serum Levels : n.a.



Canberra Hospital

DigoxinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Cardiac arrythmias, Heart failure (controversial)

Dose : < 29 weeks - Loading dose 15 microg/kg29 weeks – 1 month old – Loading dose 20 microg/kg> 1 month old – 30-40 microg/kgGive half of the loading dose stat, followed by a quarter of the loading dose at 6-12 hours and the last quarter of the loading dose at 12-18 hours.Maintenance 3-5 microg/kg/dose 12 hourly

Interval : Maintenance 12 hourly

Route : I.V. - slowly over 5 minutes.Oral with feeds

Total Daily Dose :

Comments : May cause vomiting and arrhythmias. Be aware of toxic signs. If used with phenytoin profound bradycardia may result. Increased toxicity with adrenaline and frusemide. Toxic signs on ECG include scooping of ST segment; inversion of T waves; various degrees of heart block; arrhythmias. Care when used in infants < 1500 gm. Adjust dose for renal failure. Ensure normal serum potassium, as hypokalaemia increases the risk of adverse effects. Loading doses are only necessary in the management of arrythmias. In other situations start with maintenance dose. Do not use in patients with underlying Wolff-Parkinson- White syndrome. When giving mixture orally with a syringe do not flush the syringe after the dose – the drug left in the syringe may lead to toxicity if repeatedly administered. For the treatment of life-threatening digoxin toxicity use Digibind (Digoxin Immune Fab)

Supplied as : 50 microg/2 ml ampoules50 microg/ml oral solution

Dilution : Dilute using 1ml of ampoule with 4ml NS or WFI. (= 5microgm/ml ) Administer over 5 minutes. Observe ECG during administration.



Compatibility: Compatible with cimetidine, heparin, lignocaine, KCl, TPN, midazolam, NS, D5W, N/2 Saline, flucloxacillin, frusemide, ranitidine.

Incompatibility : Fluconazole, dobutamine.

Serum Levels : Normal serum levels = 1-2 nmol/L. Sampling time at least 6 hours after the dose. Approximate time to steady state is 1 week.



Canberra Hospital

DobutamineRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Inotropic support without chronotropic effects of other drugs.

Dose : 1-20 microg/kg/minute (Maximum dosage 20 microg/kg/min.)

Interval : Continuous infusion only

Route : I.V.

Total Daily Dose :Comments : Notably more beta effects than dopamine. Has less alpha effect and

therefore tends to produce a non-selective vasodilatation which may be useful in pulmonary hypertension. At low doses dobutamine is four times more potent in increasing cardiac contractility than dopamine, but dose not increase blood pressure as might be expected. Dobutamine may be used in combination with low dose dopamine to maintain renal, hepatic, and mesenteric blood flow. Unlike dopamine, dobutamine dose not cause release of endogenous noradrenaline, nor does it have any effect on dopaminergic receptors.

Supplied as : Dobutrex. Each vial contains 250 mg Dobutamine.

Dilution : Usually made up in pharmacy.Add 15 mg per Kg of Dobutamine to a syringe and make up to 25 ml with D5W, D10W or NS.Using this resulting concentration:

1 ml/ hr = 10 microg/kg/min

Stability : Pink discoloration of solution indicates slight oxidation of the drug but does not affect potency.


Compatibility : Dextrose, Normal Saline, TPN, Calcium gluconate, Calcium chloride, Dopamine, Adrenaline, Fentanyl, Heparin, Insulin, Isoprenaline, Magnesium sulphate, Potassium chloride, Tolazoline, Vecuronium.

Incompatibility : Frusemide, diazepam, sodium bicarbonate, phenytoin. Compatible with dopamine, Calcium gluconate, Adrenaline, Isoprenaline, Ranitidine, morphine, TPN

Serum Levels :



Canberra Hospital

DopamineRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : 1] Hypotension due to impaired cardiac output.

Dose : 1] 5-20 microg/kg/minute. Starting dose is commonly 10 microg/kg/min. and varied according to response.

Interval : Continuous infusion.

Route : I.V.

Total Daily Dose :

Comments : Correct hypovolaemia prior to administration. Best given via central line in dosage > 5 microg/kg/min as leads to vasoconstriction and "white streaking" of peripheral vessels. Extravasation may cause tissue necrosis and sloughing. May treat with SC injection of site with phentolamine: 1 ml of phentolamine 1mg/ml saline injected into affected area SC in 5 divided doses, changing needle with each injection.

Supplied as : 40 mg/ml - 5 ml ampoules.

Dilution : Usually made up in pharmacy.Add 15 mg per Kg of Dopamine to a syringe and make up to25 ml with D5W, D10W or NS.Using this resulting concentration:

1 ml/ hr = 10 microg/kg/minStability : Discard unused portion. Change infusion every 24 hours. May

be mixed with dobutamine, tolazolineStorage : Room temperature.

Compatibility : TPN, Dobutamine, Aminophylline, Calcium chloride, Fentanyl, Heparin, Hydrocortisone, Midazolam, Morphine, Tolazoline, Vecuronium.

Incompatibility : Sodium bicarbonate, and other alkaline solutions. Do not use line for other stat drug administration as flush will lead to bolus dosing. Compatible but not recommended to use in TPN.



Canberra Hospital

EpoprostenolRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Persistent pulmonary hypertension of the newborn unresponsive to tolazoline and the usual ventilatory strategies.

Dose : 2-20 nanograms/kg/minute.


Route : I.V. to central venous line.

Total Daily Dose :

Comments : Half-life is 3 minutes. Most potent vasodilator known. Use is restricted – ICU availability only. Latent hypovolaemia must be corrected before administering the medication. Causes profound hypotension in cases where volume loading is incomplete.

Supplied as : Epoprostenol sodium 500 g vial.

Dilution : Must be reconstituted in the solution provided. Draw up 10 ml of diluent and dissolve contents of vial. Draw up all of solution and inject into the remainder of the diluent vial (Total of 50 ml). This solution now contains 10,000 nanograms/ml (10 g/ml) .Take ‘X’ ml. of this diluted solution and make upto 50 ml with normal saline.Strength Rate ‘X’ = Body Weight in kg. x 620ng/kg/min. @ 1 ml/hr.

Stability : The base solution is stable for 24 hours.

Storage : Refrigerated, protect from light.

Incompatibility : None known. Usual precautions apply.

Serum Levels :



Canberra Hospital

ErythromycinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Sepsis, particularly Chlamydia, Mycoplasma and ureaplasma infections as well as H. influenzae.

Dose : Infection: 10 mg/kg.Prokinetic dose: 2mg/kg

Interval : Infection: 12 hourly < 1 week oldInfection: 8 hourly > 1 week old.Prokinetic dose: 8 hourly

Route : I.V. or oral.

Total Daily Dose : 30 mg/kg.

Comments : Oral dosage regimen usually adequate in infants tolerating enteral feeds. I.V. dosage requires care in administration and is reserved for infants not taking enteral feeds. May induce vomiting. Heart rate and Blood Pressure must be monitored closely during IV administration.

Supplied as : Oral suspension 250 mg/5 ml.I.V. vials containing 300 mg.

Dilution : Made up in pharmacy I.V. dilution only. Dilute vial with 6 ml sterile water for injection and store for further use. After initial dilution (50 mg/ml) dilute 1 ml further with 4 ml of NS or D5W to final concentration of 10 mg/ml. Administer over 60 minutes.

Stability : Discard remainder I.V. solution after use.Suspension stable for 10 days after reconstitution. Observe pharmacy directions.

Storage : Store suspension in fridge.

Compatibility : Normal Saline, TPN, Aciclovir, Aminophylline, Chloramphenicol, Heparin, Hydrocortisone, Midazolam, Morphine, Pentobarbital, Potassium chloride, Ranitidine, Sodium bicarbonate.

Incompatibility : Dextrose solutions, Ampicillin, Fluconazole, Frusemide, Metoclopramide.

Serum Levels :



Canberra Hospital

ErythropoietinRevision Date : 09/01/2014 14:40:00 Approved AK, JD

Indication : Anaemia of Chronic Renal Failure and Prematurity.

Dose : 250-300 units/kg/dose.

Interval : 2 or 3 times weekly.

Route : I.V. infusion over 4 hours or s.c.

Total Daily Dose : N/A. Total weekly dose is 500-1400 Units per kg.

Comments : Currently licensed only for CRF. Approval from Janssen-Cilag. Erythropoietin is a recombinant purified glycoprotein which stimulates erythropoiesis. Half-life in pre term neonates is about 12 hours. Watch for changes in Hb, BP, and other vascular disease. Noticeable effects on Hb and reticulocyte counts can occur over a period of 2 weeks. Weekly Hb should be checked until stable state achieved (10-12 gm/dl). Dosage of HuEPO may need adjusting according to the response over the first month or so. An increase in appetite may lead to hyperkalaemia. Iron supplements may be required to compensate for higher Hb. Failure to respond may reflect other deficiencies or loss and should be investigated.

Supplied as : 2000 units/ml ampoules.

Dilution :

Stability : Discard after opening.

Storage : 18 months at 2-8oC.

Incompatibility : Not compatible with anything. Do not mix.

Serum Levels :



Canberra Hospital

FentanylRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Narcotic analgesia.

Dose : 0.5-5 microg/kg/hourStat doses for laser surgery/other procedures 1-2 mcg/kg


Route : I.V. only.

Total Daily Dose :

Comments : Short duration of action, rapid onset and potent. In large doses causes "chest wall rigidity" – difficult to ventilate.0.1 mg Fentanyl is equivalent to 10 mg Morphine (100 times more potent). Cardiovascular stability an advantage. Half-life in neonates is variable and prolonged - 6 to 36 hours compared with 2 to 4 hours in children. Can cause rapid development of tolerance and withdrawal symptoms only after 3-5 days of usage.

Supplied as : Polyamp 50 microg/ml.

Dilution : Usually made up in Pharmacy.Add ‘X’ ml of Fentanyl to 25 mls of Normal Saline or DextroseStrength‘X’ = Body weight in kg1 ml = 2 microg/kg/hr, commence at 0.25-0.5 ml/hr

Stability : Diluted for infusion lasts 24 hours only.

Storage : DD cupboard

Compatibility : Compatible with TPN, Dextrose Dobutamine, Dopamine, Adrenaline, Heparin, midazolam, hydrocortisone, morphine, atropine, ranitidine, Sodium bicarbonate and vecuronium.

Incompatibility : Thiopental, phenobarbitol

Serum Levels : Generally not done.> 1 ngm/ml = slight analgesia.> 3 ngm/ml = effective concentration for postoperative pain.



Canberra Hospital

Ferrous Sulfate (Ferro-Liquid) Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Iron supplementation in prematurity.To be prescribed for all infants < 32 weeks gestation or birth weight < 1800 grams

Dose : 0.5 ml/kg day

Interval : Daily from 14 days (to 28) when on full feeds as tolerated.

Route : Oral. Preferable to give on an empty stomach to enhance absortption.

Total Daily Dose : As Above.

Comments : Ferrous sulfate 150 mg/5 ml is equivalent to 30 mg of elemental iron. Daily requirements are for 2.5 mg/kg/day to a maximum of 15 mg/day. Breast fed infants should be supplemented as soon as full breast milk feeds are established or four weeks after birth. Infants fed on formula do not usually need additional supplementation. Infants who have had regular transfusions through the neonatal period should have their iron status reviewed before supplementation. Iron should continue until weaning from breast-feeding or 12-15 months.

Supplied as : Ferro-Liquid 150 mg/5 ml (30 mg elemental iron/5 ml)

Dilution : Nil.

Stability :


Incompatibility : Do not administer with feeds.

Serum Levels : Assess serum iron, transferrin, ferritin, Hb, reticulocyte count.



Canberra Hospital

FlecainideRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Supraventricular arrhythmias due to pre-excitation syndromes and in the absence of structural heart disease.

Dose : 2 mg/kg


Route : I.V.

Total Daily Dose : 4 mg/kg

Comments : A membrane stabilising drug with a wide range of activity. Has a slightly negative inotropic effect. May increase serum digoxin levels. Infuse slowly over 10 minutes.

Supplied as : Ampoules, 10/mg/ml Tambocor

Dilution : 5 % glucose only

Stability : Usually made up in pharmacy. Discard after dilution


Incompatibility : Not to be mixed with chloride containing solutions.

Serum Levels : 200-1000 nanog/ml.



Canberra Hospital

FlucloxacillinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Septicaemia, Skin infections.

Dose : 25 mg/kg/dose (50mg/kg/dose if required by Neonatologist)

Interval : 12 hourly for infants < 7 days.8 hourly for infants 8 days-4 weeks6 hourly for infants >4 weeks

Route : I.V.

Total Daily Dose : 50 to 100 mg/kg/day. (Maybe up to 200mg/kg/day in severe infections)

Comments : Infuse over 15-30 minutes. Caution if given to babies of mothers with known penicillin allergy. Activity decreased by chloramphenicol and erythromycin. Hepatotoxic, neutropenia after 5-6 days of use. May cause haemorrhagic cystitis. Oral absorption very erratic in infants.

Supplied as : 500 mg vials

Dilution : Add 4.6 ml WFI to a 500 mg vial to make 100 mg/ml. Further dilute to 10 ml with Normal Saline (50 mg/ml). For infusion over 30 minutes.



Compatibility: Data not available.

Incompatibility : Aminoglycosides, TPN fluids.




Canberra Hospital

FluconazoleRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Fungal sepsis, especially Candida Albicans.This is a restricted ORANGE ANTIMICROBIAL but does not require approval if used for a suspected invasive Candida infection in NICU patients.

Dose : For systemic infections:Loading dose: 12 mg/kg/doseMaintenance dose: 6mg/kg/doseSevere infection or immunocompromised: 12 mg/kg/dose

Interval : < 2 weeks: every 72 hours2-4 weeks: every 48 hours> 4 weeks: every 24 hours

Route : IV infuse over 1 hour, or Oral

Total Daily Dose : 6 -12 mg/kg

Comments : Fluconazole is usually fungistatic in action and works by disturbing cell membrane function in the yeast cell. It is rapidly and completely absorbed from the GI Tract so change to oral as soon as possible. It penetrates widely and has high urine concentrations. Good CSF penetration is obtained. Elimination is mainly in urine. Fluconazole should be administered for at least 4 weeks or two weeks after symptoms have resolved for systemic infection. Note high sodium content. (15mmol/100ml.).

Supplied as : Fluconazole IV solution 2mg/ml in 50 and 100 ml bottles. Fluconazole oral mixture 10 mg/ml for reconstitution.

Dilution : None. Single dose unit made up in pharmacy

Stability : IV solution - discard remaining solution after. Do not reuse.Oral solution – store reconstituted between 5-30 degrees Celsius (not in refrigerator).


Compatibility: Dextrose, TPN, Aminophylline, Dexamethasone, Dopamine, Dobutamine, Gentamicin, Heparin, Hydrocortisone, Metronidazole, Midazolam, Morphine, KCl, Phenytoin, Ranitidine, Vancomycin and Vecuronium.

Incompatibility : Ampicillin, Calcium gluconate, Cefotaxime, Ceftazidime, Chloramphenicol, Digoxin, Frusemide, Imipenem and Piperacillin.



Canberra HospitalSerum Levels : Not required. Reduce dosage in renal failure. Concomitant

administration with Cisapride is contra indicated. May interfere with metabolism of Caffeine, Theophylline and Midazolam. Check Drug levels during concomitant use.



Canberra Hospital

FlumazenilRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Flumazenil is a specific benzodiazepine antagonist used in the reversal of overdose.

Dose : Loading dose 5 microg/kg every 60 seconds x8 max.Maintenance 2-10 microg/kg/hr.


Route : I.V.

Total Daily Dose :

Comments : Benzodiazepines taken by the mother towards the end of gestation are often responsible for evidence of poisoning or withdrawal symptoms because of the long half-life of diazepam, chlorazepate and others in the newborn. The major metabolite, desmethyldiazepam has a longer half-life than the parent molecule and will therefore have an effect lingering for up to 2-3 weeks.

Supplied as : Flumazenil 0.1 mg/ml inj.

Dilution : Add ‘X’ mL of Flumazenil and dilute to make upto 20 mL with normal saline.‘X’ = Baby’s weight in kg.@ 1 mL/hr. = 5 microg/kg/hr.

Stability : Room temperature.

Storage : Discard after opening. Solution should not need administering longer than 12 hours.

Incompatibility : Do not mix with other drugs. Can be given with electrolyte solutions.

Serum Levels :



Canberra Hospital

Fluticasone (Flixotide)Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Inhaled corticosteroid used in the treatment of chronic lung disease of prematurity.

Dose : Metered inhaler 50 mcg-100mcg 12 hourly


Route : Inhaled via spacer

Total Daily Dose : Metered inhaler 100-200 mcg

Comments : Shake canister well before use. Avoid contact with eyes. Wash face after use. Rinse mouth after use either by feeding or with a moistened swabstick. Titrate to give effective control with the lowest possible dose. Risk of systemic effects with higher doses.

Supplied as : Fluticasone 50 mcg/dose metered aerosol inhaler.

Dilution : Nil

Stability : Keep at room temperature

Storage : Store at room temperature

Incompatibility :




Canberra Hospital

Folic AcidRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Reduce likelihood of megaloblastic anaemia, leukopenia, thrombocytopenia and growth retardation, or delayed CNS maturation associated with folic acid deficiency.To be prescribed for babies < 32 weeks gestation or < 1800 grams at birth.

Dose : 50 microg = 0.1 mL

Interval : Daily from 7 days of age when on full feeds

Route : Oral.

Total Daily Dose : Daily requirements are 50 microg. Weekly dosage will satisfy overall needs.

Comments : Involved in the maturation of rapidly proliferating tissues particularly bone marrow, gastrointestinal tract, etc. Do not mix with other multivitamin preparations. Contains a negligible amount of ethanol.

Supplied as : Folic acid solution 0.5 mg/mL = 50 microg/0.1 mL

Dilution : Nil.

Stability : As per pharmacy

Storage : At room temperature – do not refrigerate. Expiry as per the bottle label.

Incompatibility : As Above. Separate from other vitamin administration.




Canberra Hospital

FrusemideRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Diuretic for pulmonary oedema and fluid overload. Maintenance therapy in chronic lung disease.

Dose : 1-2 mg/kg.

Interval : Stat, repeat if necessary but preferably not more than 12 hourly.

Route : I.M.I.V. over 20 minutes at minimum.Oral.

Total Daily Dose : Not more than 4 mg/kg.

Comments : Correct electrolyte imbalance before and after use. Competes with bilirubin for albumin binding. Chronic usage may lead to excessive calcium loss, renal calcification and chronic hypochlorhydria. Diuresis by means of increased sodium loss in loop of Henle, therefore in chronic usage treat hyponatraemia by reduction of dosage rather than sodium supplementation. Treatment with KCl, rather than spironolactone, will prevent both hypokalaemia and hypochloraemia. Potentially nephrotoxic and ototoxic, particularly when used with aminoglycosides. Drug may precipitate at low pH. Caution with dextrose solutions as pH is variable.

Supplied as : 20 mg/2 ml Ampoules.10 mg/ml oral mixture

Dilution : Dilute 1 ml (10 mg) of ampoule up to 10 mls with NS = 1 mg/ml. Give by slow infusion at a rate not exceeding 0.05mg/kg/min (i.e. 20 minutes for a 1 mg/kg dose).For infusion: Take 0.4 ml (10 mg/ml ampoule) x baby’s weight (kg) and make upto total of 48 mls with NS 1 ml/hour = 2mg/kg/day.


Storage : Ampoules: Room temperature, protect from light.Oral mixture: Refrigerator, only stable for 3 weeks once opened.

Compatibility : Normal Saline, Amikacin, Aminophylline, Ampicillin, Adrenaline, Calcium gluconate, Dexamethasone, Heparin, Hydrocortisone, Indomethacin, Potassium chloride, Sodium bicarbonate, Tobramycin, Tolazoline Digoxin, Penicillin G.

Incompatibility : Morphine, midazolam, dobutamine, dopamine, gentamicin, fluconazole.

Serum Levels :



Canberra Hospital

GanciclovirRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : An antiviral agent active against cytomegalovirus (CMV). Ganciclovir is useful in immunocompromised patients with CMV infections and has also been used in symptomatic congenital CMV infection.This is a RED ANTIMICROBIAL and requires approval from the Infectious Diseases team.

Dose : 5 mg/kg/dose


Route : Intravenous infusion over one hour.

Total Daily Dose : 10 mg/kg

Comments : Possible side effects include thrombocytopaenia, neutropaenia

Supplied as : Cymevene

Dilution : As per pharmacy only

Stability :

Storage : Use as prepared by pharmacy

Compatibility Compatible with

Incompatibility :

Serum Levels :



Canberra Hospital

Gaviscon (Alginic acid) Revision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Suppression of oesophageal reflux and control of gastro-oesophagitis.

Dose : 0.5-1.0 g (0.25 - 0.5 Tsp.) in 60 ml of feed.Liquid preparation 1-2 ml with feed 4 hourly.

Interval : As per feed schedule.

Route : Oral.

Total Daily Dose :

Comments : Solution reacts with gastric acid to form a viscous, frothy, colloidal gel of alginic acid which floats on the feed surface to provide protection against free reflux and the irritant effects of gastric secretions on the oesophageal mucosa. Note: Each 2-gram of powder contains 4 mmol sodium.

Supplied as : Infant Gaviscon PowderInfant Gaviscon Liquid

Dilution : Give with feed when bottle-fed. Mix with 10-20ml EBM or water if breast-feeding and give at end of feed. Do not use hot water. Excess administration may result in a gel ball in the stomach.

Stability : Mixed Gaviscon may be stored refrigerated for up to 12 hours.






Canberra Hospital

G-CSF (Granulocyte-colony stimulating factorRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Persistent pre-eclampsia associated neonatal neutropaenia.Consider prophylactic G-CSF in VLBW baby, or mature baby requiring intensive care, if neutropaenia persists by age 72 hours postnatal.Neutropaenia Refs: Mature baby: <1.8 at 72 hours VLBW baby: <1.1 at 72 hours

Dose : 10 micrograms/kg/day

Interval : Once daily dose

Route : Intravenous infusion (given over 30-60 minutes) orSubcutaneous injection.

Total Daily Dose :

Comments : G-CSF is a cytokine, which regulates the proliferation of immature granulocyte hematopoietic cells as well as the function of mature cells of the granulocyte lineage.Its benefit in treatment of sepsis-associated neutropaenia, where endogenous G-CSF levels may be high, is as yet unproven.

Supplied as : Filgrastim 300 microg (in 1ml)

Dilution : Usually prepared in Pharmacy.Filgrastim can be diluted with Glucose 5% or albumin 0.2% to achieve a suitable volume for injection of the very small dose. Filgrastim concentrations >15microg/ml can be diluted with D5W, while those <15microg/ml are diluted with albumin 0.2%. (Albumin is required because of problems of adsorption of Filgrastim with plastics).

Stability : Avoid vigorous shaking. Prior to injection, allow to come to room temperature.

Storage : Refrigerator at 2º to 8ºC

Incompatibility :

Serum Levels :



Canberra Hospital

GentamicinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Systemic and CNS infection.

Dose : 2.5 mg/kg < 30 weeks gestation at time of administration3.5 mg/kg 30-35 weeks5 mg/kg > 35weeks gestation7.5 mg/kg Term infant > 7 days of age

Interval : 24 hourly – > 26 weeks gestation36 hourly - < 26 weeks gestation

Route : I.V. over 30 minutes. (No faster than 1mg per minute)I.M.

Total Daily Dose : Gestation dependent

Comments : Frequent serum levels required. Not ototoxic or nephrotoxic when used at recommended doses for 7-10 days. Reduce dosage when renal function is impaired and when on frusemide. Requires ID approval code for courses longer than 5 days, with the exception of suspected NEC, for which 7 days are approved.

