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 Formulary Chapter 24: Neonatal Formulary - Full Chapter
Notes:

A note about this section

 Details...
24.01  Expand sub section  Medication: Doses, Information & Resources
 note 

UNDER CONSTRUCTION - NOT VALIDATED BY DTG USE CURRENT SHAREPOINT FORMULARY

This formulary is for use on BTHFT Neonatal unlit only. This resource may differ from other commonly used reference sources, however the information below is locally agreed for use in BTHFT.

USEFUL EXTERNAL LINKS 

Evelina Paediactric Formulary 

Excellent resource for less common medication doses and information from Evelina Childrens Hospital, London.

BNFc

Standard reference source for all commonly used medication in both primary and secondary care.

Medusa IV Guide - Paediatric Link 

This  Injectable Medicines Guide (IMG) aims to provide:

  • guidance on the preparation and administration of injectable medicines in adult and paediatric clinical areas
  • a reference source for organisations preparing an injectable medicines administration policy.

Yorkshire & Humber ODN Formulary

This resource provides regionally agreed inforamtion on medication dosing, concentrations for infusion and additonal imformation.

BTHFT - NNU General Policy and Guidelines

Link for all documents for NNU on local intranet.

 

 

Aztreonam
View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green Specialist Recomendation

Indication

Infection- limited to Gram-negative aerobic bacteria Pseudomonas aeruginosa, Neisseria meningitidis, Neisseria gonorrhoeae and Haemophilus influenza.

Dose

30 mg/kg/dose every 12 hours in preterm
30 mg/kg/dose every 8 hours in term <7days
30 mg/kg/dose every 6-8 hours in term neonates >7days
Reduce dose in renal impairment see additonal resources for dose adjustment.

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring

U&E, LFT, FBC

Further Info:
 
Supply:
Available from pharmacy on named patient request.

 
   
Aciclovir
(NNU ONLY)
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Green

Indication:

Herpes zoster, treatment 
Varicella zoster, treatment 

Dose:

20mg/kg every 8 hours 

For further information see Y&H ODN formulary - Scroll to top

Administration:

See Medusa IV guide for infomation on administration - Scroll to top
Monitoring:

Renal function

Further Info:

Maintain adequate hydration

Supply:

Available on NNU as a stock item. 

 
   
Adrenaline
(NNU only)
View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green Specialist Initiation

Indication

Acute hypotension

Dose

Consider starting at 0.1micrograms/kg/min.
Higher doses up to 1.5 micrograms/kg/minute have been used in acute hypotension

For further information see Y&H ODN formulary - Scroll to top

Administration

Continuous IV infusion via central line.

USE GUARDRAILS ON INFUSION PUMP

Syringe concentration - 3000 microgram in 50 ml 5% or 10% glucose. (60micrograms/ml)

Monitoring 

BP, Heart rate, Peripheral perfusion, Blood sugars, Blood gas

Further Info

CHECK STRENGTH OF AMPOULE!

See " Cardiovascular support in neonates" guideline

Supply

Available from pharmacy as a stock item as vials. DSU can make named patient syringes on request during normal working hours. Contact ward pharmacist  

 
   
Alprostadil (Prostin VR)
(NNU only)
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Green Specialist Initiation

Indication:

Open/maintain patency of the ductus arteriosus

Dose:

12.5-100 nanograms/kg/min
But higher doses may be used e.g. 200 nanograms/kg/min
If well start at 12.5 or 25 nanograms/kg/min
Unwell babies with ?duct dependent problem expect to need ventilation, start at 100nanograms/kg/min
See regional guidance link

Administration

USE GUARDRAILS ON INFUSION PUMP

Syringe concentration - 300micrograms in 50ml in 5% glucose 

See guide line in link below for more infomation. 

Monitoring

Watch for apnoea(especially in U&E, bloods sugars, reflux.

Further Info:

See Y&H ODN guidline in link below
Undiluted solution must NOT come into contact with the barrel of the plastic syringe; add the required volume of alprostadil to a volume of infusion fluid in the syringe and then make up to final volume.

Supply:

Available on NNU as a stock item. Stored in fridge.

