All things Medications (ante partum, NICU, post discharge)

What is the usual dosage for Acetaminophen when treated for PDA closure

IV: 15 mg/kg every 6 hours

Ordered Dose: 15 mg/kg/dose

What is the usual dosage for caffeine administration especially for Apnea of prematurity?

Apnea of Prematurity:

Loading dose - IV:

10 to 12.5 mg/kg as caffeine BASE.

Maintenance dose - IV:

2.5 to 5 mg/kg caffeine BASE every 24 hours.

Maintenance dose should be started 24 hours after the loading dose.

What is the difference between how you give caffeine loading dose and how you give maintenance dose?

Infuse loading doses over 30 minutes and maintenance doses over at least 10 minutes.

What is the usual dosage for cefotaxime ?

First rule is to check policy but most likely

PNA less than or equal to 7 days:

IV, IM: 50 mg/kg/dose every 12 hours.

What about ampicillin?

First rule, check policy but usually

2 kg or less baby

Postnatal age (PNA) 7 days or less:

IV, IM: 50 mg/kg/dose every 12 hours.

More than 2 kg:

PNA 28 days or less:

IV, IM: 50 mg/kg/dose every 8 hours.

Also confirm if treating for Meningitis or GBS

What are some risk factors to consider when giving gent?

nephrotoxicity and Ototoxicity

When do we do gent levels?

At the 22hr mark post administration.  However, if the baby is not anticipated to have antibiotics longer than 48hrs it may not be ordered

Under what circumstances would gent be ordered then?

• Renal dysfunction: defined as urine output less than 1 mL/kg/hour or a serum creatinine at 120 micromole/L or more. 

• Hypoxic ischemic encephalopathy. 

• Concurrent indomethacin, furosemide, vancomycin, vasopressor, or inotrope administration. 

• Severe cardiac anomalies. 

• ELBW infants: defined as 29 weeks or less gestational age or less than 1250 grams birth weight.

What are some baseline investigations (prior to starting Diazoxide) and why?

a. ECHO- risk of sodium and water retention, heart failure and pulmonary hypertension.
b. CBC with differential- diazoxide can cause neutropenia and thrombocytopenia.
c. ALT/AST/alkaline phosphate- diazoxide can cause elevations.
d. Bilirubin T/D- diazoxide may displace bilirubin from albumin.
e. Electrolytes, Urea, Creatinine- diazoxide can cause decreased creatinine clearance.
f. Uric acid.
g. Clinical abdomen assessment- risk of intestinal obstruction.

What is the usual Diazoxide dosing?

Diazoxide starting dose typically 5 mg/kg/day divided BID orally (range 5 to 15 mg/kg/day).

What other meds should be started when starting diazoxide and why?

Hydrochlorothiazide should be started at the same time (1 mg/kg/day divided BID orally).

Monitor blood glucose (BG) and target is >3.9 mmol/L and <7 mmol/L.
b. Titrate Diazoxide as needed to achieve target BG every 3-4 days.
c. Monitor neonates and infants closely for signs of respiratory distress (tachypnea, flaring nostrils, grunting, chest wall retractions), cyanosis, or feeding intolerance, particularly those neonates and infants born premature or with risk factors for pulmonary hypertension (e.g, meconium aspiration syndrome, respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, sepsis, congenital diaphragmatic hernia, and congenital heart disease); discontinue if pulmonary hypertension is identified (FDA 2015).

What other follow up would you do?

10-14 Days post Diazoxide

a. ECHO (to assess for pulmonary hypertension)—complete earlier if clinical concerns.
Consult cardiology if abnormal.
b. CBC with differential, ALT/AST/Alkphos/Bilirubin T/D, Electrolytes, Urea, Creatinine, Uric Acid. c. Clinical exam (Monitor neonates and infants closely for signs of respiratory distress (tachypnea, flaring nostrils, grunting, chest wall retractions), cyanosis, or feeding intolerance).
d. Consider CXR if clinical signs of pulmonary edema.