Supplied as : 10 mg/1 mL vial.80 mg/2 mL ampoule

Dilution : Do not dilute for I.M. use.With the 10 mg/mL vial dilute the 1 mL with 9 mLs of NS, D5W, or D10W to a solution of 1 mg/mL.With the 80 mg/2 ml ampoule take 0.25 mL using a 1 mL syringe and dilute with 9.75 ml of NS, D5W, D10W in to a 10 mL syringe to make a solution of 1 mg/mL

Stability : Vial 24 hours in refrigerator. Ampoule discard immediately.


Compatibility Aciclovir, cimetidine, clindamycin, dopamine, morphine, TPN, ranitidine, tolazoline.

Incompatibility : Amphotericin B, frusemide, penicillin, cephalosporins, chloramphenicol, heparin.

Serum Levels : Levels every 2 nd dose for 36 hourly administration and every 3 rd dose for 24 hourly administration unless otherwise indicated. DO NOT GIVE NEXT DOSE UNTIL LEVELS ARE BACK. Take levels earlier if there is a decrease in urine output or creatinine rises.Normal range: Pre dose < 1.0 microg/ml



Canberra Hospital

GlucagonRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : Hypoglycaemia.

Dose : 0.02 mg/kg/ dose. (Note 1mg = 1 unit: prescribe in mg).Maximum dose- 1 mg.Continuous infusion- 10-50 microg/kg/hour

Interval : Stat, repeat 6-12 hourly if necessary.

Route : SC, IM, IV

Total Daily Dose :

Comments : Maximally effective in hyperinsulinaemic states. Role in IUGR babies controversial, although it may prove to be useful in such a situation by stimulating gluconeogenesis. Patient should receive glucose IV and not glucagon if in a chronic hypoglycaemic state.

Supplied as : 1 mg vials with 1 ml diluent.

Dilution : Add 1 ml of diluent to vial.For infusion-Add up 1 mg/kg body weight of glucagon to make up 10 ml with dextrose solution.0.1 ml/hr = 10 microg/kg/hour

Stability : Discard vial after use.

Storage : Room temperature. Powdered vial should be protected from light.

Incompatibility : Data not available. Precipitates with chloride containing solutions.


Compatibility: NS, 5%D



Canberra Hospital

HeparinRevision Date : 09/01/2014 14:40:00 Approved : AK, JD

Indication : All I.A. and Central I.V. lines.

Dose : 0.5-1 unit per ml of solution.


Route : I.A.,Central I.V.

Total Daily Dose :

Comments : Overdose - cease treatment; transfuse with fresh whole blood if required. Give protamine sulphate 1 ml per 100 units of heparin. Causes prolonged clotting time and APTT, therefore monitor APTT. Can cause thrombocytopaenia on rare occasions.

Supplied as : 1,000 Units per 1 ml ampoule.

Dilution : Usually made up in pharmacy. As for dosage.

Stability : Discard unused portion. Change infusion every 24 hours.


Compatibility : Compatible with dopamine, adrenaline, fentanyl, frusemide, morphine, TPN, ranitidine, tolazoline. Also compatible with Dextrose containing solutions and normal saline.

Incompatibility : Hydrocortisone, dobutamine, Vancomycin and all antibiotics, phenytoin.

Serum Levels : Monitor clotting time. Only done if toxicity suspected.



Canberra Hospital

Heparin CVC LockRevision Date : 12 July 2012 Approved : AK, JD

Indication : To maintain patency of secondary lumens on central venous catheters and to allow blood sampling from central line

Dose : Time between access:1] < 6 hours – 1.5 mls - Normal saline2] < 24 hours – 2 mls daily – 50 units heparin in 5 mls3] > 24 hours – 2 mls weekly – 1000 units heparin in 10 mls

Interval : 1] 4-6/242] daily3] weekly

Route : IV

Total Daily Dose :

Comments : Always remove heparin lock before accessing the catheter to ensure heparin is not injected into the patient and to remove previous heparin lock before administration of next heparin lock. All clamping is to be done on the cuffed area of the tube.

Supplied as : 1] Normal saline 10 ml ampoule2] 50 units heparin in 5 ml ampoule3] 1000 units in 1ml ampoule

Dilution : 1] Normal saline 10 ml ampoule – no dilution required2] 50 units heparin in 5 ml ampoule – no dilution required3] 1000 units in 1ml ampoule – dilute 1 ml ampoule with 9 mls of normal saline (100 units per ml)

Stability :


Compatibility:

Incompatibility :




Canberra Hospital

Hepatitis B ImmunoglobulinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : To reduce the exposure in babies born to mothers who are HBsAg positive or who are in close family contact with HBsAg positive individuals or have a significant exposure soon after birth.

Dose : 1.0 ml (100 IU)

Interval : Once only.

Route : I.M.

Total Daily Dose :

Comments : Given at the same time, but in the opposite limb, as Hepatitis B Vaccine and preferably with in 12 hours after birth but may be given within 72 hours. If Hepatitis B Immunoglobulin is to be given due to exposure it must be given within 7 days of the documented exposure.

Supplied as : Hepatitis B Immunoglobulin CSL: Supplied from blood bank.

Dilution : Nil

Stability :

Storage : At 2-8oC.

Compatibility : Not Applicable.





Canberra Hospital

Hepatitis B VaccineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Protection against Hepatitis B Virus.

Dose : 0.5 ml

Interval : Birth, 2, 4 and 6 months and booster at 12 months.

Route : I.M. Give into anterior thigh, not buttocks at birth. Given at the same time as Vitamin K. Hep. B in Left thigh and Vit. K in right thigh. Subsequent doses are given in the form of Infanrix Hexa: (Diptheria; Tetanus; Acellular Pertussis; Hepatitis B; Haemophilus Influenzae type B (Hib); and Inactivated Poliomyelitis)

Total Daily Dose : Not Applicable.

Comments : Part of standard immunisation schedule valid from 1.7.2007. Note all babies are given Hep B and Vitamin K at birth. For longer stay babies, the new schedule includes combination vaccine for all subsequent immunisations. See http://www.health.gov.au/internet/immunise/publishing.nsf/Content/home

Supplied as : Engerix-B, Ready to use vials.Infanrix Hexa pre-filled syringe/pellet vial combination.

Dilution : None required for Engerix B. Shake vigorously before use.Infanrix Hexa requires reconstitution – see separate entry for detailed instructions.

Stability : Engerix B: 2 years.

Storage : Stored in pharmacy until required. Give as soon as possible after arrival in CNC.





http://www.health.gov.au/internet/immunise/publishing.nsf/Content/home


Canberra Hospital

HydralazineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Initial treatment of hypertension. Useful as it preserves renal blood flow.

Dose : 0.1-0.2 mg/kg. Oral dosage is about twice that of required iv dose.Infusion 4-6 microg/kg/min

Interval : 6-8 hourly.Infusion

Route : I.V.Oral

Total Daily Dose : Titrate dose as per response.

Comments : May increase heart rate. Always start with a lower dose and increase the dose depending upon the response. Exerts effect by directly relaxing vascular smooth muscle tone and lowering peripheral vascular resistance.

Supplied as : Apresoline ampoules containing 20 mg Hydralazine HCl powder.

Dilution : Dissolve powder 1 ml water for injection. Add 1 ml of drug to 9 ml of Normal Saline to make up a solution of 2 mg/ml. Give slowly over 5-10 minutes.Add 9 x Xmg of drug (4.5 x Xml of the solution) where X is the weight in kg, to a syringe and make up to 25 mls with NS. 1 ml/hour = 6 microgram/kg/min


Storage : Room temperature. Do not store powdered ampoules in refrigerator.

Compatibility : Normal Saline, Dobutamine, Heparin, Hydrocortisone and potassium chloride.

Incompatibility : 5% and 10% Dextrose, Aminophylline, Ampicillin, Frusemide and phenobarbital.




Canberra Hospital

HydrochlorothiazideRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Diuretic. Used for congestive heart failure and in long term management of chronic lung disease. May improve pulmonary function in patients with BPD.

Dose : 1-2 mg/kg.


Route : Oral.

Total Daily Dose : 2-4 mg/kg.

Comments : Thiazide diuretics increase loss of sodium, potassium, magnesium, phosphorous and chloride ions from the kidney. The excretion of calcium is reduced and its use is therefore favoured in chronic lung disease where diuretic associated renal calcification is common.Displaces bilirubin from albumin binding sites.Can cause hyperglycaemia by inhibiting the release of insulin from pancreas.

Supplied as : Pharmacy can make 1mg/mL mixture during normal business hours. After hours, Hydrochlorthiazide 25 mg tablets are kept as ward stock.

Dilution : Not required for mixture.Disperse one 25 mg tablet in 10 mL of water for injection to make 2.5 mg/ml solution.

Stability : Mixture: 30 daysTablets: see manufacturers expiry date on label.

Storage : Mixture: keep in refrigerator.Tablets: room temperature. Discard solution made from tablets immediately after use.





Canberra Hospital

HydrocortisoneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1] Shock2] Intractable hypoglycaemia.3] Physiological replacement

Dose : 1] 2-4 mg/kg every 4-6 hours2] 2.5 mg/kg increased to 7.5 mg/kg3] 0.3 mg/kg/dose 8 hourly

Interval :

Route : I.M.I.V. slowly over one minute.

Total Daily Dose :

Comments : Typical corticosteroid. May cause Cushings Syndrome, protein catabolism, electrolyte imbalance, hyperglycaemia, osteoporosis, convulsions, increased bleeding tendency, growth retardation. May mask infection. The dose recommended here is based on the physiological secretion of corticosteroids (20-40mg/m2/day). Hydrocortisone increases the expression of adrenergic receptors in the vascular wall, thereby enhancing vascular reactivity to other vaso-active substances like Noradrenaline and angiotensin. Response to hydrocortisone can be seen as early as 30 minutes. Prolonged usage can result in suppression of Pituitary Adrenal Axis. Hence, weaning after prolonged therapy should be gradual.

Supplied as : 100 mg vial.

Dilution : Dissolve powder in 2ml WFI. May be further diluted to 20 ml (to give solution 5mg per ml). Give over 1minute.For infusion: baby’s body weight in kg = XTake X ml of hydrocortisone (5 mg/ml) and make up to 25 ml using10 % Dextrose.Using this resulting solution: 0.5 ml/hr = 0.1 mg/kg/hr.

Stability Discard remainder after use.


Compatibility : Dextrose and Saline solutions, TPN, Dopamine, Fentanyl, Morphine.

Incompatibility : Adrenaline, heparin, diazepam, vancomycin.

Serum Levels :



Canberra Hospital

IbuprofenRevision Date :28 January 2017 DTC Approved: March 2017

Indication : Treatment of a haemodynamically significant patent ductus arteriosus in preterm newborn infants less than 34 weeks of gestational age.1

Dose : Oral – 10 mg/kg first dose, 5 mg/kg for two further doses 24 hours apart.2

IV - 10 mg/kg first dose, 5 mg/kg for two further doses 24 hours apart. 3

Double strength dose may be prescribed for IV formulation (not oral) – 20 mg/kg first dose followed by two further doses of 10 mg/kg 24 hours apart.4

Interval : 24 hourly, administered orally or as a short infusion over 20 minutes

Route : Oral or intra-gastricIV

Comments : -RCTs comparing ibuprofen with indomethacin show equivalent PDA closure rates of about 75% with less side effects.1

-One RCT (n=70) comparing intravenous standard dose (10, 5, 5mg/kg) with higher dose (20,10,10mg/kg) showed better closure rate with higher dose (63% vs 86%, p=0.042) with no increase in side effects.4

-Three RCTs (n=236) showed significantly better closure rate with oral compared to intravenous ibuprofen at standard dose (86% vs 63%, p<0.001) with no difference in side effects.1

-Oral or IV ibuprofen could be used as first line treatment of PDA in preterm infants-Transient renal insufficiency may occur. Strict attention to fluid balance essential. Monitor urine output and Serum electrolytes. Discuss dosage with Neonatologist if UO < 0.5 mL/kg/hr &/or Se Cr > 150 micromol/L. Hyponatraemia is usually a result of fluid retention not sodium loss. This is an indication to further reduce maintenance fluids If anuria or manifest oliguria occurs after the first or second dose, the next dose should be withheld until urine output returns to normal levels.-Upper GI bleeding or perforation may occur-Rare reports of sudden onset hypoxia with PPHN.5

-Contraindications: active bleeding, thrombocytopenia or coagulopathy, necrotising enterocolitis, significant renal dysfunction, ductal dependant congenital heart disease, significant jaundice, as ibuprofen may displace bilirubin from serum albumin-Precautions: caution using other nephrotoxic drugs such as aminoglycosides or frusemide. Dose may need modification if renal function is affected. Fluconazole may reduce metabolisom of ibuprofen, increasing its concentration. Action of diuretics is reduced. An association between indomethacin, systemic steroids and GI perforation has been described. While this has not been described for ibuprofen, caution should be applied in using together with systemic steroids



Canberra HospitalSupplied as : Oral: Fenpaed® (Ibuprofen100 mg/5 mL suspension -

20mg/mL).6

IV: 'Pedea'® (Ibuprofen Sodium Salt 5 mg/mL ampoule).IV Ibuprofen is unregistered in Australia. A ‘Category A’ SAS form and a patient consent form must be completed for each course. The SAS form must be returned to pharmacy. The patient consent form should be kept in the patient notes. The blank forms are kept with the medication in the clean utility room.

Administration : Oral: preferably give with feeds. If baby is not on enteral feeds or EBM is not available give dose via intra-gastric tube and flush with 1 mL water for injection.

IV: Do not use if particulate matter is observed. Administer dose within 30 minutes of preparation and discard any unused portion.Avoid extravasation.Give undiluted or dilute to an appropriate volume with sodium chloride 0.9% or glucose 5% and infuse over 20 minutes.When dilution is to be carried out, due to the small dosing volume of ibuprofen, to avoid over dosage involved with administration of the ‘dead space’ volume, the dose should be drawn up into a syringe and transferred to a second syringe, before dilution with sodium chloride 0.9% or glucose 5%. Dilution of 2mL ampoule in 8mL sodium chloride 0.9% or glucose 5% will give a solution of 1mg/mL.

Stability : Oral: according to the expiry date on the bottleIV: Use once only and discard any residue.


Compatibility: sodium chloride 0.9%, glucose 5%

Incompatibility : Regard all other intravenous solutions as incompatible. Always flush line with sodium chloride 0.9% or glucose 5% before and after administration.

Compiled: January 2017 Review: January 2019

References:1. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or

low birth weight infants. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.CD003481. 2. Erdeve O, Yurttutan S, Altug N, Ozdemir R, Gokmen T, Dilmen U, Oguz SS, Uras N. Oral versus

intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F279-83.

3. Hirt D, Van Overmeire B, Treluyer JM, Langhhendries JP, Marguglio A, Eisinger MJ, Schepens, P, Urien S., An optimized ibuprofen dosing scheme for preterm neonates with patent ductus arteriosus, based on a population pharmacokinetic and pharmacodynamic study. Brit J Clin Pharmaco 2008;65:629-36

4. Dani C, Vangi V, Bertini G, Pratesi S, Lori I, Favelli F, et al. High-dose ibuprofen for patent ductus arteriosus in extremely preterm infants: A randomized controlled study. Clinical Pharmacology and Therapeutics 2012;91(4):590-6.

5. Gournay V. Savagner C. Thiriez G. Kuster A. Roze JC. Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet. 2002:359(9316):1486-8


http://ovidsp.tx.ovid.com/sp-3.12.0b/ovidweb.cgi?&S=HGPMFPGLMKDDNFGJNCMKCFOBFMALAA00&Complete+Reference=S.sh.41%7C4%7C1

http://ovidsp.tx.ovid.com/sp-3.12.0b/ovidweb.cgi?&S=HGPMFPGLMKDDNFGJNCMKCFOBFMALAA00&Complete+Reference=S.sh.41%7C4%7C1

http://www.ncbi.nlm.nih.gov/pubmed/22147286




Canberra Hospital6. Product Information: Fenpaed. "http: http://www.drugs.com/uk/fenpaed-100mg-5ml-oral-suspension-

leaflet.html"

IndomethacinRevision Date :October 201618/08/2015 04:37:00 AM

Approved: October 2016

Indication : Closure of Patent Ductus Arteriosus (PDA) where ibuprofen has failed or unavailable

Dose 1,2,3,4 : Age atfirst dose:

1st 2nd 3rd dose

<48h 0.2mg/kg 0.1mg/kg 0.1mg/kg

2-7 days 0.2mg/kg 0.2mg/kg 0.2mg/kg>7 days 0.2mg/kg 0.25mg/kg 0.25mg/kg

Longer treatment course may be used. 0.1-0.2mg/kg daily for 5-7 days.Maximum 2 courses (3 IV doses per course)1

Interval : 24 hourlyMay consider 12 hourly dosing for a 3 dose course

Route : IV

Total Daily Dose :

Comments : -A prostaglandin synthetase inhibitor with profound renal effects. Strict attention to fluid balance essential. Monitor urine output (UO) and serum electrolytes.Discuss dosage with Neonatologist if UO < 0.5mL/kg/hr &/or serum creatinine > 150 micromol/L. Hyponatraemia is usually a result of fluid retention not sodium loss. This is an indication to further reduce maintenance fluids.Contraindicated for infants with platelet count < 80,000/L or in infants with ductal dependent congenital heart disease.-Caution when used with frusemide and other nephrotoxic drugs such as aminoglycosides.-Caution when used with steroids (risk of spontaneous intestinal perforation)



Canberra HospitalSide effects: Renal impairment ( Modify the use of aminoglycosides during Indomethcin use)

Hypoglycaemia (monitor BGL)Platelet dysfunctionHyponatraemia (secondary to fluid retention)GI perforations/NEC (consider NBM or trophic feeds)Rapid infusion associated with reduction in organ blood flow

Contraindications : Active bleedingThrombocytopeniaCoagulation defectsNECCongenital heart disease, PPHNSignificantly impaired renal function

Supplied as : Indomethacin Agila 1mg per vial.

Dilution : Reconstitute vial with 2mL of sodium chloride 0.9% or sterile water – solution = 0.5mg/1mL. Further dilution not recommended by manufacturer due to stability issues7. Infuse over 30 minutes6.

Stability : Use immediately after reconstitution.

Storage : Store below 25°C. Protect from light

Compatibility : Water for injection, glucose 2.5%, glucose 5%, sodium chloride 0.9%, Frusemide, Insulin, Nitroprusside, Potassium chloride and Sodium bicarbonate.

Incompatibility : Glucose 10% & & Glucose 7.5%, calcium gluconate, dobutamine, dopamine, cimetidine, gentamicin, tobramycin and TPN/ lipid solutions

Serum Levels : Not clinically useful.

Compiled: October 2016

Revision: October 2020

1. Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application

2.http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/PDA_2014_guideline.pdf

3. Tammela O, Ojala R, Iivainen T et al. Short vs Prolonged indomethacin therapy for patent ductus arteriosus in preterm infants. J Pediatr 1999;134:552-557.

4. Herrera CM, Holberton JR, Davis PG. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003480. DOI: 10.1002/14651858.CD003480.pub3

5. NeoMed, August 2015

6. Colditz P, Murphy D, Rolfe P, Wilkinson AR. Effect of infusion rate of indomethacin oncerebrovascular responses in preterm neonates. Arch Dis Child. 1989; 64: 8-12.

7. Indomethacin Agila (indomethacin) Australian approved product information. Dandenong South Vic: Agila Australasia Pty Ltd. Approved 2nd April 2014



Canberra Hospital

Imipenem/CilastatinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Carbapenem antibiotic/renal dipeptidase inhibitor. Potent broad spectrum antibiotic.This is a RED ANTIMICROBIAL and requires approval from the Infectious Diseases team.

Dose : Dose refers to imipenem componentNeonates Wk 1: 25 mg/kg/dose 12 hourly Wk 2-4: 25 mg/kg/dose 8 hourlyInfants Usual: 15 mg/kg/dose 6 hourly Severe infection: 25 mg/kg/dose 6 hourly

Interval : As above

Route : I.V. only. 20-30 minute infusion.

Total Daily Dose :

Comments : May precipitate convulsions in patients with CNS disease. Generalised convulsions have been reported in patients who received Ganciclovir concomitantly.

Supplied as : Vials containing Imipenem 500mg/Cilastatin 500 mgTrade Name - Primaxin

Dilution : During Pharmacy open hours Pharmacy will provide syringes. When necessary to prepare on the ward reconstitute the vial with 9.2 ml WFI to form a suspension. Shake vial well and immediately withdraw 1 ml of suspension. Further dilute to 10 ml with NS. Agitate syringe until solution becomes clear. Concentration for administration must not exceed 5 mg/ml.

Stability : Discard unused solution and suspension.

Storage : Powder vials store at below 30 degrees Celsius. Syringes from pharmacy may be stored for up to 2 days in the refrigerator.

Compatibility : NS, 5% Dextrose, 10% Dextrose, Y Site compatible: Aciclovir, Aztreonam, Cefepime, Insulin, TPN

Incompatibility : Y Site: Amphotericin, Fluconazole, Midazolam, Sodium bicarbonate

Serum Levels :



Canberra Hospital



Canberra Hospital

Immunoglobulin IV (Intragram®P): DraftRevision Date : 18 May, 2023 Approved: TC

Indication : Isoimmune haemolytic disease (Rh, ABO, Other)1

Neonatal alloimmune thrombocytopenia (NAIT)Replacement of IgG in chylothoraxNeonatal haemochromatosis

Dose : 0.5-2 g/kg, depending upon the indication.Isoimmune haemolytic disease: 0.5-1g/kg1,2

NAIT: 1g/kg/day for 2 days1

Chylothorax: 0.5-1g/kgNeonatal haemachromatosis: 1g/kg3

Interval : Stat dose, which may be repeated in 12 hours in isoimmune haemolytic disease.

Route : I.V. only, infuse over 4 hours.

Total Daily Dose : 2g/kg/day

Comments : -IVIg is issued in accordance with the criteria for the clinical use of intravenous immunoglobulin in Australia. The medical officer requesting IVIg will be required to complete and submit a 2 page ‘Authorisation Request Form’ to the Australian Red Cross Blood Service for authorisation. This form could be downloaded from www.blood.gov.au/Ig-governance. Once authorised, IVIg would be issued from Canberra Hospital Blood Bank.4

-The dose of Intragam P is not clearly defined and the drug is expensive and in short supply. Dosages should be rounded down to whole vials and we should not require more than 1 x 50ml vial (3g) per dose.-Passively acquired antibody can interfere with the response to live attenuated vaccines, therefore administration of such vaccines (eg rotarix, oral polio, BCG) should be delayed for approximately 3 months after passive immunity-Generally a dose of 0.5-1 g/kg is given over 4 hours. The rate should be started slowly and gradually increased after 15 minutes if no reactions occur. Too rapid a rate may cause flushing and changes in heart rate and BP. Adverse reactions include vomiting, chest pain, rigors, arthralgia for 24 hours.5

Supplied as : Intragam®P 6% solution, 10 ml, 50 ml, 200 ml.

Dilution : May be infused undiluted. May be diluted with up to two parts NS or D5W.5

Stability : Vial for single use only.