Available from Pharmacy DSU on named patient request during normal hours. Contact ward pharmacist

 
Link  Regional Guideline for Prostin ( Alprostadil )
   
Amikacin
(NNU only)
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Red

Indication: 
Gentamicin resistant gram negative bacilli

Dose:
15mg/kg 36 hourly in babies < 32 weeks

15mg/kg 24 hourly for all other neonates and infants

20mg/kg may be needed in severe sepsis

Administration 

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Renal function
The target trough is <5mg/L 

Sample should be taken 6 hours prior to 3rd dose. Repeat daily until stable, then every 3 doses.  

Redose patient at 24 hours if trough level achieved.  If trough is high, recheck level 12 hours after that level was taken and redose after that if level  in range.

Further Info:

Nephrotoxicity may be increased by concurrent administration of amphotericin and potent diuretics.

Supply:
Available from pharmacy on a named patient request.

 
   
Amoxicillin
(NNU only)
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Indication

Infection - broad spectrum

Dose

IV:30-60 mg/kg/dose every 12 hours <7 days of age

IV:30-60/kg/dose every 8 hours >7 days of age

Oral: 30mg/kg/dose every 8 hours >7days of age

Administration

See Medusa IV guide for information on administration - Scroll to top

IV doses over 30mg/kg to be given by IV infusion over 30minutes

Monitoring

Renal function

Further Info:

Active againist: listeria, haemophyllus, enterococci, streptococci, pneumococci, salmonella,shigella and many coliforms

Supply:

Available on NNU as a stock item. Oral to be ordered on a named patient request. 

 
   
Amphotericin (liposomal) (Ambisome®)
(NNU only)
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Restricted Drug Restricted
Green Specialist Recomendation

Indication

Systemic fungal infections

Dose

All ages, give a test dose of 100microgram/kg, to a maximum of 1mg, over 10 minutes. Maintenence dose can be given 1 hour after test dose.

1mg/kg once a day, increased if necessary, to 3mg/kg once a day.

Administration
IV infusion over at least 30 minutes.
Amphotericin MUST be diluted in Glucose 5% for infusion.
Final concentration in neonates must be 1mg/ml
Lines MUST be flushed with Glucose 5% ONLY.
A test dose of 100micrograms over 10 minutes may be considered in older babies to reduce risk of anaphaylaxis.

See Medusa IV guide for information on administration - Scroll to top

Monitoring
Renal function
Potassium

Further Info

Prescribe as “Amphotericin liposomal (AmBisome)”

Active against aspergillosis, candidasis, coccidoidomycosis and cryptococcosis.

Supply:
Vials are available from pharmacy as a named patient supply.

 
   
Atracurium
(NNU ONLY)
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Green Specialist Recomendation

Indication:
Short acting muscle relaxant

Dose
A 500microgram/kg stat dose can produce muscle relaxation for up to 30 mins.

A continuous infusion of 300-500micrograms/kg/hour will provide continual neuromuscular blockade in neonates. Some mat need

Administration

USE GUARDRAIL INFUSION PUMP

Syringe Concentration 25mg in 25mls (1mg/ml).

Infusions made up in glucose 5%  need to be made up every 8 hours, while those in sodium chloride 0.9% can be changed every 24 hours.

See Medusa IV guide for information on administration - Scroll to top

Monitoring

U&E,  temperature,

Further Info:
In babies requiring paralysis consider sedation and pain relief were necessary.

Supply:
Available from pharmacy as a stock item. Stored in fridge

 
Link  Preparation of drugs for intubation
   
Benzylpenicillin Sodium
(NNU only)
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Green

Indication

Empirical treatment of early onset neonatal sepsis. Active againist streptococcal(including pneumococcal), gonococcal, and meningococcal infections

Dose

50 mg/kg/dose every 12 hours

50 mg/kg/dose every 8 hours 7-28 days

50 mg/kg/dose every 6 hours >28 days

For further information see Y&H ODN formulary - Scroll to top

Administration

Slow IV bolus or infusion over 15–30 minutes. Longer administration time is particularly important when using doses of 50 mg/kg (or greater) to avoid CNS

See Medusa IV guide for information on administration - Scroll to top

Monitoring
Renal function

Further Info
Consider reducing dose to 25mg/kg/dose in moderate to severe renal failure. Seek senior advice.

Supply:
Available from pharmacy as a stock item

 
   
Caffeine CITRATE
(NNU only)
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Green Specialist Initiation

Indication

Neonatal apnoea

Dose

Loading - 20mg/kg once a day. IV to be given over 30min

Maintenance - 10 mg/kg once a day. IV to be given over 10min.

