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Critical Concepts in Pediatric Emergency Medicine

Medications Used In The Newborn

Module 1: Neonatal Emergencies

Adenosine

0.05-0.1mg/kg/dose rapid IV push (first dose)

0.1-0.2 mg/kg/dose (second dose)

Given by PIV preferentially in the right arm/central line or IO.

Follow by rapid normal saline flush 5-10 mL.

Indications: SVT

Amiodarone

5 mg/kg/dose loading dose, as bolus in cardiac arrest,

over 20-30 minutes for perfusing tachycardias.

Maintenance dose 5-10 ug/kg/min

Consultation with cardiologist.

Indications: Vfib, unstable Vtach,

SVT persistent after 3 doses Adenosine

Ampicillin

50-100 mg/kg/dose, dosing interval based on age.

Indications: Suspected neonatal sepsis,

(Group B strep and Listeria and some enterococci).

Atropine

0.02 mg/kg IV/IO, minimum dose of 0.1 mg

Indication: second and third degree heart block.

Bradycardia with hypotension after epinephrine and fluid bolus.

May be used prior to elective intubation.

Calcium chloride

20 mg/kg/dose or 2ml/kg/dose over 5 minutes

Indications: Hyperkalemia, hypocalcemia

Calcium gluconate

100 mg/kg/dose or 1 ml/kg/dose over 5 minutes

Indications: Hyperkalemia, hypocalcemia

Cefotaxime

50 mg/kg/dose, dosing interval based on age

Indications: suspected neonatal sepsis

Clindamycin

5-7.5 mg/kg/dose

Indications: infections with aerobic and anaerobic organisms, MRSA, Bacteroides, Fusobacterium, Actinomyces, Clostrididum perfringens and Clostridium tetani

Diazepam

0.25-0.5 mg/kg/dose slow IV push

0.5 mg/kg/dose rectal (over 6 months)

Indications; seizures, sedation

Dobutamine

3-10 microgram/kg/min

Indications: cardiogenic shock

Dopamine

5-10 microgram/kg/min

Indications: CHF

Epinephrine (1:10,000)

0.01 mg/kg/dose or 0.1 ml/kg/dose

0.03-0.1 mg/kg/dose via ETT

May repeat q5mins if needed

Indications: cardiac arrest, bradycardia,

Epinephrine (1:1000)

0.05-0.1 microgram/kg/min

Indications: hypotension

Fentanyl

2-5 microgram/kg/dose, slow IV push.

May repeat in 2-4 hours.

Indications: Analgesia

Fosphenytoin

20 mg/kg/dose slow IV (2 mg/kg/min)

Indications: Seizures

Furosemide

0.5 mg/kg/dose over 5 minus q8h 0r q12h

Indications: CHF

Gentamicin

3.5-5 mg/kg/doseover 10-30 mins

Check trough 30-60 mins before third dose

Check peak after end of infusion of second or third dose.

Indications: Suspected sepsis

Lidocaine

1% solution

1 mg/kg/dose or 0.1 mL/kg/dose and infusion at 1-1.5 mg/kg/hour

Indications: Ventricular tachycardia, local anesthesia

Lorazepam

0.05 mg/kg/dose IV over 2-5 mins

Indications: sedation, seizures

Meropenem

20 mg/kg/dose q8h or q12h depending on age

30-40 mg/kg/dose q8h for meningitis

Indications: Sepsis or infection with multi drug resistance

Midazolam

0.05 mg/kg/dose IV over 2-5 mins

Indications: Sedation, seizures

Milrinone

Loading dose 25 microgram/kg/dose IV or

50 microgram/kg/dose over 30 minutes

Continuous infusion start at 0.5 microgram/kg/min

Indications: cardiac or septic shock

Morphine

0.15-0.1 mg/kg/dose IV

Indications: analgesia, sedation, reducing pulmonary resistance (TOF)

Nafcillin

25 mg/kg/dose q6h to q12h

Meningitis 50 mg/kg/dose

Naloxone

0.1 mg/kg/dose

Indications: Opioid overdose or infant when maternal opioids < 4 hours prior to delivery

Noeepinephrine

0.05-0.1 microgram/kg/min

Indications: hypotension in shock

Phenobarbitol

20 mg/kg/dose over 20 minutes

Maintenance 3-5 mg/kg/dose q12h

Indications: neonatal seizures (first choice)

Prostaglandin

0.05-0.1 microgram/kg/min IV

Indications: suspected ductal dependent congenital heart disease

Sildanefil

0.3-1 mg/kg/dose q6h to q8

Indications: Persistent pulmonary hypertension

Sodium bicarb

(4.2% ) 1-2 mEq/kg/dose or

Calculate using equation

Indications: Metabolic acidosis

Surfactant

Indications: Respiratory distress syndrome (RDS)

Vancomycin

15 mg/kg/dose IV over 1 hour

Dosing q8h to q18h depending on age and weight

Check serum levels before and after the second dose

Indications: gram-positive pathogens such as coagulase negative and oxacillin resistant staphylococcus, Staph epidermidis, staph aureus MRSA

Vecuronium

0.1 mg/kg/dose

Indications: Intubation

Vitamin K1

Prophylaxis – 1 mg/dose IM

Treatment for high INR – 1-2 mg/day SQ or IV

Next: Begin Post-Test