Storage : Store at 2-8 degrees Celsius (Refrigerate, DO NOT FREEZE). Once removed from refrigeration, store below 25 degrees Celsius for up to 3 months. Protect from light.5

Compatibility : Hospital policy requires that blood products not be mixed with other drugs and infused separately



Canberra HospitalContraindications : Anaphylaxis to human immunoglobulin preparations.5

Serum Levels : NA

Compiled: February 2015

Review: February 2018

References:1. Paediatrics and Neofax ®. Application Version: 7.1.2.2014-Q42. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114; 2973. Rand EB, Karpen SJ, Kelly S et al. Treatment of neonatal hemochromatosis with exchange transfusion and intravenous immunoglobulin. Journal of Pediatrics, 2009, vol. 155, no. 4, pp. 566–5714. National blood authority, Australia. Website- http://blood.gov.au/Ig-governance5. Intragram®P product information. Available at- http://www.csl.com.au/docs/146/668/Intragam%20P%20AU%20PI%2014.00%20(Supplied).pdf. Accessed 18/2/15


http://www.csl.com.au/docs/146/668/Intragam%20P%20AU%20PI%2014.00%20(Supplied).pdf

http://www.csl.com.au/docs/146/668/Intragam%20P%20AU%20PI%2014.00%20(Supplied).pdf

http://blood.gov.au/Ig-governance


Canberra Hospital

IndomethacinRevision Date :October 201618/08/2015 04:37:00 AM

Approved: October 2016

Indication : Closure of Patent Ductus Arteriosus (PDA) where ibuprofen has failed or unavailable

Dose 1,2,3,4 : Age atfirst dose:

1st 2nd 3rd dose

<48h 0.2mg/kg 0.1mg/kg 0.1mg/kg

2-7 days 0.2mg/kg 0.2mg/kg 0.2mg/kg>7 days 0.2mg/kg 0.25mg/kg 0.25mg/kg

Longer treatment course may be used. 0.1-0.2mg/kg daily for 5-7 days.Maximum 2 courses (3 IV doses per course)1

Interval : 24 hourlyMay consider 12 hourly dosing for a 3 dose course

Route : IV

Total Daily Dose :

Comments : -A prostaglandin synthetase inhibitor with profound renal effects. Strict attention to fluid balance essential. Monitor urine output (UO) and serum electrolytes.Discuss dosage with Neonatologist if UO < 0.5mL/kg/hr &/or serum creatinine > 150 micromol/L. Hyponatraemia is usually a result of fluid retention not sodium loss. This is an indication to further reduce maintenance fluids.Contraindicated for infants with platelet count < 80,000/L or in infants with ductal dependent congenital heart disease.-Caution when used with frusemide and other nephrotoxic drugs such as aminoglycosides.-Caution when used with steroids (risk of spontaneous intestinal perforation)



Canberra HospitalSide effects: Renal impairment ( Modify the use of aminoglycosides during Indomethcin use)

Hypoglycaemia (monitor BGL)Platelet dysfunctionHyponatraemia (secondary to fluid retention)GI perforations/NEC (consider NBM or trophic feeds)Rapid infusion associated with reduction in organ blood flow

Contraindications : Active bleedingThrombocytopeniaCoagulation defectsNECCongenital heart disease, PPHNSignificantly impaired renal function

Supplied as : Indomethacin Agila 1mg per vial.

Dilution : Reconstitute vial with 2mL of sodium chloride 0.9% or sterile water – solution = 0.5mg/1mL. Further dilution not recommended by manufacturer due to stability issues7. Infuse over 30 minutes6.

Stability : Use immediately after reconstitution.

Storage : Store below 25°C. Protect from light

Compatibility : Water for injection, glucose 2.5%, glucose 5%, sodium chloride 0.9%, Frusemide, Insulin, Nitroprusside, Potassium chloride and Sodium bicarbonate.

Incompatibility : Glucose 10% & & Glucose 7.5%, calcium gluconate, dobutamine, dopamine, cimetidine, gentamicin, tobramycin and TPN/ lipid solutions

Serum Levels : Not clinically useful.


Revision: October 2020

1. Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application

2.http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/PDA_2014_guideline.pdf

3. Tammela O, Ojala R, Iivainen T et al. Short vs Prolonged indomethacin therapy for patent ductus arteriosus in preterm infants. J Pediatr 1999;134:552-557.

4. Herrera CM, Holberton JR, Davis PG. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003480. DOI: 10.1002/14651858.CD003480.pub3

5. NeoMed, August 2015

6. Colditz P, Murphy D, Rolfe P, Wilkinson AR. Effect of infusion rate of indomethacin oncerebrovascular responses in preterm neonates. Arch Dis Child. 1989; 64: 8-12.



Canberra Hospital7. Indomethacin Agila (indomethacin) Australian approved product information. Dandenong South Vic: Agila Australasia Pty Ltd. Approved 2nd April 2014



Canberra Hospital

INFANRIX hexaRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Primary immunisation of all children from 2 months of age against diptheria, tetanus, pertussis, hepatitis B, poliomyelitis and haemophilus influenzae type b.

Dose : 0.5 ml

Interval : Immunisation schedule: 2, 4 and 6 months of age.

Route : IM to anterolateral aspect of the mid thigh for infants under 12 months. For children over 12 months, the deltoid region of the arm is used.

Comments : The vaccine must NEVER be administered intravenously. INFANRIX hexa vaccines must not be mixed with other vaccines in the same syringe. INFANRIX hexa vaccines may be given on the same day as any of the other standard childhood vaccines, but at a separate site.

Supplied as : INFANRIX hexa is supplied in two parts. A turbid white suspension in a pre-filled syringe containing 5 of the 6 vaccines. A second vial containing a lyophilised pellet of Hib vaccine.

Dilution : The pre-filled syringe should be shaken well to obtain a homogeneous suspension. The entire contents of the pre-filled syringe are added to the vial containing the Hib pellet. After addition of the liquid component to the pellet the mixture should be shaken well until the pellet is completely dissolved. The final product may appear cloudy.

Stability : After reconstitution, the vaccine should be injected promptly. However, the vaccine may be kept for up to 8 hours at room temperature.

Storage : Store between 2-8 degrees Celsius. Freezing destroys the vaccine. Protect from light.

Incompatibility : Do not mix with any other preparation.



Canberra Hospital

Infloran®Revision Date : 15 May 2015 DTC Approved: 29/5/15

Indication : Prevention of necrotising enterocolitis (NEC) in infants at high risk of NEC i.e. < 32 weeks gestation and/or < 1500 grams.1,2

Dose : 125 -250 mg. 3, 4

Interval : Once daily

Route : Oral

Total Daily Dose : 250 mg

Comments : -Consent: Infloran is not a registered product in Australia. Parents of eligible babies should be given parent information sheet and medication should be charted by the authorised prescriber only after informed written consent is obtained. The original of the signed consent form should be filed in the patient notes-Dosing: For preterm neonates who are on minimal enteral feeds (1mL 4hrly) the daily dose is half capsule per day (1 mL of reconstituted volume after dissolving capsule in 2mL of milk) given as a single dose irrespective of the gestation at birth. Once the neonate is on 3mL 2hrly, the supplementation dose will be one capsule (reconstituted in 2mL of milk) per day given as a single dose-Probiotics should be stopped during periods when the enteral feeds are stopped (at the discretion of Neonatologist). Supplements could be recommenced 24 hours after restarting feeds-Probiotics should be discontinued at 34 weeks corrected gestational age or prior to discharge or transfer to other hospital, whichever is earlier. Probiotics should be continued till 38 weeks in the growth restricted group (≥32 weeks, <1500grams). Probiotics will be ceased at any time the parents wish to withdraw consent for any reason.

Supplied as : Infloran® capsule, 250 mg/capsule (contains Lactobacillus acidophilus [109 colony-forming units, NCDO 1748; National Collection of Dairy Organisms] and Bifidobacterium bifidum [109 colony-forming units, NCDO 1453; National Collection of Dairy Organisms, Reading, United Kingdom])4, 5



Canberra HospitalDilution : Contents of one capsule of Infloran is dissolved

in 2 mL of mother’s expressed breast milk or formula (1mL = 125mg). To be administered with routine feeds.

Stability : Discard unused portion

Storage : Refrigerate 2 - 8oC. Do not freeze

Incompatibility : Do not mix with any other drugs

Serum Levels : Not Applicable

Compiled: May 2015 Review: May 2019

References:1. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD005496 DOI: 10.1002/14651858.CD005496.pub42. Wang Q, Dong J, Zhu Y. Probiotic supplement reduces risk of necrotizing enterocolitis and mortality in preterm very low-birth-weight infants: an updated meta-analysis of 20 randomized, controlled trials. J Pediatr Surg. 2012;47:241-8. 3. Deshpande G, Rao S, Keil A, Patole S. Evidence-based guidelines for use of probiotics in preterm neonates. BMC Medicine. 2011; 9 92-1054. Lin H-C, Hsu C-H, Chen H-L, Chung M-Y, Hsu J-F, Lien R-i, Tsao L-Y, Chen C-H, Su B-H. Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008; 122 (4):693-7005. Infloran product information. Natural Medicines Comprehensive data base: Available at http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=nd&pt=103&id=70621 (Accessed: 8th Jan 2015)


http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=nd&pt=103&id=70621

http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=nd&pt=103&id=70621


Canberra Hospital

Insulin (Actrapid – for hyperglycaemia) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hyperglycaemia.

Dose : 1] 0.1 units/kg.2] 0.01 – 0.1 units/kg/hour Continuous infusion

Interval : 1] Hourly until blood sugar level < 8 mmol/L.2] Continuous infusion over 24 hours.

Route : 1] S.C. or I.V.2] I.V- as a 5 minute bolus.

Total Daily Dose : Up to 3 units/kg/day.

Comments : Used for the treatment of hyperglycaemia, usually in infants less than 1200 grams, on total or partial parenteral nutrition.Insulin has a tendency to bind to binding sites in plastic. Dilution with Gelofusine reduces the amount of insulin adsorption to plastic infusion materials.When used with Gelofusine, Insulin must be thoroughly mixed to avoid the possibility of Insulin floating on top of the solution.Tubing must be pre-conditioned for one hour prior to beginning the infusion to saturate the insulin binding sites. This should be followed by flushing the apparatus with 5 mL of Insulin solution.Insulin is NOT to be administered through any filter.

Supplied as : Actrapid - Soluble insulin: 100 units per mL vial.

Dilution : Usually made up in pharmacy. Dilute 1mL (100 units/mL) of Insulin to 10 mLs with Gelofusine then take 5 units/kg from this solution and further dilute to 50 mL with Gelofusine (Read comments). Write the pharmacy order as 5 units/kg in 50 mL gelofusine.(0.1 Unit/kg/hr. = 1 ml/hr).

Stability : Infusion stable for 24 hours only.

Storage : Refrigerate, do not freeze.

Incompatibility : Aminophylline, chlorthiazide, dopamine, phenobarbitone, phenytoin, thiopentone sodium.

Compatibility: Dextrose solutions, TPN, dobutamine, morphine, heparin, indomethacin, gentamicin, midazolam, vancomycin.

Serum Levels :



Canberra Hospital

Insulin (for hyperkalaemia) Revision Date : 03/07/2014 Approved: TC, LZ, JD

Indication : 1. Severe hyperkalaemia (K+ >7 mmol/L), significant ECG changes, cardiac arrhythmias2. Moderate hyperkalemia (K+ >6.5 mmol/L), maintenance infusion following bolus

Dose : 1. 0.15 units insulin/kg per 0.5g glucose/kg in either 10%, 25% or 50% dextrose (see dilution below)2. 0.15 units insulin/kg per 0.5g glucose/kg/hr (see dilution below)

Interval : 1. Bolus injection over 10 minutes2. Continuous infusion. Gradually wean infusion when hyperkalaemia is resolving (K+ <5.5mmol/L)

Route : Intravenous route depending on accessInsulin/glucose 10%: peripherallyInsulin/glucose 25% and 50%: centrallyIf there is only peripheral access, insulin/glucose 25% may be given peripherally due to the urgency of treatment

Total Daily Dose :

Comments : -Insulin enhances the cellular uptake of potassium, which decreases the concentration of potassium in the blood. This is only a temporising measure to lower the serum potassium levels acutely, while awaiting more definitive measures.Bolus injection is usually reserved for emergency treatment of cardiac arrhythmia associated with hyperkalemia.Measure blood glucose concentrations every 15 – 30 minutes after starting the insulin infusion and after changes are made to the infusion rate. When stable, the glucose can be checked at 2 hour intervals. Aim for normal BSL between 3-10mmol/L. Watch for late hypoglycaemia.

Monitor potassium levels every 30-60 minutes on blood gases initially and if stable then check at 2 hour intervals. Repeat formal lab potassium levels every 4-8 hours until hyperkalaemia has resolved. Gradually wean insulin when hyperkalemia is resolving (K+ <5.5 mmol/L)

Insulin has a tendency to bind to binding sites in PVC. The IV line must be primed with the insulin infusion solution and allowed to stand for one hour, then flushed with at least 10 mLs of the insulin solution prior to connecting to the infant. This will saturate the insulin binding sites in the line and prevent erroneous changes to the concentration of the solution during the subsequent infusion. In an emergency, omit the one hour conditioning but still prime and flush the line prior to connecting.

Insulin is NOT to be administered through any filter



Canberra HospitalSupplied as : Actrapid® neutral insulin injection:

100 units per mL, 3mL vial.Dilution Can be made up in pharmacy during working hours. Pharmacy

will connect and prime tubing to the syringe/bag.

Bolus injectionStep 1: Transfer 100 units (1 mL) of insulin from an insulin syringe into a 10mL syringe and make up to 10mL using sodium chloride 0.9%. This gives a 10 unit in 1mL solution

Step 2: Three options - choose the appropriate concentration of dextrose

10% Dextrose option a:Add 15units (1.5mL) of the 10u/mL insulin solution into a 500mL bag of 10% dextrose. Invert the bag several times to ensure thorough mixing of insulin throughout the solutionBolus dose = 5mL/kg over 10 minutes5mL/kg provides 0.15u/kg of insulin and 0.5g dextrose/kg

25% Dextrose option b:Add 75units (7.5mL) of the 10u/mL insulin solution into a 1000mL bag of 25% dextrose. Invert the bag several times to ensure thorough mixing of insulin throughout the solutionBolus dose = 2mL/kg over 10 minutes2mL/kg provides 0.15u/kg of insulin and 0.5g dextrose/kg

50% Dextrose option c:Add 75units (7.5mL) of the 10u/mL insulin solution into a 500mL bag of 50% dextrose. Invert the bag several times to ensure thorough mixing of insulin throughout the solutionBolus dose = 1mL/kg over 10 minutes1mL/kg provides 0.15u/kg of insulin and 0.5g dextrose/kg

Step 3: Do not hang the dextrose/insulin bag. Load an adequate volume from the bag into a syringe (eg 25mL). If time permits, prime and flush the line as described under comments

Continuous infusionChoose the appropriate dextrose concentration and make up a dextrose/insulin bag according to step 2 above. Use the solution to load a 25mL or 50mL syringe. Prime and flush the line as described under comments

10% dextrose/insulin solution:A rate of 5mL/kg/hour provides 0.15u/kg/hr of insulin and 0.5g dextrose/kg/hr



Stability : Discard after use



Canberra HospitalStorage : Refrigerate, do not freeze

Incompatibility : See hyperglycaemia protocol

Ipratropium BromideRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Anticholinergic Bronchodilator.

Dose : 50 microg


Route : Nebuliser.

Total Daily Dose : 200 microg

Comments : Inhibits cholinergic bronchoconstriction. Onset of action is 3-5 minutes. Peak action 1-2 hours after dose and persists for up to 6 hours. Used in severe BPD in which there is an element of wheeze. Used in conjunction with Salbutamol.

Supplied as : Nebuliser solution 250 microg/ml.

Dilution : Dilute with 2 ml NS. Use gas flows at required oxygen concentration between 4-6 l/min.

Stability : Discard after dilution.

Storage : Use as soon as possible after opening and discard after 28 days.





Canberra Hospital

IsoprenalineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hypotension due to impaired cardiac output. Both inotropic and chronotropic. Has peripheral vasodilator action and is therefore useful in patients with PPHN.

Dose : 0.05 – 2.0 microg/kg/min.

Interval : Continuous infusion. Double rate every 2-5 minutes until response is obtained. It also has to be titrated against the heart rate. Max 2 microg/kg/hr.

Route : I.V.

Total Daily Dose :

Comments : May cause tachycardia, arrhythmias, cardiac enlargement, focal myocardial ischaemia and rarely pulmonary oedema. Hypoglycaemia can occasionally be seen with Isoprenaline usage.

Supplied as : 200 microg/ml.Dilution : Stable in D5W, D10W, NS.

Take 7.5 ml/kg of Isoprenaline(200 microg/ml solution) and make upto 50 ml with the base solution. This gives a strength of 30 microg/ml solution.0.5 microg/kg/min at 1 ml/hour.

Stability : Discard unused portion after opening. Change I.V. solution every 24 hours.

Storage : Refrigerated.

Compatibility : TPN, Aminophylline, Dobutamine, Heparin, Hydrocortisone, Potassium chloride and Vecuronium.

Incompatibility : Frusemide, Sodium bicarbonate.

Serum Levels : Use extreme caution if patient has high serum digoxin levels. Must not flush line for other drugs because of risk of bolus effect. An alternative IV/IA line is needed.



Canberra Hospital

IsovueRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Checking placement of central catheters (i.e. {PICC lines, etc)

Dose : 0.5ml

Interval : Once only

Route : Intravenously instilled into the central line

Total Daily Dose :Comments : Sterile gloving and gowning by Neonatal Registrar

required. X-Ray plate needs to be in place before procedure begins. Registrar injects 0.5 ml of Isovue, and as the last 0.1ml is being injected the x-ray should be taken. Use a 1 mL syringe. Following the x-ray, flush with 1 ml of Normal Saline.The position of the line must be confirmed before commencing maintenance infusions.Isovue injection is a nonionic, radiopaque contrast medium for intravascular administration. Contraindicated in known hypersensitivity to iopamidol and thyrotoxicosis. Caution in patients with reduced renal or hepatic function. Isovue is excreted primarily by the kidneys. Fatal reactions have been associated with the administration of water soluble contrast media, most of which have been attributed to chemical, allergic or idiosyncratic effects. It is of utmost importance that a course of action be carefully planned in advance for the immediate treatment of serious reactions, and that adequate and appropriate facilities and personnel be readily available in case of a severe reaction.

Supplied as : Isovue-300 (iopamidol injection 61%) provides iopamidol 612 mg with trometamol 1 mg and sodium calcium edetate 0.39 mg, and contains approximately 0.037 mg (0.002 mEq) sodium and organically bound iodine 300 mg/mL

Dilution : None required.

Stability :

Storage : Store below 30 degrees C. Protect from light

Incompatibility : Do not mix with any other iv fluids.

Serum Levels :



Canberra Hospital

LabetalolRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hypertension.

Dose : Commence initially at 1-2 mg/kg/dose .

Interval : 6-12 hourly.

Route : Oral

Total Daily Dose : Up to 10 mg/kg/dose can be given 6 hourlyComments : Alpha-beta blocking agent. Contraindicated in asthma. Use

with caution, if at all, in patients with cardiac failure and conduction disorders.

Supplied as : 100 mg and 200 mg tablets.

Dilution : Pharmacy will prepare powders.

Stability :


Incompatibility :

Serum Levels :



Canberra Hospital

LactuloseRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1) Hepatic encephalopathy2) Second line (after poloxalkol – coloxyl drops) for a

laxative

Dose : 1) 1 ml/kg2) 0.5 ml/kg

Interval : 1) 6 hourly2) 24 hourly

Route : Oral.

Total Daily Dose : 1) 4 ml/kg/day2) 0.5 ml/kg/day

Comments : May take 24-48 hours for defecation to occur. May be more palatable when mixed with water or milk.

Supplied as : 3.3g/5ml.

Dilution :

Stability :


Incompatibility :

Serum Levels :



Canberra Hospital

Levetiracetam (Keppra)Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Intractable seizures.

Dose : 10 mg/kg per dose, increase 10 mg/kg once per week until seizures controlled

Interval : First 28 days of life – daily≥ 29 days of life – 12 hourlyMaximum of 30 mg/kg/dose

Route : IV or PO

Comments : Sedation and irritability have been reported in neonates and young infants. When discontinuing therapy wean slowly to minimise risk of seizure recurrence. Trough serum levels are generally not measured. Therapeutic concentrations 10-40 mcg/mL. Keppra® is renally cleared so dosage should be adjusted in patients with renal failure. Mechanism of action thought to involve intraneuronal Ca levels, GABA and the synaptic vesicle protein 2A. Conversion from iv doses to oral doses can be done directly without titration.

Supplied as : Keppra® injection for IV use – 500 mg in 5 mLs (100 mg/mL)Keppra® oral solution – 100 mg/mL

Dilution : Dilute iv doses to 5mg/mL to administer. Take 1mL of Keppra® 100mg/mL and 19 mL of 0.9% NaCl or 5% Dextrose, making 100mg/20mL (=5mg/mL).Administer iv doses slowly over 15 minutes.

Stability : IV ampoules - use once only and discard any residue.Where practical, the Pharmacy IV room will prepare the doses in syringes.

Storage : IV ampoules - Room temperature.Oral solution – Room temperature

Compatibility : Normal saline, Hartmann’s, 5% Dextrose

Incompatibility :



Canberra Hospital

Lignocaine for seizuresRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Persistent clinical and/or electrical seizure activity unresponsive to phenobarbitone and midazolam.

Dose : Loading dose – 2 mg/kg over 10 minutes6 mg/kg/hour for 6-12 hours depending on seizure response4 mg/kg/hour for 12 hours2 mg/kg/hour for 12 hours

Interval : InfusionRoute : IVTotal Daily Dose : Note - levels above 9mg/L are less often encountered when

6mg/kg/hour is used for 6 hours rather than 12 hours.Comments : Lignocaine stabilises all potentially excitable membranes and prevents the

initiation and transmission of nerve impulses. Lignocaine is metabolised in the liver. Metabolites (which may be posess activity) are renally extcreted. Phenytoin, phenobarbitone, primidone and carbamazepine appear to enhance the metabolism of lignocaine possibly due to an induction of microsomal enzymes, but the significance is unknown. Phenytoin and lignocaine have additive cardiac depressant effects. Constant ECG monitoring is essential during intravenous administration of lignocaine. If signs of excessive depression of cardiac conductivity (e.g. prolongation of the PR interval or QRS complex), aggravation of arrhythmias or other severe reactions occur, lignocaine should be promptly discontinued. Patients with reduced hepatic blood flow or function, and those on prolonged infusions of lignocaine will have a longer half-life and a lower clearance. During congestive cardiac failure, clearance will be reduced and in renal failure, accumulation of lignocaine may occur. Such instances will require a reduction in dosage. Lignocaine may increase ventricular rate when it is administered to patients with atrial fibrillation. Ischaemia or necrosis may occur in patients with hypertensive vascular disease or with an exaggerated vasoconstrictor response. Contraindications: Known hypersensitivity to local anaesthetics of the amide type. Use with caution in hepatic disease, renal disease, congestive cardiac failure, marked hypoxia, severe respiratory depression, severe shock or hypovolaemia. Hypokalaemia, hypoxia and disorders of acid/ base balance should be corrected before treatment with lignocaine.

Supplied as : Lignocaine Injection 2% Steriamps (clear, colourless, sterile, isotonic solution), 100 mg/5mL (20 mg/mL - stored in box of emergency drugs in fridge).

Dilution : Bolus solution: Can be administered undiluted or dilute to a final concentration of 1mg/mL with NS. Give over 10 minutes.Infusion syringes: prepared in pharmacy using undiluted 2% (20mg/mL) solution. If prepared after hours in the unit use undiluted 2% or can be diluted with NS to 1 mg/mL.

Stability : Steriamps for single use only. Discard unused portion. Infusion syringes are stable for 48 hours once prepared, but may only be used on patient for 24 hours.

Storage : Steriamps: store below 25 deg. C. Infusion syringes: store in refrigerator until required for use, maximum of 24 hours at room temperature.



Canberra HospitalCompatibility : NS, 5% Dextrose, Aminophylline, Caffeine, Calcium,

Ciprofloxacin, Dexamethasone, Digoxin, Dobutamine, Dopamine, Flucloxacillin, Frusemide, Heparin, Hydrocortisone, Insulin (regular), Lipid emulsion, Metoclopramide, Penicillin G, Potassium, Ranitidine. Compatible at the Y site only: Adrenaline, Cephazolin, Gentamicin, Midazolam, Morphine, Noradrenaline, Propofol, Timentin, TPN, Vancomycin

Incompatibility : Ampicillin (variable compatibility/incompatibility depending on concentration. Check with Pharmacy for more information) Milrinone, Phenobarbitone, Phenytoin,

Serum Levels : Lignocaine levels are not performed at TCH. If required they can be sent away to RNS, ring specimen referrals on 42845. Levels above 9mg/L are associated with cardiac toxicity in adults, but there is little information regarding levels in neonates.