IV = PO dose

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring
Levels (not routinely needed) 75-150 mmol/litre

Further Info

Prescribed as CAFFEINE CITRATE only

Supply

Available from pharmacy as stock item

 
   
Calcium Gluconate
(NNU ONLY)
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Restricted Drug Restricted
Green Specialist Recomendation

Indication

Acute hypocalcaemia

Dose

Urgent correction

0.46 mmol/kg (2 mL/kg calcium gluconate 10%) for hypocalcaemia

Maintenance

0.5 to 1mmol/kg daily, adjusted according to response, dose to be given over 24 hours, use oral route as soon as possible due to risk of extravasation.

Administration

See Medusa IV guide for information on administration - Scroll to top

USE GUARDRAILS ON INFUSION PUMP

Syringe Concentration 2.25mmol Ca in 50mL (0.045mmol/mL)

Monitoring

Potassium, Calcium and Phosphate 

Further Info

Use PN "Side order" guideline for making continious infusion - search link below.

Storage & Supply

Available on NNU as a stock item

 
Link  Calcium Gluconate PN side order
   
Captopril
(NNU only)
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Green Specialist Recomendation

Indication

Congestive cardiac failure and hypertension

Dose

Initailly a test dose 10 microgram/kg,
If tolerated increasing to max dose of 100microgram/kg/dose every 8 hours.
Older babies usually require a larger dose. Discuss with Paediatric Cardiology.

Administration

Oral - Liquid

Monitoring

Close monitoring of blood pressure essential every 1-2 hour after test dose.

Montior blood pressure regulary when on maintenance regime.
Renal function

Further Info
Also used to reduce proteinuria in nephrotic syndrome

Supply:
Available from pharmacy on named patient request.

 
   
CefoTAXime
(NNU only)
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Green Specialist Recomendation

Indication:

Severe susceptible infections due to sensitive Gram-positive and Gram-negative bacteria

Dose
50mg/kg/dose very 12 hours in <7 days of age 

50mg/kg/dose every 8 hours in >7 to 20 days of age 

50mg/kg/dose every 6 hours in >21 days of age

For further information see Y&H ODN formulary - Scroll to top

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring
Renal function-consider dose reduction in severe renal failure.Consider 25mg/kg every 12 hours.

Further Info
Cephalosporins are not active against enterococci, listeria, campylobacter or clostridia

Supply
Available as stock from pharmacy

 
   
CefTAZidime
(NNU only)
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Green Specialist Recomendation

Indication

Infections due to sensitive Gram-positive and Gram-negative bacteria 

Dose

50 mg/kg every 24 hours <7 days of age

50 mg/kg every 12 hours 7 to 21 days of age

50 mg/kg every 8 hours >21 days of age

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Renal function

Further Info

If reduced renal fucntion extend dosage interval - see resources above for further information.

Cephalosporins are not active against enterococci, listeria, campylobacter or clostridia

Supply:
Held as stock on NNU

 
   
Chloral Hydrate
(NNU only)
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Restricted Drug Restricted
Green Specialist Initiation

Indication

Short term sedation

Dose
10-30 mg/kg/dose every 8 hours
reduce dose in mild to moderate hepatic impairment

Administration
Oral/Enteral liquid

Monitoring

LFT and U&E

Further Info

Prescribe as when required if on initiation. May accumulate with repeated doses.
Avoid in severe renal and hepatic impariment

Supply
Available from pharmacy on a named pateint request

 
Link  BNFc Monograph
   
Chlorothiazide
(NNU only)
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Green Specialist Initiation

Indication

Heart failure, hyperinsulinaemic hypoglycaemia and chronic lung disease.

Dose

10 mg/kg every 12 hours.

Administration

Oral - liquid available

Monitoring

U&E
Renal function

Further Info

May cause hypokalaemia and hyperuricaemia. Doses may vary from 5-20mg/kg depending on indication and specialist advice.

Supply

Available from pharmacy as a named patient request.

 
Link  BNFc Monograph (Diuretic)
   
Chlorpromazine
(NNU only)
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Red

Indication

Neonatal abstinence syndrome

Dose

1mg/kg every 8 hours.

Administration

Oral - liquid available

Monitoring

Blood pressure

Further Info

Dose can be doubled in severe withdrawal. Maximum dose 6mg/kg/day

Supply

Available from pharmacy as a named patient.

 
   
Clonazepam
(NNU only)
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Red

Indication

Continuous severe seizures resisant to routine anticonvulsants.

