Drug

Doses

Comments

Acetaminophen

Oral

Loading: 20 mg/kg/dose PO x 1 then 10-15 mg/kg/dose

<32 wks=q8hr

 ≥32 wks=q6hr

Rectal

Loading: 30 mg/kg x 1 then 20 mg/kg/dose

<32 wks=q12hr

≥32-40 wks=q8hr

≥40 wks =q6hr 

Administer 30 minutes prior to immunizations and continue for 24 hours.

Scheduled use should not exceed 72 hours

Chloral Hydrate

25-75 mg/kg/dose PO  x1

Use repeat doses with caution. Contraindicated in patients with significant hepatic or renal dysfunction.

EMLA

1. Apply 0.5gm of topical mixture of lidocaine/prilocaine (generic EMLA) in a 1 X 1 cm square (dime sized) surface over the anticipated puncture sites (maximum of 3 sites)

2. Cover with an occlusive dressing for 45 minutes (maximum 60 minutes)

3. Remove dressing

4. Wipe/wash away topical medication

Local anesthestic used for procedural pain management such as central line placement and lumbar punctures.

Fentanyl

Intermittent: 1-2 mcg/kg/dose IV q2-4h prn

     ELBW: 0.5 mcg/kg/dose IV q2-4h prn

Infusion:

    Usual starting dose: 1-3 mcg/kg/hr

    *ELBW: 0.5 mcg/kg/hr

    Range: 1-12 mcg/kg/hr

Intermittent doses may cause chest wall rigidity.  Administer doses over at least five minutes.  Tachyphylaxis and opioid dependence will often occur. 

Tacyphylaxis to fentanyl may develop with chronic use which may improve with a conversion to morphine.  Equipotent doses published in standard tables are not applicable for chronic dosing and may result in overdose.  Please use the following conversion (1:10) 10 mcg/kg/hr fentanyl = 0.1 mg/kg/hr  morphine

Hydromorphone

Infusion:
Usual starting dose: 4 mcg/kg/hr
Range: 2-20 mcg/kg/hr
 

Not first-line analgesic in NICU.

Lorazepam

Intermittent: 0.05-0.1 mg/kg/dose IV q2-4h prn

Infusion: Usual initial dose: 0.1-0.15 mg/kg/hr.

See: Benzodiazepine Taper 

Do not administer through UAC. Used for sedation.  Does not provide pain relief.   Seizure-like myoclonus has occurred in some premature infants.  Adverse effects: respiratory depression, hypotension.  May need to be tapered in neonates receiving > 7 days of therapy due to physiologic dependence.

Methadone

Please see Methadone taper for opioid-dependent neonates for detailed dosing information.

Used for iatrogenic opioid dependence and neonatal withdrawal.

Midazolam

Intermittent: 0.05-0.1 mg/kg/dose IV q2-4h prn

Infusion: Usual initial dose: 0.1 mg/kg/hr.

Range 0.05-0.15 mg/kg/hr.

Do not administer through UAC. Used for sedation.  Does not provide pain relief.   Seizure-like myoclonus has occurred in some premature infants.  Adverse effects: respiratory depression, hypotension.  May need to be tapered in neonates receiving > 7 days of therapy due to physiologic dependence.

Morphine

Intermittent: 0.05-0.1 mg/kg/dose IV q2-4h prn

Infusion: Initial 0.01 mg/kg/hr. Range: 0.01 - 0.2 mg/kg/hr

Should be reserved for term and older infants without hemodynamic compromise.

Tacyphylaxis to fentanyl may develop with chronic use which may improve with a conversion to morphine.  Equipotent doses published in standard tables are not applicable for chronic dosing and may result in overdose.  Please use the following conversion (1:10) 10 mcg/kg/hr fentanyl = 0.1 mg/kg/hr  morphine

Naloxone

0.01 -0.1 mg/kg/dose IV or ET.  Repeat doses may be needed in some patients.

Reversal agent for opioids. May be used for maternal opioid use 4 hours PTD.  Avoid use in patients born to narcotic-addicted mothers as sudden reversal may cause life-threatening withdrawal symptoms.

Acyclovir

< 1200 gm: 20 mg/kg/dose IV q12h

> 1200 gm: 20 mg/kg/dose IV q8h

For HSV encephalitis.  May cause nephrotoxicity.  Maintain good hydration to prevent crystallization in kidneys.  Monitor liver and renal function.