Canberra Hospital

Lignocaine for local anaesthetic, cardiac arrhythmiaRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1) Ventricular arrythmias2) Local anaesthesia3) Topical anaesthesia

Dose : 1) 1 mg/kg (0.1 ml/kg of 1%) loading dose. Follow within 15 minutes with an infusion of 10-50 microg/kg/min otherwise repeat loading dose.

2) Nerve block: maximum dose without adrenaline 5 mg/kg

3) Surface anaesthesia of mouth, throat and upper GI tract: mixture up to 3 mg (0.15 ml)/kg/dose

Interval : 1) Can be repeated after 5 minutes3) Do not repeat within 2 hours

Route : 1) IV over 2 minutes2) Local infiltration3) Topical, can dab onto severe mouth ulcers before feeds

Total Daily Dose :

Comments : Can give 1% undiluted or dilute with NS. Excessive topical use in mouth can paralyse gag reflex.

Supplied as : 1% ampoules (10mg/ml)Mixture: 2% Xylocaine ViscousGel: 2%

Dilution : For IV infusion using 1% lignocaine solution (10mg/ml) take 3 ml multiplied by weight of the patient in kg and make up to 50 ml with NS. 1 ml/hr = 10 microg/kg/min. DO NOT USE THIS DILUTION FOR SEIZURE PROTOCOL

Stability : Discard any remaining solution from ampoules – intended for single use only.


Incompatibility : Thiopentone, phenytoin, ampicillin.

Compatibility: 5%D, N/2 Saline, NS, aminophylline, calcium gluconate, digoxin, dobutamine, dopamine, adrenaline, frusemide, heparin, hydrocortisone, insulin, nitroglycerine, KCl, ranitidine.

Serum Levels :



Canberra Hospital

Magnesium SulphateRevision Date : October 2016 Dtc Approved: October 2016

Indication :1] Hypomagnesaemia due to hypocalcaemia. Suspected in infants with severe birth asphyxia. .2] Severe acute hypomagnesaemia (ie Seizures)3] As a vasodilator in Persistent Pulmonary Hypertension of Newborn (PPHN)

Dose : Note: Doses are expressed as magnesium sulphate NOT elemental magnesium1] 100mg/kg/dose2

2] 50mg-100mg/kg/dose2

3] Loading dose: 200mg/kg2

Maintenance dose: 20-75mg/kg/hour given for up to 5 days. (To commence immediately after loading dose and to maintain plasma concentrations of 3.5-5.5mmol/L).2

Interval : 1] Stat, repeat if necessary 12 hourly for 2-3 doses2.2] stat, repeat 6-12 hourly if required according to serum levels1,3

3] Continuous infusion.Route : 1] IM injection or diluted IV infusion over 30-60minutes

2] Diluted IV infusion over 20minutes3] Diluted IV infusionContinuous intravenous infusion.

Total Daily Dose : According to response/ serum magnesium levels.

Comments : May cause hypotension (vasodilatation), loss of reflexes, respiratory depression. Contraindicated in the presence of a heart block. Dangerous if used in the presence of renal failure. May cause sedation and flaccid paralysis if used at levels recommended for pulmonary vasodilatation.Note, the concentration of magnesium sulphate (MgSO4) ampoules varies from 49.3% (493mg/mL magnesium sulphate) to 50% (500mg/mL magnesium sulphate) depending on brands. These concentrations are considered interchangeable and both are referred to as a concentration of 50%.

Supplied as : Magnesium Sulphate 50% solution in 5mL ampoules, containing Mg 2mmol/mL = 500mg/ml magnesium sulphate



Canberra HospitalDilution : 1] For IM and IV use: Dilute 4mL (2000mg) of MgSO4

50%

solution with 6mL of water for injection.3

This dilution = 200mg/mL.2] Dilute to 200mg/mL (as above).3

3] Dilute 10mL (5000mg) of MgSO4 50% with 40mL of water for injection. This dilution = 100mg/mL.Loading dose: 200mg/kg = 2mL/kg over 20-30minutes.Maintenance dose: 20-75mg/kg/hr = 0.2-0.75mL/kg/hr.

Stability : Discard ampoule and unused portion after initial use. Fresh solution must be prepared every 24 hours


Compatibility: Glucose 5 %, Glucose 10 %, Sodium chloride 0.9%, Water for Injection.

Incompatibility : Do not mix with any other drug.

Serum Levels : Normal newborn serum magnesium is 0.7 - 1.1 mmol/l. Recommended serum Mg. Level in PPHN is 5-7 mmol/l. Serum levels should be measured every 6-12 hours.



Australian Medication Handbook Childrens Dosing Companion, July 2015

2 BNF for Children 2015

3 Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application Version: 7.1.2.2015-Q3A



Canberra Hospital

Magnesium AspartateRevision Date : October 201618August 2015

DTC Approved: October 2016

Indication : Hypomagnesaemia

Dose : 0.1-0.2 mmol/kg TDS (>1 month of age), increase to 0.4-0.5mmol/kg/dose up to 4 times per day as required.1

Interval : Divided into 1-3 doses/day with food.

Route : PO

Total Daily Dose :

According to response/serum magnesium levels.

Comments : Limited data available; dosing can vary greatly. Monitor blood magnesium concentration and adjust dose according to response. Diarrhoea is a common dose-limiting adverse effect.1

1 mmol Mg=2 mEq Mg.Smallest dose that can be dispensed from pharmacy is 125mg = 0.4 mmol. Please prescribe in 125mg (0.4mmol) increments.

Supplied as : Magmin, Tab, magnesium 37.4 mg (1.55mmol) (magnesium aspartate dehydrate 500 mg)

Storage : Room temperature.Compatibility: N/A

Incompatibility :

N/A

Serum Levels : Normal newborn serum magnesium is 0.7 - 1.1 mmol/l2



1 Australian Medication Handbook, July 2015

2 Rennie JM, Roberton NRC (Eds). Textbook of Neonatology, 3rd Ed. Churchill Livingstone, Edinburgh, 1999



Canberra Hospital

MeropenemRevision Date : 9 January 2014 Approve : AK, JD

Indication : A very broad-spectrum carbapenem antibiotic which penetrates well into the CSF and most body tissues.Used for treatment of Pseudomonas sp. and other serious infection caused by susceptible organisms resistant to other antibiotics.This is a RED ANTIMICROBIAL and requires approval from the TCH Infectious Disease team, but can be prescribed in paediatric patients with Febrile Neutropenia under direction from Sydney Oncolgists.

Dose : Sepsis: 20mg/kg per doseMeningitis: 40mg/kg per dose

Interval : 1st week of life 12 hourly> 1 week of life 8 hourly

Route : IV infusion over 30 minutes

Total Daily Dose : 40-120mg/kg

Comments : Clearance is directly related to renal function. Hepatic function does not affect pharmacokinetics. Serum half-life is 3 hours in preterm and 2 hours in full term neonates.Adverse effects: diarrhoea, nausea/ vomiting and rash have been reported in paediatric patients.

Supplied as : 500mg and 1g vials (Merrem©)

Dilution : Usually prepared in Pharmacy.Reconstitute 500 mg vial with WFI to make 10 ml total (1000mg vial to 20 ml total). Remove 4 ml from vial and further dilute with NS to total of 10 ml (20mg/ml).

Stability : Use immediately and discard any unused solution from the vial. The diluted syringe is stable for 8 hours at room temperature and for 24 hours in the fridge.

Storage : Keep vials at room temperature.Keep syringes in the fridge

Compatibility : Aminophylline, dexamethasone, dopamine, dobutamine, gentamicin, heparin, insulin, morphine, noradrenaline, phenobarbitone, ranitidine, vancomycin.

Incompatibility : Aciclovir, calcium gluconate, diazepam, zidovudine, amphotericin B, metronidazole.

Serum Levels :



Canberra Hospital

MetoclopramideRevision Date : 9 January 2014 Approved: AK, JD

Indication : Vomiting and gastro-oesophageal reflux not responding to more conservative measures. Feed intolerance or gastric stasis in preterm infants. CAN ONLY BE USED WITH CONSULTANT APPROVAL

Dose : 0.1-0.2 mg/kg.

Interval : 12 or 8 hourly.

Route : OralI.V.

Total Daily Dose : Do not exceed 0.3 mg/kg/day.

Comments : Toxicity causes extrapyramidal side effects - oculogyric crises, torticollis, neck pain. Effects can be reversed with diphenhydramine.

Supplied as : Syrup 1 mg/ml.I.V. solution 5 mg/ml.

Dilution : Use syrup as supplied.I.V. - dilute 1 ml IV solution with 4 ml NS = 1 mg/ml.

Stability : Discard ampoule once opened.


Compatibility: Aciclovir, Aminophylline, Dexamethasone, 5% Dextrose, Fentanyl, Heparin, Hydrocortisone, Insulin, Midazolam, Morphine, Normal saline, Potassium chloride, Ranitidine, TPN.

Incompatibility : Calcium gluconate, cephalothin, chloramphenicol, frusemide, penicillin, sodium bicarbonate.

Serum Levels :



Canberra Hospital

MetoprololRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication: Hypertension, palliation of tetralogy of fallot, SVT.

Dose: IV: 0.05-0.1mg/kg/dose. May be repeated twice if required, then an infusion of 0.5-2.5microg/kg/min.PO: 0.5-1 mg/kg/dose

Interval: IV: stat dose/s then IV infusionPO: 6-12 hourly

Route: IV: slow IV bolus over minimum 5 minutes or infusion.

Total Daily Dose: 4mg/kg/day.

Comments: Metoprolol is a relatively cardioselective beta-1 adrenergic blocking agent without intrinsic sympathomimetic activity. Beta blockers can cause bronchoconstriction and bradycardia. Use with caution in cardiac failure and conduction disorders. Affects glucose metabolism. Caution in diabetes, hyperthyroidism. Potentiates effect of calcium antagonists. Withdraw gradually over 8-14 days. Overdose signs – excessive bradycardia, hypotension, possible cardiac failure, bronchoconstriction.

Supplied as: Ampoules 5mg/mLTablets 50mg

Dilution: Usually made up in pharmacy.Add 1.5 mg per Kg of Metoprolol to a syringe and make up to 25mL with either D5W or NS.1mL/hour = 1.0 microg/kg/min

Stability: Diluted ampoules: 24 hours at room temperature. Discard any unused drug.

Storage: Ampoules and tablets at room temperature. Diluted IV infusions in the refrigerator until ready for use.

Compatibility: NS 5DW Morphine

Incompatibility: Amphotericin

Serum Levels:



Canberra Hospital

MetronidazoleRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Anaerobic infections, peritonitis, NEC, and infections involving bacteroides, clostridium, fusobacterium etc.

Dose : Loading dose: 15 mg/kg.Maintenance dose: 7.5 mg/kg. Commence one dosage interval after the loading dose:

Interval : Corrected gestational age (weeks)

Postnatal Age(days old)


≤ 29 weeks 0-28≥29

4824

30 to 36 weeks 0-14≥15

2412

37 to 44 weeks 0 to 7≥8

2412

More than 44 weeks All 8

Route : I.V. over 20-30 minutes.

Total Daily Dose : 15 mg/kg/day.

Comments : Peripheral neuropathy, possible seizures, reversible neutropenia. Drug metabolites may cause a brownish discolouration of the urine.

Supplied as : 0.5% solution (100 mg in 20 ml = 5 mg/ml).

Dilution : Nil.

Stability : Discard after 24 hours from initial use.

Storage : Do not store in refrigerator (Crystals form, which redissolve on warming to room temperature).

Compatibility: TPN, 5% Dextrose, Normal Saline, aminophylline, cefotaxime, chloramphenicol, cimetidine, fluconazole, dopamine, hydrocortisone, morphine, heparin, gentamicin

Incompatibility : Do not use with 10% dextrose. The primary iv solution should be discontinued during metronidazole infusion.

Serum Levels :



Canberra Hospital



Canberra Hospital

Miconazole (Topical Gel) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Oral or G.I. Candida infections (gel).

Dose : 25 mg (1/4 of the 5 mL measuring spoon or 1.25 ml in syringe).


Route : Oral

Total Daily Dose : Up to 100 mg/day.

Comments : Fungostatic activity without significant G.I. absorption. Provided as a gel so that it remains in the mouth for a longer period. For rectal clearance in infants with a NG tube additional treatment with Nystatin via the NG tube may be necessary.

Supplied as : Daktarin 2% Gel 20 g tube.

Dilution : Use dosage prescribed by measuring gel volume correctly.

Stability : Stable at room temperature.


Compatibility: Not Applicable.

Incompatibility : Nil.

Serum Levels :



Canberra Hospital

MidazolamRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Midazolam is a short acting benzodiazepine with hypnotic, sedative and anticonvulsant activity. Use in the neonatal unit is for treatment of seizures and sedation

Dose : 0.1-0.2 mg/kg/doseNeonatal Infusion: 10-100 microg/kg/hourPaediatrics Infusion: 10-300 microg/kg/hour (change infusion guardrails to paediatrics from NICU)

Interval : 1 - 4 hourly or by infusion.

Route : IV stat or infusionIntranasal – stat only. Drop dose into alternate nostrils over 15 seconds. Absorption is rapid with maximum effect within 10 minutes and duration up to 2 hours. May be irritating.

Total Daily Dose : Individualise for patient. With infusion start at 10 microg/kg/hr. and increase as required to a maximum of 100 microg/kg/hr in neonates and 300 microg/kg/hour in paediatric patients. For sedation most neonates will only require 30 microg/kg/hour while paediatric patients may require 200-300 microg/kg/hour. For neonatal seizure management in HIE patients maximum dose is 100 microg/kg/hour

Comments : May cause apnoea, hypoventilation. Hypotension can occur when used in combination with narcotics. Use under supervision. May increase bronchial secretions. Pharmacokinetics are linear over a wide range (0.05 to 0.4 mg/kg dose range.). Maybe reversed with Flumazenil 5microg/kg/dose undiluted by rapid IV bolus or infusion.

Supplied as : 15 mg/3ml ampoules and 1 mg/ml ampoules.

Dilution : Stable in water, NS, D5W, D10W.Infusion: Weight in kg = "X". Add "X" mg to 50 ml of D5W, D10W, or NS - 1 ml/hr. = 20 microg/kg/hr.

Stability : Discard after initial opening of ampoule.


Compatibility: 5%D, 10%D, NS, Calcium gluconate, Cefotaxime, Digoxin, Dobutamine, Dopamine, Noradrenaline, Erythromycin, Fentanyl, Fluconazole, Gentamicin, Heparin, Insulin, Morphine, Potassium chloride, Vancomycin, Adrenaline, Vecuronium, Ranitidine at Y-site only.

Incompatibility : Ampicillin, Ceftazidime, Dexamethasone, Hydrocortisone, Sodium bicarbonate, TPN, Flucloxacillin, Frusemide.

Serum Levels :



Canberra Hospital

MilrinoneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Poor cardiac output confirmed by echocardiogram despite adequate support with dobutamine. Only to be ordered by Consultant Neonatologist after echocardiogram.

Dose : Commence infusion at 0.5 mcg/kg/minContinuous infusion 0.2-0.75 mcg/kg/min (must not exceed 0.75mcg/kg/min)

Interval : Continuous infusion

Route : IV

Total Daily Dose :

Comments : Milrinone may cause hypotension and this should be managed with a Noradrenaline infusion and preload support. A Noradrenaline infusion should be prepared and ready to commence when starting milrinone to manage hypotension should it occur. Milrinone may cause hypotension if run at high doses – hence must not exceed 0.75 mcg/kg/min. Frusemide should never be administered in an IV line containing Milrinone as this will cause precipitation. Milrinone is primarily renally excreted and reductions in infusion rate may be required in renal failure. Milrinone may also cause arrhythmias, hypokalaemia and thrombocytopenia.

Supplied as : Primacor 10 mg/10 ml ampoule (1 mg/ml)

Dilution : Prepare 1.5 mg/kg of Milrinone into 50 mls of D5W or NS. 1 ml/h = 0.5 mcg/kg/min.

Stability : Discard ampoule and unused portion after initial use.

Storage : Room temperature, protect from light. Do not freeze.

Compatibility: D5W, NS, Adrenaline, aminophylline, atropine, calcium, glyceryl trinitrate, digoxin, dobutamine, dopamine, fentanyl, insulin, heparin, magnesium, morphine, noradrenaline, potassium chloride, ranitidine, sodium bicarbonate, vecuronium.

Incompatibility : Frusemide.

Serum Levels :



Canberra Hospital

Morphine IVRevision Date : 15 April 2014 Approved: TC, LZ, JD

Indication : 1 & 2] Premedication for intubation, Analgesia or sedation

Dose : 1] Stat 0.1 - 0.2 mg/kg (100 - 200 microg/kg)2] Infusion 10 - 30 microg/kg/hour

Interval : 1] 4 - 6 hourly2] Infusion.

Route : 1] I.M. or I.V. over 5 minutes2] IV

Total Daily Dose : Treat overdose with Naloxone - 0.01 mg/kg

Comments : May cause sweating, anorexia, dysuria, restlessness, bradycardia, sedation, respiratory depression - decreased response to CO2 tension; apnoea, urinary retention, hypotension, seizures, reduced gut mobility. Use I.V. route only if patient receiving mechanical ventilation. Infusion prevents risk of intermittent hypotension in sick infants. Pharmacokinetics in the newborn varies and dosage should be reduced in ELBW infants. Elimination half life is approximately 9 hours in preterm infants. Addiction during short term use (< 1 week) not a problem and weaning not necessary. May be reversed with Naloxone [0.01 mg/kg/dose - IV bolus].

Supplied as : Morphine sulphate 5 mg/mL ampoules.

Dilution : Not required for I.M.For stat I.V. : Add 1mL of solution (5mg/mL) to 4 mL of NS (makes 1mg/1mL = 100 microg/0.1mL)Dose = 0.1mL/kg (= 100 microg/kg)Infusion: Add 1mL of solution (5mg/mL) to 4 mL of NS (makes 1mg/1mL). Add 1mL/kg (=1mg/kg) of the diluted Morphine solution to a syringe and further dilute to 50 mL using D5W, D10W or NSUsing this resulting concentration:

1 mL/ hr = 20 microg/kg/hrStability : Discard ampoule and unused portion after initial use

Storage : Unopened ampoules: room temperature, locked in drug safe

Compatibility: Compatible with aminophylline, atropine, fentanyl, heparin, sodium bicarbonate, cimetidine, ranitidine, TPN, dopamine

Incompatibility : Iodides, sulphas, thiopentone sodium, phenytoin, phenobarbitone, methicillin, pethidine

Serum Levels :



Canberra Hospital

Morphine OralRevision Date : 15 April 2014 Approved: TC, LZ, JD

Indication : 1] Neonatal narcotic abstinence syndrome.2] Analgesic and Sedation

Dose : 1] Starting dose: 0.5 mg/kg/day (500 microg/kg/day) in 4 divided doses. See NAS protocol; change to 4 hourly if symptoms poorly controlled.2] Ventilated 100-200 microg/kg/dose Non-ventilated 50 microg/kg/dose

Interval : 1] 6 hourly2] 4-6 hourly

Route : Oral

Total Daily Dose : Upto 0.9mg/kg/day

Comments : May cause sedation, respiratory apnoea, urinary retention, hypotension, reduced gut mobility. Pharmacokinetics in the newborn varies and dosage should be reduced in ELBW infants.

Intravenous route is the preferable route for morphine administration for pain relief and sedation. Baby who is ventilated for more than 1 week and on full enteral feeds may be changed to oral morphine

To switch from intravenous to oral therapy: find dose baby is receiving intravenously per hour, multiply by 6 (because oral morphine is given six hourly) and then multiply by 2 because oral morphine is half as bioavailable as the intravenous preparation. Prescribe this dose 6 hourly. (Eg: A baby receiving 10microg/kg/hour by intravenous infusion should receive 120 microg/kg 6 hourly orally)

Supplied as : Oral solution of morphine hydrochloride 1mg/mL

Dilution : Use undiluted

Stability : Stable for 6 months once the bottle is opened

Storage : Room temperature, locked in drug safe





Canberra HospitalSerum Levels : NA

MylantaRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : A compound antacid preparation useful in reducing gastric erosions and bleeding during stressful intensive care particularly in the presence of drugs with intense histamine reactions. Also used in the amelioration of oesophagitis in association with gastric reflux.

Dose : 1 - 3 ml (0.5 ml/kg/dose).

Interval : 4 - 6 hourly. Separate from other oral medication.

Route : Oral.

Total Daily Dose :

Comments : An aluminium hydroxide base. Will precipitate phosphate and therefore should be used with caution where nutritional phosphate is important. Note high level of magnesium in compound.

Supplied as : Mylanta liquid.

Dilution : Not required.

Stability : Use as per expiry date.






Canberra Hospital

NaloxoneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Narcotic antagonist. Opiate drug depression.As an adjuvant therapy in resuscitation for narcotic- induced respiratory depression.

Dose : 0.1-0.2 mg/kg (=100-200microg/kg), (0.25-0.5 ml/kg of 0.4 mg/ml solution).

Interval : Stat; repeat up to 3 times if necessary.

Route : I.V.I.M.Intra-tracheal, if necessary.

Total Daily Dose : Not more than 400 microg/kg

Comments : If successful in documented narcotic depression infants must be monitored closely as the half-life of pethidine and morphine exceeds the half-life of Naloxone. Exercise caution when administering drug to infants of known or suspected drug addicts due to risk of seizures and withdrawal: Tachycardia, tachypnoea, hypertension, tremors, vomiting.Not effective against non-narcotic drugs.

Supplied as : 400 microg/ml; 1 ml ampoules.

Dilution : Use 400 microg/ml vial. No dilution necessary.



Compatibility: Data not available. Compatible with Heparin

Incompatibility : Alkaline solutions, sodium bicarbonate.

Serum Levels :



Canberra Hospital

NeostigmineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1] Myasthenia test.2] Maintenance, in Neonatal transient myasthenia gravis and Neonatal persistent myasthenia gravis.3] Reversal of muscle relaxation.Anticholinesterase

Dose : 1] 0.04 mg/kg (40 microg/kg)2] 0.05-0.25 mg/kg (50-250 microg/kg)3] 0.05 mg/kg (50 microg/kg) with atropine 0.02 mg/kg

Interval : 1] Stat2] 2-4 hourly3] Stat.

Route : IV, IM, SC

Total Daily Dose : For overdose give Atropine.

Comments : May cause vomiting, increased salivation, diarrhoea, increased bronchial secretions, nystagmus, sweating, hypotension. Contraindicated in mechanical intestinal or urinary obstruction. May result in cardiac arrest, central respiratory depression, pulmonary oedema, convulsions.

Supplied as : 0.5 mg/ml ampoules.

Dilution : 1] & 2] Not required.3] Neostigmine 50 microg/kg with Atropine 20 microg/kg IV.Draw up 0.5 mg (1 ml) of Neostigmine into a 5 ml syringe. Add 200 microg (0.5 ml) of Atropine. Add NS or N/2Saline to make up 5 ml of solution. Give 0.5 ml/kg of solution = 50 microg/kg Neostigmine and 20 microg/kg Atropine.



Compatibility: NS, heparin, 5%D, hydrocortisone, KCl.

Incompatibility : Sodium bicarbonate, suxamethonium.

Serum Levels :



Canberra Hospital



Canberra Hospital

NoradrenalineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Severe refractory hypotension.

Dose : 0.1 – 1.0 microg/kg/min by continuous infusion.

Interval : Continuous infusion.Start infusion at 0.1 microg/kg/min. Rate may be increased slowly to maximum 1.0 microg/kg/min provided limb perfusion and urine output are watched carefully. Monitor central vascular pressures where possible.

Route : Must only be given into a central vein.

Comments : Potent vasoconstrictor. Consider use where need to increase vital organ perfusion outweighs the risk of lowering cardiac output. Has been used in septic shock, with simultaneous low dose dopamine to sustain renal blood flow. Main effects are to increase cardiac contractility, heart rate and myocardial oxygen consumption via beta-1 stimulation. High dose infusions can cause a decrease in cardiac output (from increased afterload on the heart) and compromise ventricular function from increased myocardial oxygen consumption.