Dose

100 micorgram/kg every 24 hours. slow IV bolus

IV infusion, initially bolus dose as above, followed by a continuous infusion starting at 10 microgram/kg/hour.  Adjust according to response, up to 60microgram/kg/hr has been used.

Administration

Slow IV injecition over 2-3minutes

Continuious infusion if recommended by specialist.

Adsorbed on PVC. If PVC apparatus used complete infusion within 2 hours

IV or PO

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Respiration
Salivary and bronchial hypersecretion.


Further Info

Prolonged infusion may lead to accumulaiton and delay recovery

Can be reversed by flumazenil. IV injection, 10microgram/kg repeat at 1 minute intervals to a maximum of 40microgram/kg(2mg).  If necessary this may be followed by an infusion of 2-10microgram/kg/hour.

Supply

Available from pharmacy as a stock item

 
   
Dalivit
(NNU only)
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Red

0.6mls once daily

 
   
Dexamethasone BASE
(NNU only)
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Green Specialist Recomendation

Indication

Ventilator dependent chronic lung disease(CLD)

Dose

Prescribe and dose as Dexamethasone BASE

Individualised dosing after discussion with consultant.
Doses have ranged from 50micrograms/kg/ alternate days to 500micrograms/kg/day in divided doses.

See Neonatal Formulary for further information if required

Administration

IV or PO

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Blood sugars, Blood pressure, Renal function, Liver function, GI side effects

Further Info

IV may be diluted in sodium chloride 0.9% or glucose 5% to aid administration

Supply

Available from pharmacy as a stock item

 
   
Diazepam
(NNU only)
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Restricted Drug Restricted
Green Specialist Recomendation

Indication

Sedation and Seizures

Dose

200mg/kg/dose repeated after 10 minutes if necessary.

Administration

Slow IV bolus if given IV

IV can be given orally or rectally

See Medusa IV guide for information on administration - Scroll to top

Monitoring
hypotension, apnoea, respiratory depression, urinary retention,gastro-intestinal disturbances

Further Info:
Use Diazemuls band only for IV injection, less irritant than other brands.

Can be reversed by flumazenil. IV injection, 10microgram/kg repeat at 1 minute intervals to a maximum of 40microgram/kg(2mg).  If necessary this may be followed by an infusion of 2-10microgram/kg/hour.

Supply:
Available from pharmacy as a stock item

 
   
Digoxin
(NNU only)
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Red
REVIEW?
Indication:
Supraventricular tachycardia
Dose:

Total loading dose
given as ½ immediately
¼ at 8 hours
¼ at 16 hours
>2.5kg total loading dose:
IV = 35 micrograms/kg
oral = 45 micrograms/kg

>2.5kg oral maintenance dose:
10 micrograms/kg od

For low birth weight babies see Neonatal Formulary
Administration
IV or Oral
Monitoring
Potassium, renal function, arrhythmias, conduction disturbances, thrombocytopenia.
The plasma-digoxin concentration should be maintained in the range 0.8–2 micrograms/litre. Blood should be taken at least 6 hours after a dose
Further Info:
Hypokalaemia predisposes the child to digitalis toxicity.
Supply:
Available from pharmacy as a named pateint.
Liquid suppled as 50micrograms in 5mls (10micrograms/ml)

Always check dose carefully because an overdose can cause death.
 
Link  BNF-C monograph
   
DoBUTamine
(NNU only)
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Green Specialist Recomendation

Indication

Hypotension

Dose

5-20 micrograms/kg/min as continious infusion.

For further information see Y&H ODN formulary - Scroll to top

Administration

See Medusa IV guide for ADDITIONAL information on administration - Scroll to top

USE GUARDRAILS ON INFUSION PUMP

Syringe concentrations

60mg in 50mL (1200micogram/mL) SINGLE STRENGTH

120mg in 50mL (2400micogram/mL) - DOUBLE STRENGTH

Monitoring

Blood pressure(marked increase in systolic blood pressure indicates overdose)
arrhythmias,dyspnoea, bronchospasm and hypokalaemia

Further Info

Compatibility information can be found on Medusa

Solutions of dobutamine may turn pink due to a slight oxidation of the drug.  Such solutions are safe to use and there is no significant loss of potency.

Supply:
Available from pharmacy as a standard stock

 
Link  DOBUTamine - making up - Guideline
   
DOPamine
(NNU only)
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Green Specialist Recomendation

Indication

Hypotension

Dose

5-20 micrograms/kg/min as continious infusion.