Amikacin

0-4weeks (<1200g): 7.5 mg/kg/dose IV q24h

< 7d (> 1200 g): 7.5 mg/kg/dose IV q12h

>7d (1200-2000 g): 7.5 mg/kg/dose IV q8-12h

>7d (>2000 g): 7.5 mg/kg/dose IV q8h

Aminoglycoside used only for organisms resistant to gentamicin and tobramycin.  Monitor serum levels and SCr.  Desired trough: < 10 mcg/mL

Amoxicillin

UTI Prophylaxis: 10 mg/kg/dose PO QD

Amphotericin B

Conventional

1 mg/kg/dose IV q24h

Follow instructions in WIZ for ordering in patient’s current dextrose concentration.  Electrolyte and nutrition requirements should be calculated to run over 20 hours as TPN or IVF will be turned off during Amphotericin infusion.

Should be infused over 4 hours.  Administration through central line preferred. Adverse effects: nephrotoxicity, infusion-reactions (fever, rigors), hypokalemia, hypomagnesemia. 

Amphotericin B Lipid Complex

Abelcet®

5 mg/kg/dose IV q24h

Follow instructions in WIZ for ordering in patient’s current dextrose concentration.  Electrolyte and nutrition requirements should be calculated to run over 20 hours as TPN or IVF will be turned off during Amphotericin infusion.

Used if nephrotoxicity occurs with conventional Amphotericin B. 

Ampicillin

< 1 m.o.:100 mg/kg/dose IV q12h

> 1 m.o.: 50 mg/kg/dose IV q6h

Group B Strep Meningitis

< 7 d.o. 100 mg/kg/dose IV q8h

> 7 d.o.: 100 mg/kg/dose IV q6h

UTI prophylaxis: 10 mg/kg/dose IV QD

Used empirically to cover for Group B streptococcus and Listeria sp.  Also covers Enterococcus.

Azithromycin

Pertussis

< 6 months: 10 mg/kg/day PO x 5 days

Caution: No data available for appropriate dosing using IV.

Cefazolin

<7d:  20 mg/kg/dose IV q12h

>7d (<2000g): 20 mg/kg/dose IV q12h

>7d (>2000g): 20 mg/kg/dose IV q8h

1^st generation cephalosporin principally used for Staph aureus.

Cefepime

< 14 days:  30 mg/kg/dose IV q12h

14 -30 days: 50 mg/kg/dose IV q12h            

> 30 days: 50 mg/kg/dose IV q8-12h

4th generation cephalosporin.  Limited information available regarding appropriate dosing in neonates.  Provides coverage against susceptible S. aureus and many gram-negatives including Pseudomonas aeruginosa.

Cefotaxime

0-4 wks (<1200 g): 50 mg/kg/dose IV q12h

<7d (>1200 g): 50 mg/kg/dose IV q12h

>7d (>1200 g): 50 mg/kg/dose IV q8h

Meningitis: 67 mg/kg/dose IV q8h (if pneumococcus not suspected)

3rd generation cephalosporin.  Provides coverage against gram-negative organisms and susceptible Streptococcus pneumoniae.  . Not first line for rule-out sepsis in neonates (associated with worse outcomes in neonates in combination with ampicillin vs gentamicin + ampicillin). Can consider in rule-out sepsis patients with renal issues in place of gentamicin.

Ceftazidime

0-4 weeks (<1200 g): 50 mg/kg/dose IV q12h     

< 7d (>1200 g): 50 mg/kg/dose IV q12h

>7d (>1200 g): 50 mg/kg/dose IV q8h

3^rd generation cephalosporin used to treat susceptible strains of Pseudomonas aeruginosa.

Ceftriaxone

Please see comments section.

3^rd generation cephalosporin with spectrum of activity similar to cefotaxime.  Use in the NICU is Prohibited risk of kernicterus and life-threatening interactions when given with calcium containing intravenous fluids.  Refer to Rocephin use in the NICU.

Clindamycin

< 7d (< 2000g): 5 mg/kg/dose IV q12h

< 7d (> 2000g): 5 mg/kg/dose IV q8h

> 7d (<1200g): 5 mg/kg/dose IV q12h

> 7d (1200-2000g): 5 mg/kg/dose IV q8h

> 7d (> 2000g): 7.5 mg/kg/dose IV q6-8h

Provides coverage against anaerobes and Group A streptococcus.