Supplied as : Noradrenaline base 1 in 1000 (2mg in 2ml)[Note that this is equivalent to 4mg of Noradrenaline acid tartrate in 2ml]

Dilution : Take 1.5 mg/Kg of Noradrenaline base and dilute to 25 ml with D10W or D5W.Using this resulting concentration:

0.1 ml/hr = 0.1 microg/kg/minStability : Stable in solutions with a low pH, such as dextrose, but is

best prepared afresh every 24 hours unless protected from light

Storage : Ampoules should be protected from light during storage, and discarded if discoloured.

Compatibility : May be co-infused with TPN, dopamine, dobutamine, heparin, ranitidine, calcium, adrenaline, hydrocortisone.

Incompatibility : Sodium bicarbonate, Phenobarbitone, blood.Refs: Northern Neonatal Network, Neonatal Formulary (9th Ed.), 1996. BMJ Publishing Group. L.A. Trissel, Handbook on Injectable Drugs (10th Ed.)



Canberra Hospital

Nystatin (Oral) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Oral and gastrointestinal candidiasis.

Dose : 0.5 - 1.0 ml. (Use 0.25 ml < 1000 grams).


Route : Orally/NG tube.

Total Daily Dose :

Comments : Well tolerated. No known side effects. May be used in conjunction with Miconazole gel in infants prescribed broad spectrum antibiotics and who are given nystatin via NG tube.Not absorbed well from skin, GI tract or mucus membranes.

Supplied as : Nystatin suspension.

Dilution :

Stability :






Canberra Hospital

Nystatin (Topical) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Cutaneous Candidiasis. Prophylaxis against Candidiasis in infants on broad spectrum antibiotics and steroids.

Dose : Liberal spread.

Interval : With each diaper change.

Route : Topical.

Total Daily Dose :

Comments : Well tolerated. No known side effects. Use with caution in infants under phototherapy.

Supplied as : Nystatin cream.

Dilution :

Stability :






Canberra Hospital

OctreotideRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Treatment of ongoing chylothorax

Dose : 0.5 microgram/kg/hour on day one, increasing by 1 microgram/kg/hour daily until maximum of 10 microgram/kg/hour

Interval : Continuous infusion

Route : IV

Total Daily Dose : 240 microg/kg/day

Comments : Long acting somatostatin analogue that causes vasoconstriction of splanchnic vessels and reduces gastric, pancreatic and small intestinal secretions. May result in mild abdominal distension, loose stools, flatulence, liver function abnormalities and hypoglycaemia.

Supplied as : 50microg/mL and 100microg/mL ampoules

Dilution : Not requiredDilute to a suitable volume (eg 25mL or 50mL) in 0.9% NaCl. The final concentration should be between 1 and 25microg/mL.

Stability : Ampoules: until expiry date on labelInfusions: 48 hours

Storage : Ampoules: Refrigerate. Protect from light.Infusion: protect from light

Compatability: 5% Dextrose, 0.9% NaCl, Heparin, Potassium and TPN via a Y site.

Incompatibility : Insulin, Pantoprazole




Canberra Hospital

Omegaven 10% Lipid EmulsionRevision Date: Aug 2016 DTC Approved: 28/08/2016

Indication : Sterile fat emulsion for IV infusion for infants on long term TPN with TPN induced liver disease. 1

Dose2 :Lipid dose per day

Amount of Omegaven 10%

1g/kg/day 10mL/kg/day2g/kg/day (MAX)

20mL/kg/day

Interval : Daily

Route : IV infusion over 24 hours

Total Daily Dose : -

Comments : - Consider Omegaven lipids in babies with TPN associated cholestasis with a conjugated SBR of > 35 micromol/L and predicted TPN use for more than 21 days.3

- Omegaven can be used as a sole lipid source up to a max of 2g/kg/day. SMOF lipid can used in conjunction with Omegaven to get to 3g/kg/day if required. When used together vitamins will be added to the SMOF component of the lipid.- Omegaven has been shown to reverse TPN induced cholestasis. However, there is no evidence that it prevents cholestasis in neonates; hence prophylactic use should be avoided.4

- Omegaven should be ceased with 2 consecutive conjugated SBR values < 17 micromol/L or when the baby tolerates enteral feeds adequate to cease TPN- Omegaven is not TGA approved in Australia. An SAS form needs to be completed with each prescription before it can be issued from pharmacy

Supplied as : Omegaven is an emulsion containing 10% highly refined fish oil.

If ordered without vitamins pharmacy will dispense and send Omegaven in its original packaging to the ward.



Canberra HospitalDilution : Vitamins can ONLY be added to the 2g/kg/day Omegaven solution,

not the 1g/kg/day solution (there is no compatibility data).

If vitamins are to be added pharmacy will prepare a syringe for doses up to 50mLs (with at least 5mL coverage) and bags for doses over 50mLs (with at least 25mL coverage). The Omegaven syringe/bag will also be loaded with Vitalipid N (fat soluble vitamins) 4mL/kg/day (capped at 10mL/day) and Soluvit N (water soluble vitamins) 1ml/kg/day (capped at 10mL/day). The addition of these vitamins dilutes the lipid concentration from 10% to 9.5%. This is considered an acceptable difference and bags with vitamins added will still be considered a 10% solution. Run this solution through the Braun pump at Omegaven 10% solution.

Example calculation:3kg neonate 2g/kg/day Omegaven with vitaminsTotal volume: 3 x 20 = 60mLTotal fat = 6gVitalipid 10% lipid solution 4mL/kg/day (10mL max) = 10mL (1g lipid)Solutvit 0% lipid solution 1mL/kg/day (10mL max) = 3mL(0g lipid)Omegaven 10% lipid solution to make up to 60mL (60mL final volume – 3mL Soluvit – 10mL Vitalipid) = 47mL (4.7g lipid)Final lipid = 1g + 4.7g = 5.7gFinal lipid concentration = 5.7g/60mL = 9.5%

Stability : 24 hours once prepared

Storage : Syringes/minibags – keep in refrigerator until ready to use.Protect from light.

Incompatibility : Incompatibilities may occur through the addition of polyvalent cations, e.g. calcium, especially when combined with heparin.5

Compatibility:

Serum Levels : NA

Compiled: August 2016

Review: August 2020

References:

1. Royal Hospital for Women Omegaven Drug Page. Accessed online at- https://www.seslhd.health.nsw.gov.au/rhw/Newborn_Care/Guidelines/Medication/pdf/LipidOmegApril14.pdf2. Park KT, Nespor, Kerner J J. The use of Omegaven in treating parenteral nutrition-associated liver disease. Journal of Perinatology (2011) 31, S57–S60; doi:10.1038/jp.2010.1823. Lam HS, Tam YH, Poon TC, Cheung HM, Yu X, Chan BP et al. Double-blind randomised controlled trial of fish oil-based versus soy-based lipid preparations in the treatment of infants with parenteral nutrition-associated cholestasis. Neonatology 2014;105:290–6.4. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis. J Nutr 2015;145:277–83



Canberra Hospital5. Omegaven product information. https://www.drugs.com/uk/omegaven-leaflet.html. Accessed online on 25-08-16

OmeprazoleRevision Date : 28 January 2015 DTC Approved: March 2015

Indication : Hyperacidity, significant gastroesophageal reflux and gastric ulcers. Proton pump inhibitor.

Dose : 0.5 mg/kg to 1.5mg/kg. 1

Interval : Daily dosing but may go to 12 hourly (max 0.75 mg/kg/dose) if required.

Route : Orally

Total Daily Dose : 1.5 mg/kg


https://www.drugs.com/uk/omegaven-leaflet.html


Canberra HospitalComments : Babies with feeding tubes should be given omeprazole

2mg/mL mixture, prepared by the pharmacy department.For babies without a feeding tube, dispersed tablets are preferred. It is unreliable to measure doses other than 5mg or 10mg from a 10mg tablet. Adjust dose to 5mg increments (when possible) for ease of administration.Half of a 10mg dispersible tablet (5mg) may be dispersed in an oral dispenser with a small amount of water for injection (WFI). DO NOT CRUSH the tablet as it is composed of tiny enteric coated granules. Vigorously agitate the oral dispenser to disperse the tablet. Administer the dose and rinse the oral dispenser with more WFI to retrieve any remaining granules from the dispenser. The granules settle in the dispenser rather quickly. The dose should be agitated and administered immediately. This dispersed fluid is unsuitable for babies with small bore feeding tubes as the granules may block the tube.

Babies going home on full suck feeds should be changed to dispersed solution (see above) one week prior to discharge. This will ensure appropriate training of the parents for administering the correct dose. Freshly boiled (for 3 minutes) and cooled water can be used at home instead of WFI.

Caution routine use of PPI in neonates with reflux due to possible association of PPI use with NEC, sepsis and gastrointestinal infections. 2

Supplied as : 10 mg dispersible tablets.Oral mixture made by pharmacy 2 mg/mL for those babies with feeding tubes

Dilution : Not Applicable.

Stability : Tablets – use immediately and discard unused half of tabletOral mixture – according to expiry date on the label. Shake the bottle daily.

Storage : Tablets – room temperatureOral Mixture – refrigerate and protect from light





References:



Canberra Hospital1. Paediatrics and Neofax ®. Application Version: 7.1.2.2014-Q42. Chung EY1, Yardley J. Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease? Hosp Pediatr. 2013 Jan;3(1):16-23.

Pancreatic Enzymes/CreonRevision Date : 21/3/1718/08/201504:37:00 AM

Approved KO/TC

Indication : Pancreatic enzyme replacement or supplementation for conditions of pancreatic enzyme insufficiency. E.g. cystic fibrosis.

Dose : Different brands of enzyme products are available. All contain lipase, amylase and protease. The dose is expressed in units of lipase and is titrated to control steatorrhoea. If on full feeds start with 5000 units/kg/day and increase if necessary. Use a lower dose if on partial feeds.

Interval : Divide total daily dose between each feed, so that some is given with every feed

Route : Orally.



Canberra HospitalTotal Daily Dose : Maximum 10,000 units/kg/day.

Comments : The capsules contain enteric coated beads. They can be mixed with acidic food such as apple puree, but not alkaline foods or antacids as these will dissolve the coating. Do not crush the beads. Give with fluid. The small measuring scoop that is provided with the bottle is designed to contain a dose of 100 mg of granules. This amount provides 5,000 units of lipase. The dose will most likely be a portion of a scoop, if so estimate the portion. There are reports of high doses causing colonic strictures.

Supplied as : Creon 5000: Micro enteric coated bead with scoop- lipase 5000 U, amylase 3600 U, protease 200 U/100mg scoop

Dilution : Nil. Mix with apple sauce/apple puree for administration on spoon.

Stability : Do not administer with alkaline foods or antacids





PancuroniumRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Muscle relaxation for infants on full ventilation, especially ones requiring high ventilator pressures.

Dose : 1] 0.1 mg/kg (100microg/kg)2] 0.25-0.75 microg/kg/min

Interval : 1] Hourly and P.R.N.2] infusion

Route : IV

Total Daily Dose :



Canberra HospitalComments : Non-depolarising neuromuscular blocking agent that produces skeletal muscle

paralysis mainly by causing a decreased response to acetylcholine at the myoneural junction. Ensure that pH, electrolytes and fluid balance are normal. Generally not usually associated with a fall in BP, but both hypo- and hypertension can occur. Ventilator support may need to be increased particularly in larger infants, where spontaneous respiratory effort may be underestimated. Cardiac output and heart rate usually increased. Sensation remains intact in babies on paralysis and sedation should be used along with paralysis. Peak effect in 4 - 5 minutes. Duration 40-60 minutesReversal :Neostigmine 50 microg/kg with Atropine 20 microg/kg IVDraw up 0.5 mg (1 ml) of Neostigmine into a 5 ml syringe. Add 200 microg (0.5 ml) of Atropine. Add NS or N/2Saline to make up 5 ml of solution. Give 0.5 ml/kg of solution = 50 microg/kg Neostigmine and 20 microg/kg Atropine.

Supplied as : Pancuronium bromide 4 mg/2 ml (4000 microg/2 ml) ampoules.

Dilution : Add 2 ml (4 mg) Pancuronium to 2 ml NS to make total of 4 ml solution. 1 ml = 1mg = 1000 microg. For infusion multiply baby’s weight (kg) X 1.5 ml (of the 1 mg/ml) solution and further dilute to 50 ml with NS or 5%D. 1 ml/hr = 0.5 microg/kg/min.


Storage : Refrigerator.

Compatibility: 5 % Dextrose, Normal Saline, Aminophylline, Dobutamine, Dopamine, Fentanyl, Fluconazole, Gentamicin, Heparin, Hydrocortisone, Midazolam, Morphine, Nitroprusside, Ranitidine, Vancomycin.

Incompatibility : May precipitate with other drugs. Usual precautions apply. Effect is increased in the presence of hypokalaemia, hypocalcaemia, hypercapnia, acidosis, myasthenia etc. Decreased effect is noted if infant is cold. With prolonged use dosage may change.



Canberra Hospital

PantoprazoleRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Proton pump inhibitor which inhibits gastric acid secretion in gastro-oesophageal reflux disease

Dose : 1.0 mg/kg/dose

Interval : Daily (may be administered as 0.5 mg/kg 12 hourly if daily dosing does not control symptoms)

Route : Intravenous infusion over 15 minutes

Total Daily Dose : 1 mg/kg/day

Comments : Generally well tolerated but very occasionally may cause nausea, vomiting or skin rash. Consider alternative options with liver disease.Change to oral omeprazole when practical.

Supplied as : Pantoprazole (Somac) 40 mg vial in powder form

Dilution : Add 10 ml of Normal saline to 40mg vial to make 4 mg/mL solution. Take 1 mL (4 mg) of 4 mg/mL solution and dilute with 9 mL of normal saline making 0.4 mg/mL solution

Stability : Vial is for single use only. Discard unused solution.

Storage : Vials: Store below 25 degrees. Protect from light.Compatibility : 5% dextrose, 10% dextrose, normal saline

Incompatibility : Atazanavir this is because PPIs substantially reduce the absorption of atazanavirMultiple – consult with pharmacy

Serum Levels : Nil



Canberra Hospital

Paracetamol (Draft)Revision Date : 27/04/2017 DTC Approved: (TBA)

Indication1 : 1] Analgesic when narcotics are not required.2] Antipyretic.3]Prevention/treatment of side effects related to immunisations.4] Treatment of PDA

Dose1 : 1-3] IV/Oral:< 2 kg – Load 15mg/kg then 7.5 mg/kg/dose; >=2 kg and <3 kg – 15 mg/kg then 10mg/kg; >=3 kg – Load 20mg/kg then 10mg/kg4] IV/Oral:15 mg/kg/dose 6 hourly

*CGA/PMA: Corrected gestational age/Post menstrual ageInterval : 1-3] 6 hourly

4] 6 hourlyRoute : IV (only indicated if NBM, review after 48 hours).

Administered as an undiluted infusion over 15 minutes.Oral

Total Daily Dose : 1-3] IV/Oral*: < 2kg – 30 mg/kg/day; >= 2 kg and <3 kg – 40 mg/kg/day; >= 3kg – 40 mg/kg/day4] IV/Oral*:60mg/kg/day for 3-6 days

*Excluding loading dose



Canberra HospitalComments : Non-narcotic analgesic and antipyretic. Paracetamol is rapidly absorbed

by mouth and widely distributed in the body. Extensively metabolized in the liver, primarily by sulfation with a small amount by glucuronidation. Metabolites and unchanged drug are excreted by the kidney. Elimination half-life is approximately 3 hours in term neonates, and up to 11 hours in preterm neonates. Elimination is prolonged in patients with liver dysfunction or jaundice. Optimum pain relief occurs over an hour after the blood level peaks. Caution should be used in the presence of hepatic impairment. Overdose may result in liver cell necrosis and death. Caution in dehydration and severe renal impairment.

Efficacy and safety (PDA)

One published, randomised, controlled trial has compared paracetamol with placebo2. In 48 preterm infants intravenous paracetamol (20 mg/kg loading; 7.5 mg/kg every 6 hours) was compared with no paracetamol within the first 24 hours of life; with a higher closure rate and shorter time to closure in the treatment arm and no reported adverse events. A systematic review of two randomised, controlled trials reported comparisons of oral paracetamol versus oral ibuprofen for the treatment of an echocardiographically diagnosed PDA in 250 infants born preterm (≤ 34 weeks postmenstrual age [PMA]). The success rate for paracetamol to close a PDA was similar to that of ibuprofen. Adverse events were similar in both groups. However, in general, the trends favoured infants who received paracetamol and additionally the adverse events were lower in the paracetamol group3. A second systematic review of studies involving the use of paracetamol in preterm infants reported on sixteen studies: Two randomised controlled trials and 14 uncontrolled studies. The quality of selected studies was rated as poor. The majority of studies used 15 mg/kg every 6 hours for 3–7 days. Proportion meta-analysis of uncontrolled studies demonstrated a pooled ductal closure rate of 49% (95% CI 29% to 69%) and 76% (95% CI 61% to 88%) after 3 and 6 days of treatment with paracetamol, respectively4. A third, randomised, controlled trial involving 77 preterm infants has since been published comparing oral paracetamol and NSAIDs (intravenous indomethacin) with similar closure rates and no reported adverse events5. More recently El Mashad compared paracetamol, ibuprofen and indomethacin in an RCT involving 300 extremely premature babies less than 28 weeks and showed 80% closure rate with paracetamol similar to other groups but without any hepatic, renal or haematological side effects6.

Repeat LFT’s pre-treatment and at 3 days.Supplied as : 100mg/ml syrup SHAKE WELL BEFORE USE

1000mg/100mL (10mg/mL) vialDilution : Not required.

Stability : As per expiry date on the original container. IV paracetamol is a single use vial.

Storage : Room temperature. Do not refrigerate or freeze vials of iv paracetamol.

Compatibility: IV paracetamol is compatible with 5% Glucose and 0.9% Sodium Chloride

Incompatibility : No information. IV paracetamol should not be mixed with other drugs.

Serum Levels : Routine levels not recommended. Levels to be taken if concerns of toxicity.



Canberra Hospital

References:1. Neomed consensus guideline. http://192.168.104.10/neomed/Drug.aspx?@drugid=87. Accessed 28-04-20172. Härkin P, Härmä A, Aikio O, Valkama M, Leskinen M, Saarela T, Hallman M. Paracetamol Accelerates Closure of the Ductus Arteriosus after Premature Birth: A Randomized Trial. J Pediatr. 2016 Oct;177:72-77.e2. doi: 10.1016/j.jpeds.2016.04.066. Epub 2016 May 20.3. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-birth-weight infants. Cochrane Database of Systematic Reviews. 2015;3:CD0100614. Terrin G, Conte F, Oncel MY, Scipione A, McNamara PJ, Simons S, et al. Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2016;101:F127-365. Dash SK, Kabra NS, Avasthi BS, Sharma SR, Padhi P, Ahmed J. Enteral paracetamol or Intravenous Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A Randomized Controlled Trial. Indian pediatrics. 2015;52:573-86. El-Mashad AE, El-Mahdy H, El Amrousy D, Elgendy M. Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates. Eur J Pediatr. 2017 Feb;176(2):233-240. doi: 10.1007/s00431-016-2830-7. Epub 2016 Dec 21.


http://192.168.104.10/neomed/Drug.aspx?@drugid=87


Canberra Hospital

Penicillin, Benzyl (Penicillin G)Revision Date : 15 May 2015 DTC Approved : May 2015

Indication : 1. Empiric therapy for early onset sepsis in combination with an aminoglycoside

2. Directed treatment of infection to a susceptible bacterium3. Treatment of congenital syphilis4. Treatment of meningitis to a susceptible bacterium,

including GBS (Group B Streptococcus)Dose : 1, 2 and 3. 60mg/kg/dose1

4. 90 mg/kg/dose2

Interval: Dosing interval chart3

Post-menstrual age (weeks)

Postnatal age (days) Interval (hours)

≤29 0-28>28

128

30-36 0-14>14

128

37-44 0-7>7

128

≥45 All 6Route : IV

IM: Deep IM injection in anterolateral thighTotal Daily Dose :

300mg/kg/day4

Note: Adjust meningitis doses to comply with maximum dailyComments : 600mg of benzylpenicillin is equal to 1million units

Each 600mg vial contains 1.8mmol of sodium

Separate dose from aminoglycosides (eg. gentamicin) and flush line between administration.

Dose adjustment required in renal impairment

Cardiac arrest and CNS toxicity has been reported with high doses and rapid administration. Bone Marrow Depression, granulocytopenia and hepatitis are rare side effects.

Hypersensitivity does not occur in neonates3

Supplied as : 600mg benzylpenicillin sodium powder for reconstitution



Canberra HospitalDilution : IV: Dilute with 1.6 ml of WFI to make a 300mg/mL solution.

Further dilute with WFI to final volume 10mL (60mg/mL) and then withdraw desired volume5.

IV infusion over 15-30 minutes. IV infusion over 30-60 minutes recommended for larger doses e.g. meningitis1,5

IM: Use 300 mg/mL solution.Stability : Use as soon as possible and discard any unused solution5

Storage : Store below 25 degrees Celsius and protect from light6

Compatibility: Solution compatibility: 5% glucose, 10% glucose, 0.9% sodium chloride,WFIY site compatibility: calcium gluconate, cefotaxime, dextrose/amino acid solutions, dopamine, fluconazole, frusemide, heparin, hydrocortisone sodium succinate, insulin regular, morphine, potassium chloride, ranitidine, vancomycinStability is variable with lipid emulsion

Incompatibility : Aminoglycosides, aminophylline, amphotericin B, dobutamine, phenobarbitone, phenytoin, Stability is variable with lipid emulsionRefer to Micromedex IV compatibility for more information

Serum Levels: NA

Compiled: March 2015

Review: March 2019

References:1. Paediatric Pharmacopoeia 13th Edition 2002. Pharmacy Department, Royal

Children’s Hospital 2. Neomed Consensus group. http://192.168.104.10/neomed/Drug.aspx?

@drugid=4. Accessed online 27/3/153. Neofax Penicillin G Drug Monograph, 2015. Accessed Online 25/03/2015 4. Paediatric Injectable Drugs Handbook, 10th Edition 2013. Penicillin G

Potassium/Sodium American Society of Health-System Pharmacists 5. SHPA Australian Injectable Drugs Handbook, 6th Edition 2014.

Benzylpenicillin Sodium 6. Product Information, BenPen, MIMS Amended 01/12/2006



Canberra Hospital

Pentavite (Multivitamin Prep) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Vitamin supplementation of preterm infants.To be prescribed for all infants < 32 weeks gestation or < 1800 grams birthweight

Dose : 0.45 ml BD

Interval : Twice daily when 7 days of age and on full feeds.

Route : Oral.

Total Daily Dose : 0.9 ml.Comments : Often given to low birth weight infants. Needs are usually

for vitamins A, D, C, & K. Vitamins E, B1, B2, B6 may sometimes be necessary. Prescribed and recommended (ESPGN) amounts are as follows:

Vit A 480 microg (300 microg)Vit B1 540 microg ( 50 microg)Vit B2 810 microg (200 microg)Vit B3 710 microg (500 microg)Vit B6 135 microg ( 20 microg)Vit C 42 microg ( 20 microg)Vit D 22 microg ( 20 microg)

Vitamin supplementation after 2 kg is considered not to be essential.

Supplied as : Pentavite

Dilution : None required.

Stability : Stable for 9 weeks after opening

Storage : Room temperature prior to opening, followed by refrigeration after opening.

Compatibility:

Incompatibility : None.

Serum Levels :



Canberra Hospital

PhenobarbitoneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : An anticonvulsant, sedation, seizures.

Dose : Loading dose: 20 mg/kg (may be given as 2 x 10 mg/kg doses 3-4 hours apart).Maintenance Dose: 4- 6 mg/kg/day.