For further information see Y&H ODN formulary - Scroll to top

Administration

See Medusa IV guide for ADDITIONAL information on administration - Scroll to top

USE GUARDRAILS ON INFUSION PUMP

Syringe concentrations

60mg in 50mL (1200micogram/mL) SINGLE STRENGTH

120mg in 50mL (2400micogram/mL) - DOUBLE STRENGTH

Monitoring

Blood pressure(marked increase in systolic blood pressure indicates overdose)
arrhythmias,dyspnoea, bronchospasm and hypokalaemia

Further Info

Compatibility information can be found on Medusa

Supply
Available from pharmacy as a standard stock

 
Link  Link to Sharepoint document
   
Erythromycin
(NNU only)
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Restricted Drug Restricted
Green Specialist Recomendation

Indication

Gastric reflux

Infection

Dose

12.5 mg/kg every six hours IV or Oral

3mg/kg every six hours for gastro-intestinal stasis - oral only

Administration

See Medusa IV guide for information on administration - Scroll to top
 
Monitoring

Renal function, LFT,
Long term use for reflux may cause pyloric stenosis

Further Info

2/52 course for confirmed chlamydia

Supply

Available from pharmacy as named patient. Oral liquid kept as stock.

 
   
Fentanyl
(NNU only)
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Red

Indication

Sedation for intubation

Dose

3 micrograms/kg/dose

Administration
Take 1.0mL (50micrograms) of fentanyl and add to 4.0mL of sodium chloride 0.9%. Giving a concentration of 10micrograms in 1mL

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Blood pressure, muscle rigidity and respiratory rate

Further Info:
See  Preparation of drugs for intubation

Supply:
Available from pharmacy as a stock item IV as 50micrograms in 1ml Controlled drug.

 
Controlled Drug Order from Pharmacy in CD request book
   
Flucloxacillin
(NNU only)
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Restricted Drug Restricted
Green Specialist Recomendation

Indication

Infection - beta-lactamase-producing staphylococci.
 
Dose

50mg/kg every 12 hours < 7 days of age

50mg/kg every 8 hours 7 - 21 days of age 

50mg/kg every 6 hours 21 - 28 days of age 

IV = PO dose

For further information see Y&H ODN formulary - Scroll to top

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Renal function, liver function

Further Info
 
Supply
Available from pharmacy as a stock item

 
   
Fluconazole
(NNU only)
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Green

Indication:
Systemic Candida infection
Dose:

Prophylaxis - All babies with central IV access and <1kg

3 mg/kg every 72 hours if less than 14 days of age 
3 mg/kg every 48 hours 2-4 weeks of age
3 mg/kg every 24 hours >4 weeks of age 

Treatment

6-12 mg/kg every 72 hours if less than 14 days of age 
6-12 mg/kg every 48 hours 2-4 weeks of age
6-12 mg/kg every 24 hours >4 weeks of age 

Excreted unchanged in urine so extended dosage interval after first  dose if poor renal function. See Evelina formulary

For further information see Y&H ODN formulary - Scroll to top

See Fungal Infection Guideline

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring

Renal fucntion, U&E, ECG(QT prolongation)

Further Info:
IV contains equivalent of 0.46mmol/kg of sodium for 6mg/kg dose.

Supply:
Available from pharmacy as a stock item

 
   
Furosemide
(NNU only)
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Green Specialist Initiation

Indication

Oedema in heart failure, renal disease and pulmonary oedema

Dose

PO & IV

0.5–1 mg/kg every 12–24 hours, alternatively 0.5–1 mg/kg every 24 hours, if corrected gestational age under 31 weeks.

0.5–1 mg/kg every 8 hours  as needed increased if necessary up to 2 mg/kg every 8 hours.

