CHAPTER 7
NEONATAL INTENSIVE CARE DRUG THERAPY
The following chapter contains recommended dosages for a multitude of drugs used in infants in a NICU setting. Unfortunately, not many of these drugs have been thoroughly studied in this population of patients. This is an important concept to understand as it is known that premature infant pharmacokinetics differ quite dramatically from term infant pharmacokinetics and as do the pharmacokinetics of sick infants.
Thus, these recommended drug doses and intervals may vary from patient to patient and, as knowledge of infant pharmacokinetics improves, the use of these drugs may change over time. We recommend consulting any of the Neonatal pharmacy texts to confirm the reasons behind any drug use (or dose) with which you are not familiar. Always consult with an Attending Neonatologist if you are not sure why a certain drug is being used.
Important phone numbers to know:
Main Pharmacy : 455-8815 5th Floor Pediatric Pharmacy: 455-1363
Clinical Pharmacy Pager: 390-1164
Important drug order writing tips:
1. LEGIBILITY of drug orders is of utmost importance
2. Drugs that are ordered as integers (whole numbers) need NO DECIMAL POINTS; even if you are ordering only one gram or milligram of a substance.
For example: 1 mg of Lasix IV Q 8 hours (NOT 1.0 mg of Lasix…)
3. Drugs ordered as fractions of units require a zero (or other whole number) in front of the decimal point
For example: 0.5 mg of Lasix IV Q 8 hours or 2.5 mg of Lasix IV Q 8 hours
4. All medications that are run as a continuous infusion in the NICU now come in a standard concentration. This helps to eliminate medication ordering errors which may occur during calculations. As such "the rule of sixes" and other formulas once used at the bedside are no longer employed. When ordering a continuous infusion, one must include the patient's weight and the dose desired. For example: dopamine 5 mcg/kg/minute, weight 2 kg
5. Always make sure to include the patient’s weight that the drug dose is based on and include the drug dose on a per kilogram basis (ex. Ampicillin 125 mg IV Q 12 hours – 100 mg/kg/dose)
While the following pages are useful as a handy, quick reference, no infant should ever be given one of these drugs without:
- discussion with a supervisor
- thorough understanding of the contraindications and possible side effects of the drug
- appropriate monitoring initiated
and
- two individuals, separately, calculating the drug dose
CALCULATIONS AND FORMULAS: NOTE: please use caution and write legibly in order to differentiate between “mg” or “mcg”