Interval : Daily, may be divided into 2 doses but best given as once a day at night to reduce drowsiness during the day.

Route : I.V. over 20 minutes.I.M.Oral.

Total Daily Dose :

Comments : Overdose may cause hypoventilation, hypotension, hypothermia, renal failure, decreased anticoagulation. Withdrawal may occur with prolonged use. Half-life in neonates is 96 hrs. IV dose must not be given faster than 1mg/kg /min.Should not be used for routine sedation of babies on ventilator, as it has no pain relief properties and sedative levels are much higher than therapeutic anticonvulsant blood levels.Elixir contains 10% ethanol and 30% sorbitol solution, so try to avoid using Elixir. Tablets can be crushed and mixed with water - the tablets are insoluble in water so the resultant mixture should be shaken and the dose measured immediately, discarding any excess. Wherever possible, order oral doses in 15mg increments so that on discharge, half tablets can be crushed & administered.PLEASE NOTE THAT IV PHENOBARBITONE IS NOT TO BE ADMINISTERED THROUGH A FILTER

Supplied as : Phenobarbitone Sodium 200 mg/1 ml.Phenobarbitone 30mg TabletsPhenobarbitone Elixir 15mg/5mL

Dilution : Dilute 1ml solution with 4 mLs N saline giving 40 mg per mL for IV use.



Compatibility: Compatible with 5% and 10 % Dextrose, Normal Saline, aminophylline, calcium gluconate, heparin, sodium bicarbonate.

Incompatibility : Phenytoin, cephalosporins, erythromycin, hydrocortisone, streptomycin, morphine, vancomycin.

Serum Levels : 65 -130 mmol/L10 - 20 mg/L.



Canberra Hospital



Canberra Hospital

Phenylephrine hydrochloride eye drops (2.5%)Revision Date : 18 May, 2023 DTC Approved: August 2015

Indication : Used in conjunction with cyclopentolate to dilate the pupil for:1] ROP examination.2] Intraocular surgery

Dose : 1drop of 2.5% w/v of Phenylephrine hydrochloride in each eye both 30 mins and 15 mins prior to examination

Apply pressure to the lacrimal sac during and for 1-2 minutes after instillation to minimize systemic absorption1,2

Interval : Every 15 mins

Route : Topical (Eyes)

Total Daily Dose : NA

Comments : -Used in conjuction with cyclopentolate-Eye specialist on call will telephone the Unit and give phone instructions for eye drops to be given prior to his arrival in the unit-Effect begins within 5 mins and lasts for 60 mins.-Phenylephrine can be absorbed systemically. Systemic effects are those of sympathomimetic drugs: tachycardia, hypertension, ventricular dysrythmias2

-May decrease pulmonary compliance, tidal volume, and peak air flow in babies with BPD1

Supplied as : Minims® Phenylephrine hydrochloride 2.5% w/v

Dilution : Not required

Stability : For single use only. Discard any unused portion

Storage : Store at 2°C to 8°C. (Refrigerate. Do not freeze.). Do not expose to strong light2



Serum Levels : NA

Compiled: Aug 2015 Revision: Aug 2019

References:1. Neofax online. Accessed 21/10/15



Canberra Hospital2. Minims Phenylephrine Product Information.

https://gp2u.com.au/static/pdf/P/PHENYLEPHRINE_EYE_DROPS_MINIMS-PI.pdf. Accessed online 21/10/15

PhenytoinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Seizures.

Dose : Loading Dose: 20 mg/kgMaintenance dose (start 12 hours after loading dose)Infants < 37/40: 4 mg/kg/day in 2 divided doses (12/24)Infants > 37/40: 4-8 mg/kg/day in 2 or 3 divided doses


Route : Loading dose should be infused over 1 hour. Maintenance doses may be infused over half an hour.Maximum rate of infusion - 0.5 mg/kg/min. IM route is not acceptable as the drug crystallises in muscle. Oral absorption may be quite erratic.

Total Daily Dose : Maintenance dose 4-8 mg/kg/day depending on gestational age.

Comments : Use with caution. Very irritant to veins. Phenytoin has a pH of 12 and if extravasated can cause tissue necrosis. Causes hypotension and bradycardia if given rapidly. Erratic metabolism. Not an ideal anticonvulsant in neonatal period. Phenytoin has a narrow therapeutic index and metabolism is non-linear. Small increases in dose may produce a large increase in plasma concentration. Phenytoin is highly bound to plasma proteins. Therapeutic plasma concentrations are reduced in the first 3 months of life because of reduced protein binding. Phenytoin metabolism changes dramatically in newborns as metabolic pathways mature. Multiple serum concentration measurements are required in newborns.

Supplied as : Phenytoin 50 mg/mL in 2mL ampoules (100mg in 2 mLs)6 mg/mL mixture

Dilution : Phenytoin may be given undiluted or diluted with Normal Saline to a final concentration of 3-10mg/mL. Diluted solution must be used within ONE hour. Take 100mg phenytoin (2mL) and add to 8mL Normal Saline or 200mg phenytoin (4mL) and add to 18mL Normal Saline (makes 10mg/mL). Discard any solution after one hour. The flush given after the dose must run at the same rate as the dose, to avoid the drug being bolused.

Stability : Discard unused portion after one hour.


Compatibility: Compatible with fluconazole, sodium bicarbonate, N Saline


https://gp2u.com.au/static/pdf/P/PHENYLEPHRINE_EYE_DROPS_MINIMS-PI.pdf.%20Accessed%20online%2021/10/15

https://gp2u.com.au/static/pdf/P/PHENYLEPHRINE_EYE_DROPS_MINIMS-PI.pdf.%20Accessed%20online%2021/10/15


Canberra HospitalIncompatibility : Aminophylline, erythromycin, vitamins, Dextrose.

Phenytoin is highly unstable in any iv solution.Serum Levels : 0-3 months: 24-55 micromol/L; > 3/12 40-80 micromol/L. Sample

dose should be taken immediately prior to a dose (trough level). Levels can be checked 24 hours after a loading dose or 5-10 days after a change to the maintenance dose.



Canberra Hospital

Phosphate SupplementRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hypophosphataemia related to phosphate depletion and osteopenia of prematurity.

Dose : Phosphorous: 15-30 mg/kg/dose

Interval : 6 hourly

Route : Oral

Total Daily Dose : Phosphorus: 60-125 mg/kg/day

Comments : Dibasic or monobasic solution of sodium or potassium phosphate is used for enteral supplementation. This can be prepared in pharmacy.(In Nutritional needs of the preterm infant. Ed Tsang 1993)

ATTENTION: Phosphate (Sandoz) tablets contain 500 mg phosphorous/16.1 mmol Phosphate per 500mg tablet. Orders are to be written in mg/kg phosphorous. (0.5-1.0 mmol phosphate = 50-100 mg phosphate = 15-30 mg phosphorous.)

Supplied as : 500 mg phosphorous tablets (containing 16.1 mmol phosphate)

Dilution : Dissolve 1 tablet in 18 ml sterile water – 500 mg Phosphorous (16.1 mmol phosphate) per 20ml = 25 mg/ml phosphorous. Work out dose as per order (ensure mg or mmol dose).

Stability : Refrigerate after making up and discard at the end of the shift

Storage : As per pharmacy

Compatibility:

Incompatibility : Give at separate times to oral calcium to prevent precipitation and malabsorption.

Serum Levels : Monitor serum calcium and phosphate regularly until maximum dosage administered and levels stabilise.



Canberra Hospital

Piperacillin/Tazobacatam

Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Broad spectrum semi synthetic penicillin combined with a beta lactamase inhibitor. For treatment of non-CNS infections including Pseudomonas aeruginosa, E. coli, Enterobacter, Klebsiella, Haemophilus influenzae, Proteus mirabilis, Staph. aureus and group B streptococcus.This is a restricted ORANGE ANTIMICROBIAL and can only be used for the indications outlined in the AMS SOP unless otherwise specified by the Infectious Disease team.

Dose : 50-100mg/kg/dose(Dose expressed as the Piperacillin component)

Interval : Corrected gestational age (weeks)

Postnatal Age(days old)


≤ 29 weeks 0 to 28>28

128

30 to 36 weeks 0 to 14>14

128

37 to 44 weeks 0 to 7>7

128

>45 weeks ALL 8

Route : IV infusion by syringe pump over 30 minutes

Total Daily Dose :Comments : Restricted ‘orange’ antibiotic. Requires ID approval if

prescribed outside the restricted indications.Each gram contains approx 2.79 mmol Na. May cause prolonged bleeding time, hypokalaemia, raised creatinine, raised LFTs, hyperbilirubinaemia. Prolonged use (greater than or equal to 21 days): monitor renal, hepatic, haemopoietic function.

Supplied as : Tazosin 4g/500mg Vials(Piperacillin 4g + Tazobactam 500mg)

Dilution : Reconstitute vial with 16.8mL WFI. Makes 200mg/mL. Further dilute each 1mL (200mg) to 10mL with NS.If fluid restricted can use a smaller dilution volume eg 5mL. Administer over 30 minutes.Usually made up by pharmacy. Advise pharmacy if reduced volume (other than 200mg/10mL) is preferred.

Stability : Discard after use. Syringes made by Pharmacy will have expiry date printed on syringe label

Storage : Vials at room temperaturePrepared syringes in the refrigerator

Compatibility : 0.9% NaCl, 5% Dextrose, Clindamycin, Dopamine, Fluconazole, Frusemide, Heparin, Metronidazole, Morphine, KCl, Ranitidine

Incompatability : Aminoglycosides – separate infusion by 1 hr. Aciclovir, Amphotericin Lipid Complex, Azithromycin, Caspofungan, Dobutamine, Pantoprazole, Vancomycin

Serum Levels Not applicable



Canberra Hospital

Potassium ChlorideRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hypokalaemia – secondary to prolonged diuretic therapy or steroid administration, or as maintenance therapy for infants on parenteral feeds.

Dose : Maintenance requirement is 2mmol/kg/day. Calculate Potassium deficit and daily requirement. Give in divided dosage. Intravenous correction should never be with a solution containing more than 100mmol/l, and not given at a rate more than 0.2 mmol/kg/hr.

Interval : 2 - 12 hourly.

Route : Oral.IV infusion.

Total Daily Dose : As needed.

Comments : Use with care in renal failure. In infants on chronic diuretic therapy, KCl replacement therapy should be used cautiously.

Supplied as : I.V.: Strong Potassium Chloride 7.5 % IV solution 10 mmol/10 ml.Oral: 10% KCl Oral mixture containing 20 mmol KCl in 15 mL, i.e. 1.33 mmol/mL.

Dilution : Oral: Mix with feeds.I.V.: Add to IV fluids or if used as a side-arm infusion, the ratio should be 1 ml of 7.5% KCl to 9 mLs of D10W or normal saline.

Stability : As per pharmacy.


Compatibility: Most drugs and infusions.

Incompatibility : Amphotericin B, Diazepam and Phenytoin.

Serum Levels :



Canberra Hospital

Povidone-Iodine (Betadine)

Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : A topical antiseptic, to prevent infection in minor cuts, wounds and abrasions

Route : Topical

Comments : Povidone-Iodine 10% (Betadine®) is equivalent to 1% available iodine. Povidone-Iodine is an iodophore in which iodine is bound to a carrier molecule, povidone. This complex slowly liberates inorganic iodine when in contact with skin and mucous membranes. Only a small amount of iodine is released at any one time, giving Povidone-Iodine a lower irritant potential and longer duration of action than conventional iodine solutions.Povidone-iodine is a topical microbiocidal antiseptic and is microbiocidal to viruses, bacteria, fungi and spores.Premature infants. Not recommended for use as an antiseptic on premature newborn infants.Full term infants. The use of povidone-iodine containing preparations on full term infants is associated with a small risk of transient hypothyroidism particularly if applied to large areas of the body and/or for extended periods of time (greater than five days). Repeated or large applications of Betadine in full term infants should be coupled with appropriate monitoring of thyroid function

Supplied as : Ointment 10%Cream 5%Liquid 10%w/vLiquid spray 5%w/v

Dilution :

Stability :

Storage : Store below 25°C

Serum Levels :

References eMIMs; 2012http://www.orion.net.au/products/pdf/rio01598_ug.pdf



Canberra Hospital

PrednisoloneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Asthma, croup, chronic lung disease.

Dose : 1 mg/kg/dose

Interval : Every 12-24 hours

Route : Orally

Total Daily Dose : 1-2 mg/kg/day. Use lowest dose possible.

Comments : 1mg prednisolone is equivalent to 4mg hydrocortisone in glucocorticoid activity. Single daily doses are best given in the morning and with feeds. May suppress linear growth. Consider bone mineral density assessment for patients receiving large and long term doses of oral steroids. Immunosuppressant. Steroids may mask signs of infection. Prolonged treatment may cause adrenal suppression and atrophy may occur and secretion of corticotropin may be suppressed. In this situation withdrawal of steroids should be gradual. The lowest possible effective dose should be used to treat the condition. Side effects include electrolyte disturbances, gluconeogenesis, adrenal axis suppression, osteoporosis, increased liability to infection, growth retardation, GI irritation (with ulceration).

Supplied as : Oral mixture 5 mg/ml

Dilution :

Stability :


Compatibility:

Incompatibility :

Serum Levels :



Canberra Hospital

Prevenar 13Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication: Active immunisation against invasive disease, pneumonia, acute otitis media caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F in infants, children 6 wks-5 yrs

Dose: 0.5 mL

Interval: Immunisation schedule: 2, 4 and 6 months of age. A single booster injection should be given in the second year, at least 2 months after the primary series.

Route: IM to anterolateral aspect of the mid thigh for infants under 12 months. For infants over 12 months, the deltoid region of the arm is used. Do not inject into the gluteal area.

Total Daily Dose:

Comments: For further or more detailed information on vaccine schedules, consult The Australian Immunisation Handbook (most recent edition, or the website: http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips

Supplied as: 0.5 mL suspension in single use glass vials or pre-filled syringes.

Dilution: Before use shake well to obtain a homogeneous white suspension.

Stability: Prevenar is for single use in one patient only. When using vials, Prevenar is to be administered immediately after being drawn up into a syringe.

Storage: Store in refrigerator 2 to 80 Celsius

Incompatibility: Do not mix with other vaccines or products in the same syringe.

Serum Levels:



Canberra Hospital

PropofolRevision Date : 30 June 2009 Approved: AK, JD

Indication : Propofol is a short acting intravenous anaesthetic agent dispersed in a soya oil emulsion base.Bolus intravenous induction agent for endotracheal intubation ONLY. Do not use as an infusion. Propofol is contraindicated for sedation in all paediatric patients.

Dose : 2.5mg/kg/dose IVDose may be repeated three times in total

Interval : Stat dose for intubation only, administer over 20 seconds.

Route : IV. Do not administer via an in-line filter.

Total Daily Dose : 7.5 mg/kg

Comments : Onset of action is approximately 30 seconds. Duration of action: 3-10minutes. Metabolised mainly in the liver to form inactive sulphate and glucuronide conjugates that are excreted in the urine. 95% bound to plasma proteins. Sleep is expected in <1 minute. Treatment has failed if sleep (defined as loss of eyelash reflex) is not achieved in three minutes and the infant must be intubated with morphine, atropine and suxamethonium.Contraindications: Impaired cerebral circulation; Raised intracranial pressure; Known allergy to egg, lecithin, glycerol, soya oil, sodium hydroxide and disodium edetate. Potential Adverse Effects; CARDIOVASCULAR: Hypotension, myocardial depression, bradycardia; RESPIRATORY: Respiratory depression and acidosis. Apnoea, pulmonary oedema, anaphylaxis; SKIN: Rash, pruritis, pain on injection

Supplied as : 10mg/mL 20mL vial

Dilution : Not requiredStability : Do NOT use if the emulsion is separated or discoloured.

Discard unused contents immediately.Storage : Store below 25C. Do NOT freeze. Protect from light

Compatability: 5% Glucose

Incompatibility : Adrenaline, aminophylline, amphotericin, ampicillin, atropine, benzylpenicillin, calcium chloride, cefepime, ceftazidime, ciprofloxacin, clindamycin, dexamethasone, digoxin, dobutamine, dopamine, fentanyl, fluconazole, frusemide, gentamicin, heparin, hydralazine, hydrocortisone, imipenem-cilastatin, lignocaine, metoclopramide, midazolam, morphine, naloxone, noradrenaline, pancuronium, phenobarbitone, phenytoin, potassium chloride, ranitidine, sodium bicarbonate, sodium nitroprusside, suxamethonium, ticarcillin-clavulanate, vancomycin




Canberra Hospital

PropanololRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1. Hypertension particularly associated with thyroid crises. Consider use of other antihypertensives according to aetiology of hypertension.

2. Infantile haemangiomaDose : 1. Oral: 0.25 - 0.5 mg/kg. Maximum of 3.5 mg/kg/dose

2. Initial dose: 2 mg/kg/day in 3 divided doses, but may commence at 0.3-1 mg/kg/day to assess tolerability, increasing to 2 mg/kg/day over several days.Maintenance dose: 2-3 mg/kg/day in 3 divided doses. Taper over 2-4 weeks

Interval : 1. 6 - 8 hourly.2. 8 hourly

Route : Orally

Total Daily Dose : 1. Oral: 12 mg/kg/day2. Oral: 3 mg/kg/day

Comments : Bradycardia may be considerable. Atropine will reverse associated severe bradycardia. Start at smaller dose and increase over 3-4 days to maximum. May take 7-30 days to reach maximum effect.Measure systemic blood pressure frequently. Assess for increased airways resistance. Give consistently in relation to feeds to avoid fluctuations in absorption. Regular feeds (3-4 hourly) may be required to avoid hypoglycaemia, particularly during initiation and after dose changes.

Supplied as : Oral Solution 2mg/mL. If oral dose is needed after hours, disperse tablet in Water for Injection to give 2mg/mL solution, eg 10mg tablet in 5mL. Discard unused portion

Dilution :

Stability : Expiry date printed on product label.


Compatibility:

Incompatibility :



Canberra HospitalSerum Levels :



Canberra Hospital

Prostaglandin E1(Alprostadil) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Ductal dependent congenital heart disease.

Dose : Graded infusion. Start at 10 nanog/kg/min increasing to 100 ng/kg/min. Usual maintenance dose is 10-20 nanog/kg/min.


Route : I.V.

Total Daily Dose :

Comments : Causes apnoea and bradycardia. Where the infant is not ventilated there must be a ventilator available and ready to use. Also cuases pyrexia, hypotonia, skin flushing, seizures, oedema, sepsis and DIC.If undiluted Alprostadil solution comes in direct contact with a plastic container (eg a syringe barrel) the solution may turn hazy. If this occurs the solution should be discarded. Consequently, the infusion solution should be added to the chamber first.

Supplied as : Prostin 500 microg/ml.

Dilution : Put 20mL of fluid (NS or 5DW) into a syringe. To this syringe, add 0.06mL x weight per kg of Alprostadil solution and then make up to a total volume of 25mL using the NS or 5DW. Using this resulting concentration:0.5mL/hour = 10nanogram/kg/min.

Stability : Discard unused portion. Prepare solution every 24 hours.

Storage : Refrigerated

Compatibility: Caffeine, pantoprazole, and sodium nitroprusside.

Incompatibility : No data available.Incompatible with levofloxacin – never heard of it, must be a quinolones they use in the US

Serum Levels :



Canberra Hospital

Prostacyclin PGI2(Epoprostenol) Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Vasodilator used for persistent pulmonary hypertension. Anticoagulant.

Dose : 0.002 microg (2nanog) – 0.012 microg (12nanog)/kg/min titrated to response.

Interval : Infusion.

Route : I.V.

Total Daily Dose :Comments : The high pH of the solution will cause tissue damage if extravasation

occurs – the use of a central line is preferred. Concurrent use of inotropes is recommended. Facial flushing and or sweating may occur. Continuous monitoring of BP and HR – report hypotension, tachycardia or bradycardia immediately. Elevated blood sugar levels have been reported. Observe for bleeding. Test gastric pH and report if < 3 – a histamine antagonist may be required. Measure urine output and perform urinalysis 4-6 hourly. 1000 nanograms = 1 microg

Supplied as : Flolan. Pack contains one 500 microg freeze-dried Epoprostenol vial, two 50 ml sterile glycine buffer solution vials and a filter unit.

Dilution : Only the sterile diluent provided may be used to reconstitute and dilute the Epoprostenol.Reconstitution: Withdraw 10mL of the sterile buffer solution and inject it into the Flolan vial. Shake gently until dissolved, then withdraw the entire contents of this 10mL vial and re-inject it back into the remaining 40mL solution of the first vial. This vial now contains 500microg/50mL (=10microg/mL).Dilution: The concentrated solution above can be further diluted, using the other vial of sterile buffer solution. The most dilute solution able to be used is 2microg/mL (=2000nanogram/mL). This solution can be prepared by diluting 10mL of the concentrated Flolan solution and making it up to a total volume of 50mL with the other sterile buffer solution. Use the filter provided to draw these two solutions into the 50mL syringe.

Stability : Vial for single use only. Discard remainder after reconstitution. Reconstituted and diluted solution only stable for 12 hours at room temperature in refrigerator. Note that potency may be reduced with time, so may need to titrate dose towards end of 12 hours, and freshly made solutions may have higher potency. Approximately 90% of potency retained after 12 hours at room temperature in manufacturers diluent.

Storage : Store vials at room temperature, protect from light.

Compatibility: No fluids are considered compatible, including normal saline

Incompatibility : This drug should not be mixed with other drugs and is administered through a dedicated line. The line should not be flushed or stopped and the solution must be changed every 12 hours.




PyridoxineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Seizures, suspected pyridoxine deficiency or dependency.Vitamin B6. This is an SAS drug. The Consultant Neonatologist must complete an SAS form and return this to pharmacy.

Dose : Diagnostic : 100mgMaintenance 10-15mg/kg/dose

Interval : Daily

Route : I.V. or I.M.Oral

Total Daily Dose : 10-100 mg

Comments : Differentiate between dependency and deficiency. Infuse slowly over 1-2 minutes. Perform this therapeutic test under continuous EEG monitoring.

Supplied as : Ampoules 50mg/mlTablets 25 mg and 100 mg.

Dilution : Nil

Stability :


Compatibility: 5%D, NS

Incompatibility : Alkaline solutions.

Serum Levels :



Canberra Hospital

RanitidineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Treatment of oesophagitis, gastric or duodenal ulceration in babies during intensive care in which stress ulceration may occur. Use when tolazoline therapy is established.

Dose : I.V. dose: 0.5 - 0.7 mg/kg/dose.Infusion: 0.05-0.25 mg/Kg/hrOral dose: 2-4mg/kg/dose

Interval : I.V.: < 1500 gm 8 hourly, > 1500 gm 6 hourly.Oral : 8 –12 hourly

Route : I.V. or Oral

Total Daily Dose : I.V. 3mg/kgOral 12 mg/kg

Comments : H2 receptor antagonist with 5 - 12 times the potency of cimetidine. Renal excretion predominates and levels should be monitored in renal impairment. No side effects have been reported apart from one case report of thrombocytopenia.

Supplied as : Ranitidine hydrochloride 50 mg in 5 ml ampoules.

Dilution : Take 1 ml of 50 mg/5 ml ampoule and dilute in 9 mls of NS (= 1mg/ml solution) and administer over 20 minutes



Compatibility: Compatible with Aciclovir, aminophylline, dexamethasone, dobutamine, dopamine, gentamicin, Dextrose solutions, Normal Saline, TPN, morphine, vancomycin.

Incompatibility : Diazepam, phenytoin, phenobarbital.

Serum Levels :



Canberra Hospital

Recombinant Factor VIIaRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Ongoing microvascular bleeding and coagulopathy from any cause refractory to other corrective measures. To be ordered by a Consultant Neonatologist only and requires permission from the On-Call Haematologist. Supplies should come from transfusion service.

Dose : 90 micrograms/kg.

Interval : Usually a single dose, but may be repeated 2 hourly if bleeding persists.

Route : I.V. bolus injection over 2-5 minutes.