Erythromycin (see GI section for motility doses)

<7d: 10 mg/kg/dose IV/PO q12h

>7d (<1200g): 10 mg/kg/dose IV/PO q12h

>7d (1200-2000g): 10 mg/kg/dose IV/PO q8h

>7d (>2000g): 10 mg/kg/dose IV/PO q6h

Pertussis and chlamydial pneumonia and conjunctivitis: 12.5 mg/kg/dose PO q6h

Macrolide antibiotic used in neonates for Chlamydia trachomatis pneumonia, Ureaplasma urealyticum infections and pertussis.  Cardiac arrhythmias have been reported with IV use (infuse slowly).  Other adverse effects: abdominal pain, vomiting, nausea, pyloric stenosis, thrombophlebitis.   Fluconazole increases erythromycin levels (monitor for cardiac arrhythmias).

Fluconazole

<29 wks and < 14 days: 5-6 mg/kg/dose IV/PO q72h

<29 wks and > 14 days: 5-6mg/kg/dose IV/PO q48h

30-36 wks and < 14 days: 3-6mg/kg/dose IV/PO q48h

30-36 wks and > 14 days: 3-6 mg/kg/dose IV/PO q24h

37-44 wks and < 7 days: Loading dose 6-10 mg/kg IV/PO x1 followed by maintenance of 3-6 mg/kg/dose IV/PO Q48H

37-44 wks and > 7 days: Loading dose 6-10 mg/kg IV/PO x1 followed by maintenance of 3-6 mg/kg/dose IV/PO Q24H

Neonates and infants > 45 weeks: 3-6 mg/kg/dose IV/PO q24h

Prophylaxis Dosing: <26wk (<750g) on vent with PICC/CVC line = 3 mg/kg/dose IV twice weekly x 6wk as long as line is in.  Not if in liver failure.

Treatment of systemic fungal  infections including meningitis caused by Candida albicans and other susceptible fungi.  .  Twice weekly prophylaxis may be used in high risk infants.  Refer to Fluconazole Prophylaxis Protocol for Criteria.   Monitor hepatic function with long courses of therapy.  Monitor phenobarbital and phenytoin levels as fluconazole can increase levels.  Rifampin decreases fluconazole and hydrochlorothiazide increases fluconazole levels.

Gentamicin

< 30 weeks and <= 7 days postnatal age:  5 mg/kg/dose IV Q48H

< 30 weeks and >7 days postnatal age: 4 mg/kg/dose IV Q24H

> 30 weeks, < 30 days postnatal age: 4 mg/kg/dose IV Q24H

> 30 weeks, > 30 days postnatal age, < 2 kg:  4 mg/kg/dose IV Q24H

> 30 weeks, > 30 days, > 2 kg:  5 mg/kg/dose IV Q24H

Impaired renal function: Give dose X 1 and base interval on drug levels.

Aminoglycoside used for gram-negative organisms including E. coli and Pseudomonas aeruginosa.  Desired trough: < 2 mcg/mL prior to the 4^th dose. Patients being treated for meningitis should have both peaks and troughs drawn.  May cause nephro- and ototoxicity.

Meropenem

< 7d: 20 mg/kg/dose IV q12h

> 7d (1200-2000 g): 20 mg/kg/dose IV q12h

> 7d (> 2000 g): 20 mg/kg/dose IV q8h

Carbapenem with a broad spectrum of activity to be used in cases of documented resistance to other antibiotics.  Should not be used as monotherapy due to rapid development of resistance. 

Metronidazole

0-4 weeks (< 1200 g): 7.5 mg/kg/dose IV q48h

< 7 d (1200-2000 g): 7.5 mg/kg/dose IV q24h

< 7 d (>2000 g): 7.5 mg/kg/dose IV q12h

> 7 d (1200-2000 g): 7.5 mg/kg/dose IV q12h

> 7 d (>2000 g): 15 mg/kg/dose IV q12h

> 1 m.o.: 7.5 mg/kg/dose IV q6h

Provides anaerobic coverage.

Nystatin (Oral)

Preterm: 1 mL (100,000 units). Give 0.5 mL (50,000 units) to each side of mouth QID

Term: 2 mL (200,000 units).  Give 1 mL (100,000 units) to each side of mouth QID

Topical antifungal used for oral candidiasis.

