(Version 2.0 4/1/2003 - 7/10/2006)

Prostin

For an anticipated delivery of an infant with ductal-dependent CHD, prostin should be ordered as:

150 mcg prostin in 50 ml D5W to make a concentration of 3 mcg/ml.  This concentration when run at a rate in ml/hr equal to the baby’s weight in kg will deliver 0.05 mcg/kg/min prostin.This may be a relatively large volume but should be adequate to keep a peripheral iv open even after weaning to lower doses.

To concentrate a prostin drip or to order one when the baby’s weight is known, you can use the equation:

Weight (in kg) x 0.3 = the number of mg of prostin to mix with 100 mL D5W

then 1 mL/hr delivers 0.05 mcg/kg/min.

On transport, the NNPs will be using the formula:

            Weight (kg) x 60 = # mcg of prostin to add to 10mL D5W

            Then 0.5 mL/hr delivers 0.05 mcg/kg/min and unnecessarily large volumes

of medication are neither created nor wasted.

Dopamine or Dobutamine

To order either one of the most commonly used pressors in the NICU, use the equation:

Weight (in kg) x 60 = the number of mg of pressor to mix in 100 ml of D5W

then an iv infusion rate of 0.1 ml/hr will deliver 1 mcg/kg/min.

This is a concentrated formula to deliver small volumes to our small patients and conveniently allows one to know the amount infusing with a glance at the iv infusion rate.

Fentanyl

A concentration formula for a continuous narcotic infusion is:

Weight (in kg) = the number of mg of fentanyl to add to 100 ml of D5W

then an iv infusion rate of 0.1 ml/hr will deliver 1 mcg/kg/hr.

Since fentanyl is supplied as a 50 mcg/ml preparation, if a baby weighs > 5 kg, (s)he should receive undiluted fentanyl, and an infusion rate will have to be calculated to deliver the desired amount of fentanyl per hour.

Insulin

To order an insulin drip:

Weight (in kg) x 10 = the number of units of insulin to add to 100 ml of D5W

then an iv infusion rate of 0.1 ml/hr will deliver 0.01 Unit/kg/hr.

With the advent of Wiz Order, most of these calculations will be performed by the computer order entry system. The PCCU continuous infusion web pages have been adapted for NICU usage.

To order drips for an unborn or outborn patient not yet entered in the Vanderbilt computer system, a pre-printed order sheet is available that assists with calculations.

In an attempt to standardize the formulation of these medications for continuous infusion, the pharmacy requests (and WizOrder pages require) that drips be ordered in either D5W or D10W. The tiny volumes in which these drips are administered to neonatal patients preclude providing a significant increase in a baby’s caloric intake by using a higher glucose concentration. However, if the patient is severely fluid-restricted or hypoglycemic, exceptions may need to be made, and the pharmacy should be contacted.