For further information see Y&H ODN formulary - Scroll to top

Administration

See Medusa IV guide for information on administration - Scroll to top

Monitoring

U&E, Ca, Blood sugars, urine output
Nephrocalcinosis and nephrolithiasis reported with long-term use of furosemide in preterm infants

Further Info:

IV can be given orally. Caution with liquid preparations and their alcohol content

Supply:
Available from pharmacy as stock item

 
   
Gentamicin
(NNU only)
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Red
Indication:
Infection
Dose:
4 mg/kg IV slow bolus
>= 28/40 once daily
<28/40 36hourly
Administration
IV injection over 3-5 minutes or infusion over 30 minutes
Monitoring
Levels before 3rd dose >=28/40
Levels before 2nd dose <28/40
Pre dose levels only (trough).
Levels >2mg/L are considered undesirable, consider modifying dose interval if treatment is to be continued
Levels are not necessary if it is likely gentamicin will be stopped at third dose for negative blood cultures.
It is appropriate to stop blood cultures 36 hours or so after they have been taken, as opposed to when they were recorded as arriving in the lab, if baby was always well.
Further Info:
Gentamicin should be prescribed at 0600, 1200, 1800, 2400 times when being administered on postnatal wards, to minimise risk of maladministration.
Supply:
Available from pharmacy as a stock item. Ensure ONLY the 20mg in 2ml vial is used 
Link  NICE Guidance
   
Ibuprofen
(NNU only)
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Red
Indication:
Patent Ductus Arteriosus
Dose:
10 mg/kg loading dose then,
5 mg/kg OD for 2 days
Administration
slow IV bolus or infuse over 15mins
Oral can be considered if IV access is an issue.
Monitoring
Renal function, liver function, platlets and bilirubin
Further Info:
May be diluted in sodium chloride 0.9% or glucose 5% if necessary.
Avoid steroids during course if possible.
Supply:
Available from pharmacy as a stock item.
Double check strength! TWO strengths currently stocked due to manufacturer supply issues. 
Link  BNF-C monograph
   
Imipenem
(NNU only)
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Red
Indication:
Infection-
Dose:
20 mg/kg dose
< 7days BD
7 - 21 days TDS
21 - 28 days QDS
Dose frequency should be reduced if renal failure suspected and stopped if patient anuric.
Caution in CNS disorders
Administration
IV infusion over at least 30minutes
Dilute to a concentration of 5mg/ml(imipenem) in sodium chloride 0.9% or glucose 5%.
Monitoring
Renal function, hypotension, seizures, myoclonic activity,thrombocytopenia, neurotoxicity(see neonatal formulary)
Further Info:
Also refered to as Imipenem with cilastatin.
Prescribe in terms of Imipenem
Supply:
Available from pharmacy as a named patient.DSU cannot manufacturer. 
Link  BNF-C monograph
   
Immunisations
(NNU only)
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Red
See BNF-C share point document 
Link  BNF-C Monograph
Link  Link to Sharepoint document
   
Indomethacin
(NNU only)
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Restricted Drug Restricted IV NOT available, REVIEW??

Either:
200mcg/kg IV then 100mcg/kg daily for 5 days
or
200mcg/kg repeated 12hourly x 3 doses in total
Watch for renal and GI side effects.
Make 100microgram / ml solution by diluting 1mg in 10ml 0.9% saline, use infusion pump to infuse appropriate dose over 20mins.
 
   
Insulin (Actrapid)
(NNU only)
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Red
Indication:
Hyperglycaemia
Dose:
Dose range 0.02-0.1units/kg/hour
Start at 0.05 units/kg/hour
For hyperkalaemia 1 unit is needed for every 30g of glucose.
Administration
IV infusion
5 units of soluble insulin(Actrapid) into 50mls 5%dextrose(0.1units/ml)
See “Insulin – making up and giving” guideline
Monitoring
Blood sugars, potassium, glucosuria and blood gases.
Further Info:
Prime lines and slowly flush with 10mls of infusion to prevent insulin binding to plastic.
Insulin is generally given by a separate intravenous cannula, but when circumstances prevent this an insulin infusion may be connected aseptically to the ’lipid port’.
Supply:
Available from pharmacy as a stock vial. DSU cannot make due to product expiry.  
   
Magnesium Sulphate
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Restricted Drug Restricted
Red
Indication:
Hypomagnesemia, PPHN
Dose:
For low magnesium (usually <0.5mmol/l) 100mg/kg bd IM or oral usually x 2 doses
For PPHN loading dose 250mg/kg over 10 mins then 20-75 mg/kg/hour IV infusion
Administration
4ml of magnesium sulphate 50%(2g or 8.2mmol) made up to 40 mls with glucose 10%.(50mg/ml)
Monitoring
High doses often produce hypotonia, respiratory depression, systemic as well as pulmonary vasodilation.
Further Info:

Supply:
Available from pharmacy as ward stock. Magnesium Sulphate 50% comes as a 2ml or 10ml ampoule 
   