Total Daily Dose :

Comments : Complications to rFVIIa are rare. Thrombosis is uncommon. Hypersensitvity may occur, rash, fever, nausea and increased LFT’s have been reported.

Supplied as : Novoseven or Eptacog alfa 1.2 mg vial

Dilution : Reconstitute 1.2 mg vial with 2.2 ml of WFI to a final concentration of 0.6 mg/ml. Swirl gently. The remainder of the solution may be used within 3 hours if repeat doses are required.

Stability : 3 hours after reconstitution

Storage : Store in refrigerator. Protect from light. Do not use after expiry date.

Incompatibility : Do not mix with infusion solutions.

Serum Levels :



Canberra Hospital

Resonium ARevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Treatment of hyperkalaemia.

Dose : 0.25 - 1 gram/kg per dose, adjusted according to serum electrolyte results.

Interval : Oral: 6 hourly.Rectal : 6 hourly

Route : OralRectal

Total Daily Dose :

Comments : Fine powder of sodium polystyrene sulphonate a cation exchange resin. Used to treat hyperkalaemia in renal failure. Ensure evacuation by colonic irrigation after 8 –12 hours, if possible. May take hours to days to have an effect. Can cause constipation. In children, 1 gram will exchange 1 mEq K+. May cause magnesium and calcium loss.

Supplied as : Fine powder.Sodium Polystyrene sulphonate

Dilution : Pre-weighed aliquots supplied by pharmacy. Mix with water, D5W or D10W.If necessary, the resin can also be prepared on the ward immediately prior to use by mixing with enough liquid to make it liquid enough to pass down the nasogastric tube, or of a suitable paste consistency for rectal administration using a feeding tube. This may be anything from 2-5 ml/kg.


Storage : Room temperature. Do not refrigerate.



Serum Levels : Check electrolytes regularly.



Canberra Hospital

RifampicinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Oral treatment of MRSA in conjunction with fusidic acid, vancomycin. Also used in treatment of tuberculosis and for prophylaxis against N. meningitidis and Haemophilus infections, amongst contacts.This is a restricted ORANGE ANTIMICROBIAL and can only be used for the indications outlined in the AMS SOP unless otherwise specified by the Infectious Disease team.

Dose : 1) Treatment: 10 mg/kg.2) Prophylaxis N. meningiditis: 5 mg/kg/dose3) Prophylaxis HIB: 10 mg/kg/dose

Interval : 1) Once daily2) 12 hourly for 2 days3) Once daily for 4 days

Route : Oral on an empty stomachIV infusion.

Total Daily Dose : 10 mg/kg.

Comments : Drug is 35% protein bound. 35% appears in urine after 4 hours. Penetrates CSF well. Can cause gastrointestinal upset and intolerance, jaundice, and a transient rise in liver AST and ALP. Commonly colours urine and other body fluids a reddish tinge. Increases the metabolism of various drugs like chloramphenicol, diazepam, digoxin, fluconazole and phenytoin. Monitor tramsaminases and bilirubin.

Supplied as : Syrup 100 mg/5 ml.Vials 600 mg powder for reconstitution.

Dilution : Reconstitute with 10 ml of sterile water to make a strength of 60 mg/ml. A 3 mg/ml solution is prepared by adding 0.5 ml of reconstituted solution to 9.5 ml of 5% Dextrose or saline. The required amount is infused over 60 minutes.

Stability : Vials for single use only. Discard any unused portion.

Storage : Both IV vial and syrup keep at room temperature.

Compatibility: 5% D, NS.

Incompatibility : No data available.

Serum Levels : Toxicity is uncommon but serious hepatotoxicity may occur. Measurement of levels advised. Required levels 0.3 - 0.6 microg/ml.



Canberra Hospital

Rotavirus VaccineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : For the prevention of rotavirus gastroenteritis

Dose : 1.5 mL

Interval : Two doses at least 4 weeks apart. The first dose is given between 6 and 14 weeks of age, and the second dose must be given by 24 weeks of age.

Route : Oral. Under no circumstances should the vaccine be given by injection. The child should be in a reclining position. Administer orally (i.e. into the child's mouth towards the inner cheek) the entire contents of the oral applicator.

Total Daily Dose : Not applicable

Comments : Rotarix is live attenuated human rotavirus RIX4414 strain. Excretion of the vaccine virus in the stools occurs after vaccination with a peak excretion at 7 days. There is a theoretical risk of transmission to non-vaccinated contacts, therefore. Rotarix is only administered to NICU patients (of the appropriate age) at the time of discharge.Rotarix should not be administered to any patient with a history of chronic GI disease, a febrile illness, or in the presence of vomiting or diarrhoea.The first dose of Rotarix must not be administered to patients older than 14 weeks and the second dose must not be administered to patients older than 24 weeks, as there is no safety data in this age group, particularly in relation to intussusception.

Supplied as : Rotarix brand of rotavirus vaccine is supplied as a clear liquid in an oral applicator.

Dilution : The vaccine is ready to use (no reconstitution or dilution is required).

Stability : See manufacturer’s expiry date.

Storage : Rotarix should be stored between 2 and 8 degrees C.Protect from light.

Incompatibility : There are no restrictions on consumption of food or breast milk either before or after the vaccine is given.

Serum Levels : Not applicable



Canberra Hospital

Salbutamol - for I.V. AdministrationRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Respiratory failure and bronchospasm in bronchopulmonary dysplasia.Hyperkalaemia.

Dose : Loading dose 2-4 microg/kg over 10 minutes followed by an infusion at 0.1-1 microg/kg/minute (6-60 microg/kg/hour). Infusion rate may be increased until a tachycardia is noted and then reduced slightly to below this threshold rate. Utmost care is required in administration of this drug under these circumstances.An infusion of 4 microg/kg over 5 minutes can cause a drop in serum potassium by as much as 1.5 mmol/l.

Interval : 1] iv2] Continuous infusion.

Route : Intravenous only.

Comments : When used in chronic BPD sudden improvement in PaCO2 by improved ventilation may shift potassium intracellularly and create a sudden hypokalaemia. This is particularly notable in cases where prolonged diuretic use has also caused chronic low plasma chloride levels. Check chloride levels before administration of IV salbutamol and be prepared to add KCl supplements to maintain normal potassium levels.

Supplied as : Ventolin injection 500 microg/ml.

Dilution : Dilute with NS or D5W for infusion. Take ‘X’ x 0.6 ml of ventolin injection and make upto 25 ml with Normal Saline or 5% Dextrose, where ‘X’ is the baby’s weight in kg. Therefore, 0.5 ml/hour = 0.1 microg/kg/min.

Stability : Reload infusion after 24 hours.


Compatibility : No data.

Incompatibility : Usual conditions apply.

Serum Levels :



Canberra Hospital

Salbutamol (Nebulised)Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Chronic lung disease with reversible airways component.

Dose : 0.15 mg/kg to 0.25 mg/kg.


Route : Nebuliser.

Total Daily Dose :

Comments : Nebulisation into ventilator circuit is inefficient. Usually requires hand ventilation during administration. Excess dosage will cause tachycardia and tremor - half dose if this occurs.

Supplied as : Nebules 2.5 mg in 0.5 ml.

Dilution : Dilute to 2 ml with NS.

Stability : Discard unused diluted solution.







Canberra Hospital

Sandoglobulin (Normal Human Immunoglobulin)Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1] Immunoglobulin deficient states.2] Severe neutropenia.3] Septic shock.

Dose : 300 - 400 mg/kg.

Interval : Daily for three days.

Route : I.V.

Total Daily Dose : 300 - 400 mg/kg.

Comments : Prophylactic treatment with immunoglobulin to ELBW infants was thought to (but to date not proven) reduce the incidence of sepsis and NEC. When used, well tolerated by newborn. Specific reactions between antibodies and antigens not noticed.

Supplied as : Sandoglobulin 1 G, 3 G, or 6 G vials. Should only use 1 G vials as this is a very expensive product.

Dilution : Dilute 1 g vial with 20 ml of Normal Saline to give a solution containing 50 mg/ml. Infuse at a rate of 0.5 ml/kg/hour and double the rate twice at hourly intervals, if no systemic reactions are observed. Maximum rate of infusion being 2 ml/kg/hour. Do not shake the bottle or create any froth. Gentle rotation may be necessary. Re-constitution may take up to 20 minutes. Warm to body temperature before administration.

Stability : The solution will be stable and reusable within 24 hours.

Storage : Powder at room temperature. Re-constituted solution refrigerated.

Compatibility : No data.

Incompatibility : Do not use if turbid. Administer though an in-line filter.

Serum Levels :



Canberra Hospital

SildenafilRevision Date : 16/11/2015 DTC Approved: 2/12/15

Indication : Persistent pulmonary hypertension of the newborn1, or pulmonary hypertension secondary to BPD or other cause2.

Dose : Commence at 0.5-1 mg/kg per dose, increasing to a maximum of 2 mg/kg dose every 36 to 48 hours as long as blood pressure stable2, 3

Interval : 6 hourly

Route : Oral

Total Daily Dose : Maximum dose 2 mg/kg/dose every 6 hours2, 3, 4

Comments : Inhibitor of cGMP-specific phosphodiesterase-5. Contraindicated in hypotension, if patients is receiving nitrates and in hereditary degenerative retinal impairment. Administer only in situations where left ventricular performance can be monitored (i.e. via ECG). Reduce dose in renal and hepatic impairment. Withdraw treatment gradually. Monitor blood pressure. Do regular eye testing whilst on treatment. Use with caution in presence of other cardiovascular disease, bleeding disorders, active peptic ulceration, ocular disorders. Initiate cautiously if baby is on nitric oxide. Side effects: dyspepsia, flushing, headache, dizziness, penile erection, visual disturbances, raised IOP, nasal congestion. Rarely causes vomiting, priapism, painful red eyes, rash.5

Supplied as : 25 mg and 50 mg film coated tablets. Pharmacy during business hours will make a 2 mg/mL sildenafil suspension.

Dilution : Tablets are film coated. Peel film off the tablet then crush and dissolve in water. Discard any unused dose.

Stability : Store at room temperature until the expiry date indicated on packaging.

Storage : Tablets and suspension to be kept at room temperature.

Incompatibility :

Serum Levels :

Compiled: November 2015 Review: November 2019



Canberra Hospital

References:1. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates.

Cochrane Database Syst Rev. 2011 Aug 10;(8):CD005494. doi: 10.1002/14651858.CD005494.pub3. Review

2. Yaseen H, Darwich M, Hamdy H. Is Sildenafil an Effective Therapy in the Management of Persistent Pulmonary Hypertension? J Clin Neonatol. 2012 Oct-Dec; 1(4): 171–175.

3. Wardle AJ, Wardle R, Luyt K, Tulloh R. The utility of sildenafil in pulmonary hypertension: a focus on bronchopulmonary dysplasia. Arch Dis Child. 2013 Aug;98(8):613-7. doi: 10.1136/archdischild-2012-303333. Epub 2013 Apr 26. Review.

4. Joint Formulary Committee. 2010-2011 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2010. British National Formulary

5. Neofax online, accessed 21/10/15



Canberra Hospital



Canberra Hospital

Sodium BicarbonateRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : 1] Resuscitation.2] Metabolic acidosis.

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

Sodium - Increasing Sodium Content of IV Bags Revision Date : 29 October, 2010 Approved : AK, ZK

Starting Concentration

Finished Concentration

Volume to be Removed From 500 mL Bag

Volume of 20% NaCl to be added to 500 mL bag

0% N/4 = 0.225% 5.6 mL 5.6 mL

0% N/2 = 0.45% 11.25 mL 11.25 mL

For example: Add 5.6 mL of 20% NaCl to a 500 mL bag of 10% Dextrose to make N/4 10% Dextrose

168


Canberra HospitalDose : 1] 1 - 3 mmol/kg

2] Body Deficit: 0.3x weight in kg. x base deficit.Generally, half correction is given, followed by another quarter correction, if indicated on the basis of blood gas analysis.

Interval : Stat

Route : Slow I.V.

Total Daily Dose :

Comments : Dilute before administration using WFI or D10W. Give over 30 minutes if correcting metabolic acidosis. May be sometimes given with FFP where additional volume loading is required. Monitor local infusion site for complications [hyperosmotic solution] - always dilute 1:1 with water for injectionMonitor arterial blood gases as ordered by medical officerInfuse carefully - as rapid administration has been linked with IVH and local tissue necrosis;

Supplied as : Ampoules 10 ml 8.4 % NaHCO3. 1 ml = 1 mmol NaHCO3

Dilution : Dilute to 4.2 % by adding 5ml 8.4% Bicarbonate to 5ml WFI or D10W (1ml of dilute solution =0.5mmol NaHCO3).

Stability : Discard unused portion after opening.


Compatibility : Compatible with aminophylline, amphotericin B, atropine, heparin, morphine, fentanyl, cimetidine.

Incompatibility : Do not infuse with any calcium containing solution, adrenaline, dopamine, dobutamine.

Serum Levels : On Blood gas analysis.



Canberra Hospital

Sodium Chloride 20% (NaCl)

Revision Date : 3 July 2014 Approved: TC, LZ, JD

Indication : Correction of hyponatraemia

Dose : 1] Oral/Nasogastric:Starting dose depends on degree of hyponatraemia. Usual dose 2-4mmol/kg/day. Higher doses (up to 6mmol/kg/day) may be required for severe depletion. Adjust the dose according to clinical requirements. Higher doses may be required in premature infants due to significant renal losses of electrolytes.Prescribe medication name as 20% NaClPrescribe dose in terms of mLPrescribe dose calculation in terms of mmol/kg/day2] IV:Required dose of sodium in mmol= weight (kg) x 0.6 x {x – serum sodium (mmol/L)}Where x is the desired serum sodium concentrationMaximum recommended correction in 24 hours is 12mmol/L

Interval : 1] 2 - 12 hourly2] continuous infusion

Route : 1] Oral/nasogastric2] Intravenous infusion

Total Daily Dose : As directed by level of hyponatraemiaIV: Correct sodium level slowly, not raising serum level by more than 0.5mmol/L per hour. Maximum recommended correction in 24 hours is 12mmol/L



Canberra HospitalComments : Never administer undiluted hypertonic 20% sodium chloride

intravenously. 20% NaCl must be diluted prior to use. Give via central line if available.

Regularly review and adjust dose. Chronic administration without dose adjustment to account for changing renal handling of sodium is likely to lead to adrenal imbalance and hypertension.

Review any concurrent diuretic therapy as sodium replacement while on sodium losing diuretics is counter-productive.

Osmolality information:Isotonic solution = 300mOsmol/LMax via peripheral line = 900mOsmol/LPeripheral lines aim for 14.4 – 43.2mOsmol in 48mL i.e. 300-900mOsmol/L, but this may be adjusted at consultant discretion1mmol of NaCl provides 2mOsmol1mL of 5% Dextrose (5%D) provides 0.278mOsmol1mL of 10% Dextrose provides 0.556mOsmole.g. 2.5kg baby, peripheral line, desired serum Na 135, actual serum Na 120: Dose of Na (mmol) = 2.5 x 0.6 x 12 = 18mmol (÷3.4mL) = 5.3mL of 20% NaCl48mL syringe will contain 36mOsmol (NaCl) plus 42.7mL diluentUsing WFI: 36+0 = 36mOsmol/48mL (WFI preferred)Using 5%D: 36+(42.7 x 0.278) = 48mOsmol/48mLe.g. 1kg baby, desired serum Na 135, actual serum Na 128, peripheral line: Dose of Na (mmol) = 1 x 0.6 x 7 = 4.2mmol (÷3.4mL) = 1.24mL of 20% NaCl48mL syringe contain 8.4mOsmol (NaCl) plus 46.76mL diluentUsing WFI: 8.4+0 = 8.4mOsmol/48mL (5%D preferred)Using 5%D: 8.4+(46.76 x 0.278) = 21.4mOsmol/48mL

Supplied as : 1] Pharmacy prepare a 20% NaCl solution(1mL = 3.4mmol) every Friday2] Ampoule: 20% Sodium Chloride (2g in 10 mL)1 mL = 3.4 mmol NaCl

Dilution : 1] Oral: Into feed2] Intravenous: Consider total osmolality of solutionCentral line: Draw up (the required mmol dose of sodium divided by 3.4)mL of 20% sodium chloride and transfer to a 25mL syringe. Further dilute to 24 mL with or WFI, 5% or 10% dextrose. Run the solution at 1 mL/hr. Solution may be more concentrated in fluid restricted ELBW infants with central accessPeripheral IV: Calculate the osmolality of solution before making syringe. Aim for 14.4 -43.2Osmol in 48mL i.e. 300-900mOsmol/LDraw up (the required mmol dose of sodium divided by 3.4)mL of 20% sodium chloride and transfer to a 50mL syringe. Further dilute to 48 mL with WFI or 5% Dextrose. Run the solution at 2 ml/hr

Stability : 1. Discard according to expiration date on label2.Discard according to expiration date on ampoule

Storage : 1. Refrigerate2. Store at room at room temperatureDiscard any unused portion of ampoule

Compatibility : Water for injection, 5% dextrose, 10% dextrose




Canberra HospitalSerum Levels : Dictated by serum sodium levels



Canberra Hospital

SotalolRevision Date : 28 May 2012 Approved: AK, JD

Indication : Sotalol is a beta blocker used for prevention and treatment of supraventricular and ventricular arrhythmias

Dose : IV: 0.5-1.5 mg/kg/doseOral: 2-5mg/kg/day in 2 divided doses – increasing to maximum of 12 mg/kg/day. Doses above 5mg/kg/day are best given in three divided doses.

Interval : IV: 6/24Oral: 12/24 for doses up to 5mg/kg/day, and 8/24 for doses between 5-12mg/kg/day.

Route : IV.

Total Daily Dose : IV maximum daily dose: 6mg/kg/dayOral maximum daily dose: 12mg/kg/day

Comments : Continuous ECG monitoring during acute phase of treatment of SVT. Can have proarrhythmic effects (in 10% of patients), sinoatrial block, A-V block, torsades de pointes, ventricular ectopic activity, prolonged QT interval. Dose may need adjustment with reduced renal function. May mask hypoglycaemia, hyperthyroidism. Do not give with other medications that may prolong QT interval, e.g. erythromycin, fluconazole, chloral hydrate.Oral doses: administer 30 minutes prior to feed to improve absorption.

Supplied as : 40 mg/4 ml vialPharmacy will prepare a 5mg/mL suspension during normal hours. For oral doses after hours, crush an 80mg tablet and make up to 16mL with Water for Injection to make 5mg/mL. Discard unused portion.

Dilution : IV: Dilute 1mL from vial with 9 mL of Normal Saline (to make a 1mg/mL solution). Administer prescribed dose over 10 minutes.

Stability : Vials – room temperatureSuspension – room temperature

Storage :

Compatibility: 0.9% NaCl, 5% Dextrose

Incompatibility :




Canberra Hospital

SpironolactoneRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Diuretic therapy. Used in treatment of cardiac failure and chronic lung disease.

Dose : 1 mg/kg.


Route : Oral.

Total Daily Dose : 2 mg/kg/day.

Comments : Potassium sparing diuretic, usually used in combination with frusemide or chlorthiazide. In infants with CLD on diuretic therapy, potassium loss best treated with KCl replacement rather than spironolactone, which causes significant hypochloraemia.Shake suspension well before use.

Supplied as : During pharmacy working hours a suspension can be prepared. After hours, spironolactone 25mg tablets are kept as ward stock.

Dilution : Not required for suspension.Disperse one 25mg tablet in 10mL water for injection to make a 2.5mg/mL solution. Discard any unused solution immediately after use.

Stability : Suspension: 30 daysTablets: see manufacturers expiry date on label.

Storage : Suspension: keep in refrigerator.Tablets: room temperature.

Incompatibility : Nil.

Serum Levels : Monitor serum K+, Cl-



Canberra Hospital

StreptokinaseRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Arterial thrombosis after arterial catheterisation or complications of polycythemia.

Dose : Loading dose: 1000 u/kg.Maintenance: 1000 u/kg/hr.


Route : I.V.

Total Daily Dose : Not exceeding 25,000 u/kg.

Comments : Recognised therapy as an alternative to thrombectomy. Main complication is haemorrhage from administration site. Use only when fibrinogen concentration is > 1.5 g/l. Check level every 2 hours and discontinue if fibrinogen concentration falls below 1.0 g/l. Restart as level rises again. Increase infusion rate by 500 u/kg/hour at four hourly intervals. Discontinue as level of fibrinogen remains low and follow with heparin infusion 25 u/kg/hour for 48 hours.

Supplied as : Streptase 250,000 units/ampoule.

Dilution : Dilute in 20 ml NS and then further dilute with haemaccel to a solution suitable for 6 hours infusion.

Stability : 6 hours after reconstitution.


Incompatibility : Usual precautions apply.

Serum Levels : Measure fibrinogen levels for effective management. For severe overdose use EACA.



Canberra Hospital

SucroseRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication: Oral sucrose can be administered to infants under 3 months of age who are undergoing painful procedures, who are exhibiting signs of discomfort that does not respond to breastfeeding or other nursing interventions and for whom parental verbal consent is obtained.

Dose: 0.25 mL

Interval: First dose is given 2 minutes prior to the procedure, then the same dose can be administered, if required, every 2 minutes up to a total of 1 mL. This 1 mL dose can be given no more than 3 times in a 24-hour period.

Route: Orally, either onto the anterior portion of the tongue, or administered on a dummy.

Total Daily Dose: 3 mL

Comments: Sucrose should not be administered to infants with known fructose or sucrose intolerance. It is ineffective if given via a nasogastric tube. Sucrose is ineffective when given to infants of mothers who were methadone dependent whilst pregnant. Painful procedures include: venipuncture, heel lancing, eye checks, IM injections, nasogastric or orogastric tube insertion, arterial puncture, percutaneous catheter insertion, lumbar puncture (in addition to local anaesthetic), catheter insertion/bladder tap, dressing changes, post-op (in addition to prescribed paracetamol). This is a nurse-initiated medication and requires a prescription to be signed by a medical officer within 24 hours of administration.

Supplied as : 25% sucrose

Dilution : Nil

Stability : According to expiry date on the bottle


Incompatibility : Nil




Canberra Hospital

Survanta: BeractantRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Respiratory distress due to definite surfactant deficiency and hyaline membrane disease. Surfactant deficiency also occurs in pulmonary hypoplasia and congenital diaphragmatic hernia.

Dose : Survanta: 100 mg/kg/dose (4 ml/kg) maximum cumulative dose of 400 mg/kg

Interval : Survanta: 6 hourly.

Route : Endotracheal tube.

Comments : Infants less than 28 weeks gestation are usually given prophylactic surfactant at the time of birth, preferably before the institution of the first mechanical breath. Infants > 28 weeks gestation are administered surfactant if they require IMV or are on CPAP and 40-50% oxygen with the diagnosis of HMD on CXR.Given with a size 5 infant feeding tube directly down the ETT or via the suction port of the Trach-care device.

Supplied as : Survanta (Beractant): 200 mg/8 ml.

Dilution : Survanta: Nil required.Should be given by experienced person (Neonatologist) or under supervision of Neonatologist. Ventilator settings may need adjustment during administration. Beware of blockage of ETT. If possible avoid suctioning for 2 hours post dose administration.

Stability : Single vial may be used for the same patient within 24 hours. Do not warm whole vial. Draw up dose in syringe and warm, refrigerate remaining preparation for next dose.

Storage : Survanta: Refrigerated.

Incompatibility : Do not mix with anything.



Canberra Hospital

Suxamethonium Chloride (Scoline)Revision Date : 27 March 2014 Approved: TC, LZ, JD

Indication : Rapid onset, short acting muscle relaxation for intubation

Dose : 2 mg/kg. Give Atropine first

Interval : Stat, May repeat if necessary

Route : I.V.Can be given I.M. if necessary (use 2.5 mg/kg)

Total Daily Dose :

Comments : Short acting competitive inhibitor of cholinergic receptors. Complete muscle relaxation within 30 - 60 seconds, persisting for 2 - 3 minutes, gradual spontaneous recovery within 10 minutes. Approximately 10% of drug is excreted unchanged in the urineMay cause profound bradycardia or asystole. Pretreat with Atropine 10 microg/kg first. Duration of action is prolonged in patients with low plasma pseudocholinesterase concentration. Contraindicated if family history of malignant hyperthermia, pseudocholinesterase deficiency, or myopathies.