Oxacillin

0-7d (<2000 g): 25 mg/kg/dose IV q12h

0-7d (>2000 g): 25 mg/kg/dose IV q8h

>7d (<1200 g): 25 mg/kg/dose IV q12h

>7d (1200-2000 g): 25 mg/kg/dose IV q8h

>7d (>2000g): 25 mg/kg/dose IV q6h

Penicillinase-resistant penicillin used in the treatment of confirmed methicillin-susceptible Staph aureus.  May cause significant phlebitis.

Penicillin G

GBS Meningitis:

 <7d=150,000 units/kg/dose IV q8h   (450,000 units/kg/day)

 >7d=125,000 units/kg/dose IV q6h (400,000 units/kg/day)

GBS Bacteremia:

 <7d = 50,000 units/kg/dose IV q8h (150,000 units/kg/day)

>7d = 50,000 units/kg/dose IV q6h (200,000 units/kg/day)

Congenital Syphilis:

<7d(all wts)=50,000 units/kg/dose IV q12h

>7d(all wts)=50,000 units/kg/dose IV q8h

Used in treatment of confirmed susceptible Group B Streptococcus.  May also be used for congenital syphilis.

Piperacillin/

Tazobactam (Zosyn®)

50-100 mg/kg/dose IV

<29wk, <28d = q 12hr
<29wk, > 28d = q 8hr
30-36 wk, <14d = q 12hr
30-36wk, >14d = q 8hr
>37wk, 0-7d = q 12hr
>37wk, >7d = q 8hr

For empiric therapy for non-CNS infections that involve non-CoNS/MRSA gram-positives, gram-negatives (including pseudomonas) and anaerobes (e.g. gram-neg pneumonia, VAP with GNR in ETT aspirate, aspiration pneumonia, abdominal infections, etc).  It can be combined with Gentamicin for double coverage of GNR, which would eliminate the use of Metronidazole as a third drug.

Rifampin

 5-20 mg/kg/day IV divided q12h

Used for synergy for Staphylococcus aureus infections.

Tobramycin

<30 weeks (< 7 d): 5 mg/kg/dose IV q48h

<30 weeks (> 7 d): 4 mg/kg/dose IV q24h

> 30 weeks (< 30 d): 4 mg/kg/dose IV q24h

> 30 weeks (> 30 d, < 2 kg): 4 mg/kg/dose IV q24h

> 30 weeks (> 30 d, > 2 kg): 5 mg/kg/dose IV q24h

Impaired renal function: Give dose x 1 and base interval on

Aminoglycoside used for gram-negative organisms including E. coli and Pseudomonas aeruginosa.  Desired trough: < 2 mcg/mL prior to the 4^th dose. Patients being treated for meningitis should have both peaks and troughs drawn.  May cause nephro- and ototoxicity.

Vancomycin

Infants < 1 month: 10 mg/kg/dose IV Q8H

Patients with impaired renal function:

15 mg/kg/dose X 1

Infants ≥ 1 month, > 2 kg: 15 mg/kg/dose IV Q8H

Infants ≥ 1 month, > 2 kg with documented/suspected meningitis: 15 mg/kg/dose IV q6h

Initial gram positive antibiotic coverage for clinically septic infants and infants with indwelling hardware (central line, VP shunt, etc) pending culture and sensitivity results. 

Antibiotic of choice for MRSA, Staph epidermidis, and where indicated by sensitivity patterns of culture proven isolates.

 Desired troughs: 5-12 mcg/mL prior to the fourth dose. Patients being treated for meningitis should have both peaks and troughs drawn. Monitor renal function.

Zidovudine

Preterm:

< 30 weeks: 2 mg/kg/dose PO q12h or 1.5 mg/kg/dose IV q12h for first four weeks then increase the interval to q8h thereafter.

30-34 weeks: 2 mg/kg/dose PO q12h or 1.5 mg/kg/dose IV q12h for first two weeks then increase interval to q8h thereafter.

> 35 weeks: 2 mg/kg/dose PO q6h or 1.5 mg/kg/dose IV q6h

Post-exposure prophylaxis for patients born to HIV-infected mothers. Should be started within 6-12 hours of birth.   Adverse effects: anemia, thrombocytopenia, neutropenia.  Monitor CBC.

Albuterol 0.083.%

2.5 mg in 3 mL via nebulizer q4-6h 

Do not give if HR over 180.  Observe for hypoxia.  May be used to treat hyperkalemia

Budesonide

0.25 mg via nebulization per ETT or mask q12h                

A trial may be used in some patients to reduce the risk of CLD. 