Meropenem
(NNU only)
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Restricted Drug Restricted
Red
Indication:
Infection
Dose:
<7days 40mg/kg 12 hourly
>7days 40mg/kg 8 hourly
>1 month 40mg/kg 8 hourly
If renal failure of any severity is suspected, reduce dose and interval, see below:
Mild (eGFR 26-50ml/min) 20mg/kg 12hourly
Moderate (eGFR 10-25ml/min) 10mg/kg 12hourly
Severe (eGFR <10ml/min) 10mg/kg 24houly
Administration
Dilute to 10mg/ml (using displacemnt values) in glucose 5% or sodium chloride 0.9%.
IV infusion over 15-30minutes
Monitoring
Review renal function before prescribing and review daily:
Further Info:

Supply:
Available from pharmacy as stock. DSU can supply named patient syringes.  
Link  BNF-C monograph
   
Metronidazole
(NNU only)
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Restricted Drug Restricted
Red
Review dosing? BNFC?
Indication:
Anaerobic bacterial infection
Dose:
15 mg/kg loading dose then:
7.5 mg/kg 12hourly(<28 days old)
7.5 mg/kg 8hourly(>28days old)
Administration
IV infusion over at least 15 minutes
Monitoring
Liver function, FBC,
Further Info:
Dose may need adjusting if baby on steroids or barbituates
Supply:
Available from pharmacy as stock. 
Link  BNF-C Monograph
   
Midazolam
(NNU only)
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Restricted Drug Restricted
Red
Indication:
Seizures, sedation
Dose:
May require a loading dose
60-150micrograms/kg/hour continous infusion
Administration
10mg of midazolam into 50mls glucose 5%or 10% for continous infusion
Monitoring
Heart rate, hypotension, hypotonia, agitation, urine output, temp and .
Further Info:
Can accumulate in neonates, consider reducing dose after 24hours if continuious infusion likely to continue.
Antidote: See Flumazenil
Supply:
Available from pharmacy as stock. DSU can make syringes on request. Controlled drug. 
   
Morphine Sulphate
(NNU only)
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Restricted Drug Restricted
Red
Indication:
Sedation, analgesia
Dose:
20 microcrams/kg/hr
Dose range of 5 - 20 microcrams/kg/hr is normally prescribed
Administration
IV infusion
Standard stock syringes are 2.5mg in 50mls glucose 5% (50micrograms/ml)
Monitoring
Respiratory rate, blood pressure,temperature and agitation.
Further Info:
Prescribe concentration, rate and dose
Antidote: See Naloxone
Compatibility: Glucose 5%, Glucose 10%, Sodium chloride 0.9%,Adrenaline, Aminophylline, Amiodarone, Calcium chloride, Dobutamine, Fentanyl, Insulin, Magnesium sulphate, Midazolam, Potassium chloride
Supply:
Available from DSU as a stock syringe. Order every Tuesday. 1mg in 50ml diluent is also available on named requests. 
   
Morphine Sulphate (Neonatal Abstinence Syndrome)
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted Indication:
Neonatal Abstinence Syndrome
Dose:
Start: 40 micrograms/kg/dose 4 hourly review daily
Reduce as soon as tolerable to:
30 micrograms/kg/dose 4 hourly then
20 micrograms/kg/dose 4 hourly then
10 micrograms/kg/dose 4 hourly then stop.
Discuss sedative use with consultant before starting.
Administration
Oral solution(100micorgrams in 1ml)
Monitoring
Respiratory rate, blood pressure,temperature and agitation.
Further Info:

Supply:
Available from DSU as a stock item. M2(TCU) hold stock for OOH use. 
Link  Link to Sharepoint document
   
Nystatin
(NNU only)
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Restricted Drug Restricted
Red
Indication:
Prophylaxis for ventilated babies < 1500g with central lines.
Treatment of oral and perioral fungal infections
Dose:
Prophylaxis: 50,000units TDS
Treatment: 100,000units QDS usually for 7 days, and continued for 48 hours after lesions have healed.
Administration
Oral
Monitoring

Further Info:
Document on drug chart indication(Prophylaxis or treatment)
If bottle or breast fed administer after feed.
Consider treament for breast feeding mums.
Supply:
Available from pharmacy as a stock item.(100,000units in 1ml) 
Link  BNF-C monograph
   