Supplied as : Ampules 100 mg/2 mL

Dilution : Add 2mL of solution (100mg/2mL ampoule) to 3mL of D5W or N SalineMakes 100mg/5mL = 2 mg/0.1mLDose = 2mg/kg = 0.1 mL/kg

Stability : Discard unused portion

Storage : Refrigerate 2 - 8oC. Do not freeze

Incompatibility : Do not mix with any other drugs

Serum Levels : Not Applicable



Canberra Hospital

Teicoplanin Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : A glycopeptide antibiotic effective against MRSA. Restricted to patients in whom vancomycin is contraindicated.

Dose : Loading dose: 16 mg/kgMaintenance dose: 8 mg/kg

Interval : Once dailyBegin maintenance dose 24 hours after loading dose

Route : IV infusion over 60 minutes

Total Daily Dose : Maintenance 8 mg/kg

Comments : Use with caution when patient is receiving concurrent nephrotoxic drugs, due to potential for increased nephrotoxicity and ototoxicity. Perform haematological, renal and liver studies in patients on prolonged courses. Dose may need adjustment in renal failure.

Supplied as : Vial containing 400 mg (400,000 IU) Teicoplanin for reconstitution.

Dilution : Add 10 ml WFI slowly down the side wall of the vial of Teicoplanin. Gently roll the vial between the palms until dissolved. DO NOT SHAKE. If the solution foams, allow to stand for 15 minutes for the foam to subside. Withdraw gently 0.5 ml of solution and make up to 10 ml total volume with NS (2mg/ml).

Stability : Vial for single use only. Discard any remaining portion.

Storage : Store powder vial at room temperature.

Compatibility: NS, 5%D, 4%Dextrose and N/5 saline.

Incompatibility : No information available.




Canberra Hospital

TheophyllineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Recurrent apnoea and poor respiratory drive; weaning from ventilation.

Dose : Loading dose: 4 mg/kg.Maintenance: < 2 weeks: 2.0 mg/kg/dose. >2 weeks: 4.0 mg/kg/dose.

Interval : Loading dose followed by maintenance dose 12 hours afterwards. Dosage interval may be altered according to maturity. Generally interval is 12 hourly.

Route : Oral.

Total Daily Dose : According to plasma levels and maturity.

Comments : Not usually given more frequently than 8 hourly. May cause gastro-intestinal bleeding, hypotension, vomiting, tachycardia, diuresis, tachypnoea, and convulsions. Omit dose if HR > 180 bpm. Levels will increase with concurrent administration of erythromycin. 80 mg theophylline = 100mg aminophylline!

Supplied as : 100 ml bottle, 133.3 mg/25 ml = 5.3mg/ml.

Dilution : Not required.

Stability : Until expiry date.


Incompatibility : Not applicable.

Serum Levels : Greatest effect at levels > 70 micromol/ml (12.7 microg/ml). Need level > 40 micromol/ml (7 microg/ml) for any effect and the risk of toxicity occurs at levels > 90 micromol/ml (51 microg/ml).



Canberra Hospital

ThyroxineRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Hypothyroidism

Dose : 10-15 microg/kg/dose

Interval : daily

Route : orally

Total Daily Dose : Adjust according to TFT levels

Comments : Round doses off to nearest 12.5 microg (1/4 x 50 microg tablet). Some babies may need to give alternating daily dose. For example of a baby requires 20 microg/kg/day = 140 microg/week, give Mon/Wed/Fri 12.5 microg and the other 4 days give 25 microg = 137.5 microg/week. If a baby needs 30 microg/day = 210 microg/week give 37.5 microg (3/4 tablet) Mon/Wed/Fri and 25 microg (1/2 tablet) the other 4 days = 212.5 microg/week.Long plasma half-life 6-7 days in euthyroid, 9-10 days in hypothyroid, and 3-4 days in hyperthyroid states. Slow onset of action, peak effect occurs 3-4 weeks after initiating therapy. Effect of dosage adjustment is thus very slow.

Supplied as : 50 microg tablet

Dilution : Crush required portion of tablet and administer.

Stability :


Compatibility:

Incompatibility :

Serum Levels : Aim to maintain serum thyroxine in the upper half of the normal range and serum TSH in the normal range.



Canberra Hospital

Ticarcillin/clavulanic acidRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Sepsis by pseudomonas, proteus, some strains of E. coli.This is a restricted ORANGE ANTIMICROBIAL and can only be used for the indications outlined in the AMS SOP unless otherwise specified by the Infectious Disease team.

Dose : 50 mg/kg/dose of ticarcillin

Interval : Weight:< 2000 gm & < 7 days 12 hourly< 2000 gm & > 7 days 8 hourly> 2000 gm & < 7 days 8 hourly> 2000 gm & > 7 days 6 hourly

Route : IV

Total Daily Dose :

Comments : Similar to Carbenicillin. More active against Pseudomonas than Carbenicillin. Usually administered with an aminoglycoside for full therapeutic effect. Reduce dosage in renal failure.

Supplied as : Timentin 3.1 g. Vials(Ticarcillin 3g + Clavulanic acid 100mg)

Dilution : Dilute in 13 ml WFI. = 200mg/mlFurther dilution may be required. Administer over 30 minutes.Usually made up by pharmacy.



Compatibility : No data available.

Incompatibility : Do not mix with aminoglycosides.




Canberra Hospital

TobramycinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Aminoglycoside with activity against Pseudomonas. Similar spectrum to gentamicin. Restricted to infections caused by micro-organisms with documented resistance to gentamicin.

Dose : < 30 weeks 2.5 mg/kg30-35 weeks 3.5 mg/kg> 35 weeks 5 mg/kgTerm > 1 week of age 7.5 mg/kg

Interval : < 26 weeks 36 hourly> 26 weeks 24 hourly

Route : IV infusion.I.M. acceptable if large infant.

Total Daily Dose : 2.5-7.5 mg/kg.

Comments : Nephrotoxicity more likely if used with other nephrotoxic drugs. Toxicity more likely if therapy extends beyond 7 days, even if drug levels within normal range.

Supplied as : Tobramycin Sulphate 40 mg/ml 2 ml vials.

Dilution : Dilute to 1 mg/ml with NS by diluting 0.5 ml of solution (20 mg) up to 20 ml of NS.


Storage : Some brands require room temperature others refrigerator. Protect from light.

Compatibility : Compatible with 5%D, 10%D, NS, aciclovir, calcium gluconate, insulin, metronidazole, morphine, TPN, ranitidine, tolazoline, frusemide, midazolam.

Incompatibility : Ampicillin, Clindamycin, Heparin, Imipenem, Indomethacin, Penicillin G, Ticarcillin.

Serum Levels : Trough 0.5 –1 microg/ml, taken just before the dose.Peak 5- 12 microg/ml, taken 30 minutes after the end of infusion.



Canberra Hospital

Ursodeoxycholic Acid (URSO)Revision Date : 12 July 2012 Approved: AK, JD

Indication : A bile acid used to minimise cholestatic jaundice

Dose : 10-15 mg/kg/dose


Route : Oral

Total Daily Dose : 20-30 mg/kg/day

Comments : May cause diarrhoea, pruritus, hypersensitivity including urticaria, increased cholestasis, nausea, vomiting, or sleep disturbance. Continue to monitor bilirubin and liver function tests to determine response to treatment

Supplied as : Ursofalk suspension 50 mg/ml

Dilution : Nil requiredStability : Discard 4 months after opening bottle.

Storage : Room temperature. Protect from light.

Compatibility:

Incompatibility :




Canberra Hospital

Valproate Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Anticonvulsant

Dose : 2.5 - 5mg/kg/dose increasing at weekly intervals up to 20mg/kg/dose

Interval : Every 12 hours

Route : Orally

Total Daily Dose :

Comments : The mechanism of action is attributed to dose dependent enzyme inhibition of gamma-aminobutyric acid transaminase (GABA-T) and consequent increased levels of the inhibitory neurotransmitter, gamma-aminobutyric acid (GABA). Best given after feeds. Levels may be lowered by concurrent administration of phenytoin and carbamazepine. Elimination is low in neonates, and comparatively high at the end of the first post-natal month, correlating with bound and unbound drug.

Supplied as : Mixture 40 mg/ml

Dilution :

Stability :


Compatibility:

Incompatibility :

Serum Levels : Trough level 300-700 micromol/L (x0.14=mg/L), take immediately prior to a dose.



Canberra Hospital

VancomycinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : MRSA and MRSE colonisation or sepsis, nosocomial or late neonatal infection.This is a restricted ORANGE ANTIMICROBIAL and may be prescribed without prior ID approval when used for the indications outlined in the AMS SOP.

Dose : 15 mg/kg/dose.Interval : CGA

(weeks)PostNatal

(days)Interval (Hours)

≤29 0 - 14>14

1812

30-36 0 - 14>14

128

37-44 0 – 7>7

128

≥45 ALL 6Adjust dosages according to levels. If therapeutic levels are attained there is no need to increase the dosage when the weight increases.

Route : I.V.

Total Daily Dose : 15 - 60 mg/kg/day according to age and bodyweight.30 mg/kg/day for 24 hour infusion (reduce to 20 mg/kg/day if Creat > 90 micromol/L)

Comments : Causes thrombophlebitis and tissue necrosis if extravasation occurs. Febrile convulsions, anaphylaxis and eosinophilia have been reported. Give infusion over 60 minutes to avoid Red Man syndrome. Nephrotoxicity is enhanced when combined with aminoglycosides (eg. gentamicin)

Supplied as : Vials 500 mg powder. Pharmacy will prepare 50mg/10mL syringes during normal working hours.

Dilution : Reconstitute 500mg vial with 10mL WFI (500mg/10mL). Dilute 1mL (50 mg) of this solution to a total volume of 10mL with NS (5 mg/mL)

Stability : Discard vials after single usePrepared syringes – expiry date on label

Storage : Vials: Room temperature, refrigerate after reconstitution.Prepared syringes: Refrigerator

Compatibility : TPN, Amikacin, Calcium gluconate, Fluconazole, Hydrocortisone, Insulin, Meropenem, Midazolam, Morphine, Tolazoline, Vecuronium 10% D, Aciclovir, Ampicillin, Ranitidine.

Incompatibility : Cefotaxime, Dexamethasone, Heparin, Phenobarbitone, Benzylpenicillin



Canberra HospitalSerum Levels : Trough levels should be taken immediately prior to the dose at the

48 hour point. Do not withhold doses whilst waiting for levels to be reported. Levels to be maintained between 10-20 mg/L for non-CNS infections and 15-25 mg/L for CNS infections. Trough levels for 24 hour infusions should be maintained between 15-30 mg/L. Adjust dosages to achieve adequate levels, above the total daily doses recommended above, if required.Once therapeutic levels are attained there is no need to increase the dosage when body weight increases.



Canberra Hospital

VecuroniumRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : A curariform non-depolarising neuromuscular blocking agent for complete paralysis during artificial ventilation.

Dose : Initial dose 0.1 mg/kg (100 microg/kg),Subsequent doses 0.03- 0.15 mg/kg0.05 – 0.1 mg/kg/hr as infusion


Route : I.V.infusion

Comments : A shorter acting agent than pancuronium but with similar properties. Vagal and ganglion blocking activity minimal and less histamine release. Cardiovascular side effects are thus less marked. Hypotension may be a problem and counteraction by volume loading may be necessary. Reports of excessively prolonged action in neonates reported (i.e. > 1-2 days). Some form of eye lubrication is necessary in infants paralysed with vecuronium.Action reversed by neostigmine.Effect increased by aminoglycosides and other antibiotics, diuretics, -blocking agents, verapamil. Effect decreased by steroids, theophylline, anticholinesterases.

Supplied as : Powder for reconstitution 4 mg and 10 mg vial.

Dilution : The 4 mg ampoule is reconstituted with 1 ml WFI, the 10 mg vial with 5 ml WFI. Each solution should be further diluted with NS to make a 1 mg/ml solution.Multiply weight of baby (kg) x 2.5 ml (of the 1 mg/ml solution) and further dilute to a total volume of 25 ml with either NS or 5%D 1 ml/hr = 0.1 mg/kg/hr. Start at 0.5 ml/hr = 0.05 mg/kg/hr.

Stability : For single use only. Discard any unused portion.


Compatibility : NS, 5%D, Adrenaline, Aminophylline, Dobutamine, Dopamine, Fentanyl, Fluconazole, Gentamicin, Heparin, Hydrocortisone, Midazolam, Morphine, Noradrenaline, Ranitidine, Vancomycin.

Incompatibility : Do not mix with other drugs. Frusemide.




VigabatrinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Neonatal convulsions that are not satisfactorily controlled by other anticonvulsants.

Dose : 20 mg/kg/doseIncrease to 40-80/mg/kg/dose if necessary


Route : Oral

Total Daily Dose : Max 80mg/kg/day

Comments : Mechanism of action is attributed to dose dependent enzyme inhibition of GABA transaminase and consequent increased levels of the inhibitory neurotransmitter GABA.May cause drowsiness. Observe for unwanted, adverse neurological effects.

Supplied as : Vigabatrin 500mg sachets (Sabril)

Dilution : Dissolve contents of sachet in 10 ml WFI to give a clear solution 50mg/ml

Stability : Discard after 24 hours


Incompatibility : Decreases phenytoin levels by 20%. The clinical significance of this is not known. Plasma concentrations of carbamazepine, sodium valproate, phenobarbitone do not appear to be affected.




Canberra Hospital

Vitamin A (Retinol)Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Prevention or amelioration of BPD or Chronic Lung Disease.

Dose : < 1000 gm: 2000 units.1000 - 1500 gm: 3000 units

Interval : Alternate days.

Route : Oral.

Total Daily Dose :

Comments : Vitamin A is associated with BPD through its role as a mediator of epithelial cell differentiation. Deficiency states are characterised by squamous metaplasia of the tracheo-bronchial epithelium similar to those found in BPD. High doses of Vitamin A are toxic.

Supplied as : Vitamin A - Bioglan Micelle A.

Dilution : Nil.

Stability : As advised by pharmacy and as per bottle labelling.


Incompatibility :

Serum Levels : 30 - 60 microg/dL, Levels > 80 microg/dL are toxic.



Canberra Hospital

Vitamin E (Alpha-Tocopherol)Revision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : An antioxidant used in the prevention or amelioration of oxygen toxicity or oxygen free radical damage. May be administered in treatment of Vitamin E deficient anaemia.

Dose : 5 mg.

Interval : Daily.

Route : Oral.

Total Daily Dose : 5 mg.

Comments : Efficacy has been debated. Suggested value has been in the prevention of BPD, reduction in the severity of IVH and of ROP, and the prevention of anaemia of prematurity. Toxicity results in inhibition of prostaglandin synthesis in platelets, decreased platelet aggregation, increased haemorrhagic tendency in Vitamin K deficiency, creatinuria. High dose intravenous use has resulted in liver necrosis and death. Trials have shown an increased rate of sepsis and death.

Supplied as : Solution 100 mg/ml.

Dilution : Nil.

Stability : One month.


Incompatibility : Do not give with Iron.

Serum Levels : < 4 mg/dL.



Canberra Hospital

Vitamin KRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Prevention of Haemorrhagic Disease of the Newborn (prophylaxis) or as treatment for established vitamin K deficiency.

Dose : 1 mg IM or IV (0.1ml)< 1500 grams: 0.5 mg IM (0.05ml)Prophylaxis for maternal anticonvulsant therapy: parenteral 1 mg. Therapeutic: 1 mg parenterally.

Interval : Parenteral prophylaxis at birth..

Route : I.M. (preferred), I.V. Generally given IM on the right thigh soon after birth.

Total Daily Dose:

Comments : Routine administration is essential.

Supplied as : Konakion, Vitamin K1, 2.0 mg in 0.2 ml.

Dilution : Nil

Stability : Use immediately.

Storage : Room temperature, shield from light.

Compatibility : Adrenaline, Amikacin, Ampicillin, Dobutamine, Heparin, Hydrocortisone, Ranitidine, Sodium bicarbonate, Tolazoline.

Incompatibility : Phenytoin.




Canberra Hospital

Zidovudine Revision Date : 28 January 2015 DTC approved: March 2015

Indication : Reduce risk of transmission of HIV in the Perinatal period.Use in conjunction with other antiretroviral therapy if maternal viral load is >50 copies/mL at time of delivery – consult the HIV in Pregnancy SOP

Dose : Antiretroviral therapy should be commenced immediately after delivery and be continued for 4 weeks.

> 35 weeks: PO: 4mg/kg/dose every 12 hours for 4 weeks IV: 1.5mg/kg/dose every 6 hours. 1

30 – 34 weeks: PO: 2mg/kg/dose every 12 hours for 2 weeks, then increase 2mg/kg/dose every 8 hours for 2 weeks IV:1.5mg/kg/dose every 12 hours for 2 weeks, then increase 1.5mg/kg/dose every 8 hours for 2 weeks. 1,2

< 30 weeks: PO: 2mg/kg/dose every 12 hours for 4 weeks IV: 1.5mg/kg/dose every 12 hours. 1,2

Change over to oral regimen when infant is able to tolerate oral medication, to complete 4 week course.

Interval : As above

Route : PO:IV: one hour infusion (for infants unable to tolerate oral dosing)

Comments : Generally well tolerated. Haematological side effects include anaemia and leucopenia. Avoid in patients with low neutrophils (<0.75x109/L) or low haemoglobin (<75g/L).2

If infant vomits within 20 minutes of an oral dose, repeat the dose.Prepacks of Syrup and Ampoules are kept in Delivery Suite for emergency use and should accompany baby after birth. Pharmacy must be notified to replace stock when used. Intravenous zidovudine is available under the SAS scheme – an SAS Category A form must be completed and returned to pharmacy for every patient requiring IV vials

Supplied as : Oral syrup: 10mg/mL.3

IV vials: 200mg/20mL.4



Canberra HospitalDilution : IV: MUST be diluted with sodium chloride 0.9% or glucose 5%

to a maximum concentration of 4mg/mL prior to infusion. 4

Withdraw 40mg (4mL) of zidovudine and add to 16mL of diluent fluid (makes 2mg/mL). For fluid restricted pts, add 40mg (4mL) of zidovudine to 6mL of diluent fluid (makes 4mg/mL)Infuse required dose over one hour

Stability : IV ampoules - use once only and discard any residue.Where practical, the Pharmacy IV room will prepare IV doses in syringes.

Storage : Oral solution – Room temperature, protect from lightIV vials - Room temperature, protect from light

Compatibility : glucose 5%, sodium chloride 0.9%, aciclovir, amifostine, amikacin, anidulafungin, aztreonam, ceftazidime, ceftriaxone, cisatracurium, clindamycin, dexamethasone, dobutamine, dopamine, doripenem, erythromycin, filgrastim, fluconazole, gentamicin, granisetron, heparin sodium, imipenem-cilastatin, linezolid, lorazepam, metoclopramide, morphine sulfate, oxytocin, pentamidine, phenylephrine, piperacillin-tazobactam (EDTA-free), potassium chloride, ranitidine, remifentanil, tobramycin, trimethoprim-sulfamethoxazole, vancomycin 4,5

Incompatibility : Blood products, albumin, meropenem. 4,5


References

1. British HIV Association. Guidelines for the management of HIV in pregnant women 2012 (2014 interim review) http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/BHIVA-Pregnancy-guidelines-update-2014.pdf

2. Capparelli EV, Mirochnick M, Dankner WM et al: Pharmacokinetics and tolerance of zidovudine in preterm infants. J Pediatr Jan, 2003; 142(1): 47-52.

3. MIMS Australia, 2014. MIMS Online Retrovir® (zidovudine) Syrup Product Information. [Online]. Available at: https://www.mimsonline.com.au/Search/Search.aspx (Accessed: 5 December 2014)

4. Nicolette Burridge, Natalie Collard, Keli Symons. Australian Injectable drugs handbook, 6th Edition (electronic version). SHPA publications reference group, Collingwood, VIC. Available at:http://aidh.hcn.com.au/browse/z/zidovudine (Accessed: 5 December 2014)

5. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.


http://aidh.hcn.com.au/browse/z/zidovudine

http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/BHIVA-Pregnancy-guidelines-update-2014.pdf

http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/BHIVA-Pregnancy-guidelines-update-2014.pdf


Canberra Hospital

Zoster ImmunoglobulinRevision Date : 09/01/2014 14:40:00 Approved: AK, JD

Indication : Prevention of Varicella infection in babies or young infants with family contacts recently developing chicken pox or shingles. For babies of mothers who have developed chicken pox from 7 days prior to 7 days after delivery.

Dose : 125 IU

Interval : Once only, but the dose may be repeated if a second exposure occurs more than 3 weeks after the first dose.

Route : I.M.

Total Daily Dose :

Comments : Not useful in the management of established infection. ZIG must be given as early as possible in the incubation period – within 96 hours of exposure if possible.

Supplied as : ZIG - CSL. Available from blood bank.

Dilution : Nil.

Stability :

Storage : Refrigerate at 2 - 8oC. Do not freeze. Protect from light.

Incompatibility :

Serum Levels :



Canberra Hospital

References: 1. Kemp CA, McDowell JM editors Paediatric Pharmacopoeia. 13th Edition.

Melbourne: Pharmacy Department, Royal Children’s Hospital, 2002.2. Pagliaro LA, Pagliaro AM editors. 2nd Edition. Illinois: Problems in Paediatric

Drug Therapy. 1987.3. Johnson KB. The Harnet Lane Handbook. 13th Edition. St Louis, Mosby Year

Book, Inc. 1993.4. Young TE, Mangum B. Neofax 13th Edition. Raleigh, Nth Carolina, Acorn

Publishing USA. 2000.5. Trissel LA. Handbook on injectable drugs. 11th Edition. Bethesda, American

Society of Health-System Pharmacists. 2001.6. Aminophylline product information, Mulgrave, Victoria. FH Faulding and CO

Ltd (Trading as David Bull Laboratories). TGA Approval 19 May 1998. Date of most recent amendment 21 August 2000.

7. Therapeutic Guidelines: Antibiotics. 11th Edition. Melbourne. Therapeutic Guidelines Ltd. 2000.

8. Morris N. Australian injectable drugs handbook. 2nd Edition. South Melbourne, Society of Hospital Pharmacists of Australia. 1999.

9. Australian Technical Advisory Group on Immunisation. The Australian Immunisation Handbook. 7th Edition. Canberra, Australian Government Publishing Service. 2000.

10. Carlton JB. The handbook of parenteral drug administration. 4 th Edition. Shepparton, Victoria. 1997.

11. http://www.health.gov.au/internet/immunise/publishing.nsf/content/ F11B0C092AC5A5D3CA25719D00183398/$File/nip-schedule-card-july07.pdf

12. http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips 13. Royal Hospital for Women Neonatal Drug Protocol Manual, 2012.14. http://www.kemh.health.wa.gov.au/services/nccu/guidelines/drug_protocols.htm 15. Flippin Blood, Second edition June 2012 Quick reference guide16. Blood and Blood Product Administration SOP Issued September 201217. Massive Transfusion SOP Issued September 201218. Weiss, A.L. Et al (2013). Septic Shock: Ongoing management after resuscitation

in Children. Up To Date. 19. Silvergleid, A. Et al (2013). Clinical use of plasma components. UpToDate


http://www.kemh.health.wa.gov.au/services/nccu/guidelines/drug_protocols.htm%20%20%20

http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips

http://www.health.gov.au/internet/immunise/publishing.nsf/content/F11B0C092AC5A5D3CA25719D00183398/$File/nip-schedule-card-july07.pdf

http://www.health.gov.au/internet/immunise/publishing.nsf/content/F11B0C092AC5A5D3CA25719D00183398/$File/nip-schedule-card-july07.pdf

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