Caffeine citrate

Loading dose: 20 mg/kg IV/PO x1

Initial maintenance dose: 5 mg/kg/dose IV/PO q24h (starting 24 hours after load)

Range: 5-10 mg/kg/dose IV/PO q24h

Used for apnea of prematurity.  Monitor for feeding intolerance, irritability, HR.  Levels not routinely performed.  Obtain levels if toxicity suspected (usual range: 4-20 mcg/mL)

Dexamethasone

Extubation: 0.25 mg/kg/dose IV q8h x 3 doses, started 4-6 hours prior to extubation

For chronic lung disease:

Day                                        

1        0.1 mg/kg/dose IV q12h

2        0.1 mg/kg/dose IV q12h

3        0.075 mg/kg/dose IV q12h

4        0.075 mg/kg/dose IV q12h

5        0.05 mg/kg/dose IV q12h

6        0.05 mg/kg/dose IV q12h

7        0.025 mg/kg/dose IV q12h

8        0.025 mg/kg/dose IV q12h

Please see Dexamethasone protocol for criteria for use in the patients with CLD. 

Discuss the use and potential risks with family.

Supplemental interventions for patients receiving 8 day taper: discontinue Vitamin A, initiate famotidine, avoid indomethacin if possible, increase protein intake and monitor triglycerides. 

Racemic Epinephrine

0.3 - 0.5 ml of racemic epinephrine (2.25%) diluted in NS to a final volume of 3 ml

Used for post-extubation stridor.

Beractant (Survanta)

4 ml/kg/dose via ETT               

May give up to 4 doses in the first 48 hrs of life, no more frequently than q6h.

Warm to room temperature by allowing to sit for 20 minutes or warm in hand for 8 minutes.  Do not shake dose. Avoid suctioning for 2 hours post-dose unless clinically indicated.  Observe for hypoxia and bradycardia.

Vitamin A

Initial: 2000 IU/kg/dose IM every other day  starting DOL#1.  Continue until patient receiving full feeds then give 4000 IU/kg/dose PO/PT Q24H until discharge

Used to decrease the incidence of BPD. See Vitamin A protocol for criteria for use.  Should be discontinued during dexamethasone treatment.

Adenosine

0.1 mg/kg/dose IV. If no effect, give 0.2 mg/kg IV.  If effective but tachycardia reinitiates, repeat same dose rather than double the dose. 

Acute treatment of sustained paroxysmal supraventricular tachycardia.

Albumin

0.5-1 g/kg/dose IV x1

 Can also be added to TPN

Amiodarone

Consult cardiology for dosing recommendations.

IV bolus:  Five separate 1 mg/kg aliquots

Infusion: 5-15 mg/kg/day

For the treatment of life-threatening refractory arrhythmias

Alprostadil

0.05-0.1 mcg/kg/min

Not to be given through UAC.  Promotes dilation of the ductus arteriosus.  Used in neonates with CHD dependent upon ductal shunting for oxygenation/perfusion. Adverse effects: apnea, fever, flushing, hypotension, bradycardia, and seizures.

Captopril

< 44 weeks and < 2 months:

Initial dosing: 0.01-0.05 mg/kg/dose PO Q8-12H  Range: 0.01-0.1 mg/kg/dose 

< 44 weeks and > 2 months:

Initial dosing: 0.01-0.05 mg/kg/dose PO Q8-12H, Range: 0.01-0.1 mg/kg/dose

Maintenance dosing: Some infants may require 0.15-0.3 mg/kg/dose PO Q8H  Max: 6 mg/kg/day

ACE-inhibitor.  Note: Use higher doses with caution in patients < 44 weeks and < 2 months as significant decreases in cerebral blood flow have occurred in preterm infants with chronic hypertension who have received doses higher than 0.15 mg/kg/dose.

Digoxin

Neonates > 40 weeks: 

5 mcg/kg/dose PO q12h

4 mcg/kg/dose IV q12h

Preterm neonates < 40 weeks PMA:  

3 mcg/kg/dose PO q12h

2.5 mcg/kg/dose IV q12h

Monitor HR, ECG, and potassium.  Low potassium increases risk of toxicity.  Adverse effects: feeding intolerance, lethargy, bradycardia, arrhythmias. 

Dobutamine

2-20 mcg/kg/min

Do not give through a UAC.  Increases myocardial contractility with less of an impact on heart rate than other catecholamines. May cause vasodilation at high doses.   Adverse effects: tachycardia, arrhythmias, hypotension.  Use phentolamine if extravasation occurs.

Dopamine

2-20 mcg/kg/min

Do not give through a UAC. Low doses increase renal blood flow and urine output.  Intermediate doses increase renal blood flow, cardiac output, contractility, and blood pressure.  High doses cause alpha-adrenergic effects with vasoconstriction and increased blood pressure.  Adverse effects: tachycardia, arrhythmias, tissue sloughing with extravasation. Use phentolamine if extravasation occurs.

Enalapril

Initial dosing: 0.05 mg/kg/dose PO q12-24h.  Titrate upward based upon response.

Max daily dose: 0.5 mg/kg/day

ACE-inhibitor used for hypertension and afterload reduction.  Adverse effects: hypotension, oliguria.  Monitor potassium and renal function. 

Enalaprilat

0.005-0.01 mg/kg/dose IV Q8-24H

ACE-inhibitor used for hypertension.  Adverse effects: hypotension, oliguria.  Monitor potassium and renal function. 

Epinephrine

Resuscitation: 0.01-0.03 mg/kg/dose IV (0.1-0.3 mL/kg) of 1:10,000 dilution

Infusion: 0.05-2 mcg/kg/min.  Usual max in neonates is 1 mcg/kg/min

Do not give through UAC.  Stimulates alpha and beta adrenergic receptors.  Adverse effects: arrhythmias, renal vascular ischemia.  Use phentolamine if extravasation occurs.  Extravasation may cause ischemia and necrosis.

IV preferred but may be given ETT. Dosing ETT: 0.1 mg/kg/dose (1 mL/kg) of a 1:10,000 dilution 

Heparin

Bolus: 75 units/kg IV x1

Infusion: 28 units/kg/hr

Monitor aPTT.  Monitor platelets for heparin-induced thrombocytopenia (rare).

Hydralazine

0.25-1 mg/kg/dose PO q6-8h

Hypertensive crisis: 0.1-0.4 mg/kg/dose IV q6h prn.  Max daily dose: 3.5 mg/kg/day in 4-6 divided doses

Direct acting arterial vasodilator.  Reduces systemic vascular resistance.  Adverse effects: tachycardia, diarrhea, emesis, and transient agranulocytosis.

Indomethacin

0.2 mg/kg IV x1

Do not give via UAC. Please see indomethacin protocol for indications and qualifying labs.  Contraindicated if mother received indomethacin within 72 hours of delivery.  Maintain good oxygenation, fluid restrict (decrease maintenance IVF by 30%), NPO for 12-24 hours after dose, monitor UOP, and repeat labs q24h.

Isoproterenol

0.05-2 mcg/kg/min

Stimluates ß1 and ß2 receptors with no action on alpha receptors.  Positive inotropic and chronotropic effects.  Adverse effects: tachycardia, arrhythmias

Milrinone

0.25-1 mcg/kg/min

Phosphodiesterase-inhibitor.  Positive inotropic effect with decreases in preload and afterload, increased cardiac output, and decreased systemic and arterial pressures.  Adverse effects: arrhythmias, thromobocytopenia, hypokalemia, hepatotoxicity

Nicardipine

Infusion:
Initial: 0.5-5 mcg/kg/min
Usual: 1-4 mcg/kg/min
Max: 5 mcg/kg/min
 

Calcium channel blocker.  Inhibits the influx of Ca into myocardium and selectively into coronary vascular smooth muscle without altering serum calcium concentrations.  Affects contractile functions of cardiac and vascular smooth muscle.    

Nitroprusside

Initial: 0.3-0.5 mcg/kg/min.  Doses above 4 mcg/kg/min are rarely required.  Max: 10 mcg/kg/min.

Reduces preload and afterload through venous and arteriolar vasodilation. Use cautiously in patients with renal, hepatic or thyroid dysfunction.  Adverse effects: excessive hypotension, ECG changes.  Monitor thiocyanate levels if > 3 days of therapy, > 4 mcg/kg/min or renal impairment.  Monitor cyanide in patients with hepatic dysfunction.

Sotalol

Consult cardiology for dosing information

Anti-arrhythmic agent used to treat ventricular and supraventricular tachycardias.   Adverse effects: arrhythmias, hypotension, dyspnea.  Monitor ECG.

Aquamephyton (Vitamin K)

<1500 g: 0.5 mg IM x1

>1500 g:1 mg IM x1

Administer within 1 hour of birth for prevention of hemorrhagic disease of the newborn.

Enoxaparin

Infants < 2 months old:

Treatment dose: 1.5 mg/kg/dose SC q12h

Prophylaxis: 0.75 mg/kg/dose SC q12h

Infants ≥ 2 mths old:
Treatment dose: 1 mg/kg/dose SC q12h
Prophylaxis: 0.5 mg/kg/dose SC q12h
 

Low-molecular weight heparin.  Antifactor-Xa levels should be monitored.  Neonates often require higher doses.  Please see Thrombolytic Therapy protocol.

Ferrous sulfate drops

2-4 mg elemental iron/kg/day PO in 1-2 divided doses (maximum: 15 mg elemental Fe/day)

Refer to iron supplementation guidelines on website for more detailed dosing information.  May cause GI distress.  Avoid use until patient tolerating full feeds of an adequate caloric density for growth.

Fosphenytoin

Loading dose: 10 PE/kg IV x1, may repeat 10 PE/kg IV up to 20 PE/kg IV total.    

Initial maintenance: 2 PE/kg/dose IV q12h

Used for seizures refractory to phenobarbital. Monitor free phenytoin levels (usual range: 1-2 mcg/mL).  Infuse no faster than 1.5 PE/kg/min.

Levetiracetam (Keppra®)

20-60 mg/kg/day IV/PO q12h

Limited information available on its use in neonates.  Used for neonatal seizures refractory to phenobarbital.  Infuse over 15 minutes. PO and IV doses are equivalent.

Blood serum levels do not need to be monitored.  Caution in patients with renal dysfunction.  Adverse effects: drowsiness, agitation and irritability

Lorazepam

0.05 mg/kg/dose IV, may repeat in 10-15 min.

Used for status epilepticus. 

Phenobarbital

(see GI section for cholestatis dosing)

Loading dose: 20 mg/kg IV x1, may repeat 10 mg/kg IV x 2 up to 40 mg/kg IV total                            

Initial maintenance dose: 2mg/kg/dose IV or PO q12h

Drug of choice for most types of seizures in neonates.  Desired serum level: 15-40 mcg/mL.  PO and IV doses are equivalent.

Phenytoin

Initial maintenance: 2 mg/kg/dose IV/PO q12h

Note: IV formuation is non-formulary.  Use fosphenytoin instead.

Used for seizures refractory to phenobarbital.  Monitor free phenytoin levels (usual range: 1-2 mcg/mL). 

Erythromycin

1 mg/kg/dose PO/IV q6h

Used for GI motility at low doses.

Adverse effects: abdominal pain, vomiting, nausea, pyloric stenosis.

Famotidine

0.5-1 mg/kg/dose IV/PO q12h

H2-antagonist used for GERD.  Routine use is not recommended.  May be added to TPN.

Glycerin suppository

Sliver as needed.

Lansoprazole

Infants < 3 months: 7.5 mg or 0.5 – 1.5 mg/kg/day PO

Infants > 3 months: 15 mg or  0.5 – 1.5 mg/kg/day PO

Limited data in neonates. Proton-pump inhibitor.  Used in cases of GERD unresponsive to H2-antagonists and metoclopramide.  Solutabs may be diluted in 1-5 mLs of water and given PO or PT. 

Metoclopramide

0.1 mg/kg/dose q6h IV or PO

Treatment of GERD.  Adverse effects: dystonic and extrapyramidal effects at higher doses.

Omeprazole

0.5-1.5 mg/kg/dose PO q24h

Proton-pump inhibitor.  Used in cases of GERD unresponsive to H2-antagonists and metoclopramide.

Phenobarbital (for cholestasis)

2-2.5 mg/kg/dose IV/PO q12h

Ranitidine

1-5 mg/kg/dose PO q12h

H2-antagonist used for GERD.

Simethicone

20 mg PO q6h prn

Ursodiol

TPN-cholestasis: 30 mg/kg/DAY PO divided q8-12h

Biliary atresia: 10-15 mg/kg/dose PO q24h

Cholerectic agent. 

Furosemide

Intermittent:

1 mg/kg/dose IV q12-24h

2 mg/kg/dose PO q12-24h

Infants > 1 month: Administer doses above Q6-24H

Infusion:
Initial 0.1 mg/kg/hr
Range 0.05-0.4 mg/kg/hr

Loop diuretic also used in patients with BPD.   Monitor Na, K, PO4, and Cl.  Extra potassium supplementation should be considered when initiating therapy. Can cause nephrocalcinosis.

Hydrochlorothiazide

1 mg/kg/dose PO q12h

Thiazide diuretic. Diuretic effect is potentiated when used with furosemide or spironolactone. Calcium-sparing.  May cause hyperglycemia, hypokalemia, or hyperuricemia.

Spironolactone

0.5-1.5 mg/kg/dose PO q12h

Potassium-sparing diuretic. Use cautiously in patients with renal impairment. 

Spironolactone/Hydrochlorothiazide (Aldactazide®)

Dosed based on spironolactone component:  0.5 – 1.5 mg/kg/dose PO q12h

Combination thiazide and potassium-sparing diuretic.

Hydrocortisone

Physiologic replacement: 6-8 mg/m²/day IV/PO in 2-3 divided doses

Pressor- or volume-resistant hypotension (stress dose):  1 mg/kg/dose q8h x 3-5 days  (usually equivalent to 20-40 mg/m²/day)

Please refer to Hydrocortisone for Vasopressor-Resistant Hypotension

Adverse effects: hyperglycemia, hypertension, sodium and water retention.

Insulin

0.05-0.2 units/kg/hr.  Usual initial dose is 0.1 units/kg/hr.

Should be used in conjunction with dextrose infusion when used for the  treatment of hyperkalemia.  (see hyperkalemia protocol in Wiz for dosing information)

Levothyroxine

10-12 mcg/kg/dose PO q24h or

5-8 mcg/kg/dose IV q24h

Pancuronium

Intermittent: 0.05–0.1 mg/kg/dose IV q1-2h prn

Neuromuscular blocking agent.  Patient must be on ventilator.  Must be given with sedation.

Vecuronium

Intermittent: 0.05-0.1 mg/kg/dose IV q1-2h prn              

Infusion:

Usual starting dose: 0.1 mg/kg/hr

Range: 0.05-0.1 mg/kg/hr

Neuromuscular blocking agent.  Patient must be on ventilator.  Must be given with sedation.  Less effect on BP and HR (hypotension and tachycardia) than pancruronium

Calcium gluconate  (Ordered as salt not as elemental calcium)

Symptomatic hypocalcemia: 100-200 mg/kg/dose of calcium gluconate salt IV x 1

Resuscitation: 60-100 mg/kg/dose IV

Do not administer through UAC. Observe IV site closely for extravasation.  Use hyaluronidase (Amphadase®) if extravasation occurs.

Magnesium sulfate (ordered as salt not elemental Mg)

Hypomagnesemia: 25-50 mg/kg/dose IV x 1

Monitor blood pressure, HR and respiratory rate during infusion.

Sodium bicarbonate 4.2%

Resuscitation: 2 mEq/kg IV over 3-5 minutes.

*Full correction of metabolic acidosis=Wt (kg) x Base deficit (mEq/L) x 0.3 = mEq of HCO3. Give ½ of this dose.

Treats metabolic acidosis.  Give slowly over several hours for VLBW.  Must have adequate ventilation.  Do not give in presence of hypercarbia.

THAM (Tromethamine sulfate)

3.3 to 6.6 ml/kg/dose IV

Equation for full correction:

Dose(mL)=weight(kg) x Base deficit(mEq/L) x 1.1

Max dose: 15-23 mL/kg/day

Do not give through umbilical line.  Treats metabolic acidosis without elevation of serum sodium.  Do not give in patients that are anuric or uremic.

Potassium (PO)

Prevention of hypokalemia associated with diuretics:

Initial: 1-2 mEq/kg/day PO in 1-2 divided doses

May cause GI distress. 

Cyclopentolate/phenylephrine (Cyclomydril)

Instill 1-2 drop in each eye X3 doses,  5 minutes between doses.

Octreotide

Chylothorax dosing:

Infusion:

0.5-4 mcg/kg/hr, titrate to effect – doses up to 40 mcg/kg/hr have been used

Somatostatin analog.  Monitor for hyper/hypoglycemia.  Pulmonary hypertension has been reported in treated former premature infants with CLD.