Pancuronium
(NNU only)
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Restricted Drug Restricted
Red
Indication:
Muscle relaxation
Dose:
100-200 micrograms/kg/dose PRN
Administration
IV bolus over 30seconds
Dilute 1ml to 10ml with sodium chloride 0.9% or glucose 5% (200micrograms in 1ml)
Monitoring
Blood pressure, ventilation requiremnts may increase.
Further Info:
Longer acting than atracurium
Antidote: See Neonatal Formulary 6th Ed
Supply:
Available from pharmacy as stock (2000 micrograms in 1ml)  
Link  BNF-C monograph
   
Paracetamol
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Indication:
Analgesia for mild to moderate pain.
Dose:
IV
Preterm: >32/40 7.5mg/kg every 8hours(Max 25mg/kg in 24hours)
Term: 10mg/kg every 4-6 hours(Max 30mg/kg in 24hours)
Oral
Preterm 28-32/40 10-15mg/kg every 8 to 12 hours(Max 30mg/kg in 24hours)
Preterm >32/40 10-15mg/kg every 6 to 8 hours(Max 60mg/kg in 24hours)
Indicate maximum daily dose in 24hours on chart
Administration
IV infusion over 15minutes
Monitoring
Blood pressure,heart rate(tachycardia),Liver Function,
Renal function
Further Info:
Give undiluted or dilute to a concentration of not less than 1 mg/mL in Glucose 5% or Sodium Chloride 0.9%; use within 30minutes of dilution
Supply:
Available from pharmacy as a name pateint request.
Supplied as 500mg in 50ml vial (10mg/ml)
 
Link  BNF-C Monograph
   
Phenobarbital (Phenobarbitone)
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Indication:
Seizures
Dose:
20 mg/kg loading dose
5 mg/kg/day maintenance
Administration
IV over at least 20minutes(no faster than 1mg/kg/minute)
Take 1ml of 200mg/ml and dilute to 10ml with water for injection(20mg in 1ml)
Monitoring
Blood pressure(Hypotension, respiratory rate
Blood Levels 20 - 40mg/l
Further Info:

Supply:
Available from pharmacy as stock (200mg in 1ml) 
Link  BNF-C Monograph
   
Phenytoin
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Indication:
Seizures
Dose:
IV
Loading dose 15 mg/kg
Maintenance 2.5 mg/kg bd
Administration
IV(ideally centrally) over at least 15 mins(Max rate 1mg/kg/min)
May be diluted if required using sodium chlorde 0.9% ONLY to a maximium concentration of 10mg in 1ml. A filter of 0.22 -0.5micron must be used for diluted IV phenytoin.
Monitoring
Metabolism increases over 5-7 weeks then stabilises, dosage increases will be necessary during this time. Monitor levels
Trough level 40-80 mmols/L or 6-15mg/L
Further Info:
Not compatible with glucose. Flush line with sodium chloride 0.9% before and after administratrion.
Oral dose should only be given 30minutes before or after feeds.
Supply:
Available from pharmacy as a stock item.
 
Link  BNF-C monograph
   
Probiotic (Infloran®)
 Track Changes
Restricted Drug Restricted
RED ULM

Indication:

Prevention of necrotizing enterocolitis (NEC)

Dose:

1/2 capsule ONCE a day with feeds

Administration:

Add Infloran to 2ml milk or water (1 capsule) (EBM / donor or formula) prior to feeds.

Administer half the volume.

If administered mixed with water, give additional to feeds.

Further Info:

As soon as a baby has commenced enteral feeds, and is thought to be tolerating 0.5mls/h of milk.         

Probiotics can be stopped once the baby is 34 weeks corrected gestation providing the baby has been tolerating enteral feeds for the 2 weeks prior to this date

Supply:

Available on NNU as a stock item.

 

Stored in Fridge

 

 
   
Ranitidine
(NNU only)
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Restricted Drug Restricted
Red
IV 500mcg/kg slow bolus qds
or
IV infusion 125 mcg/kg/hour
or
oral 2 mg/kg tds
 
Link  BNF-C Monograph
   
Sodium Bicarbonate
(NNU only)
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Restricted Drug Restricted
Red
2-3 mmol/kg by slow infusion 8.4%sodium bicarbonate = 1mmol/ml
Dilute with water Monitor infusion site closely, extravasation can cause severe tiisue damage
 
   
Sodium Phosphate
(NNU only)
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Restricted Drug Restricted
Red
0.5mmol (=1.6ml) bd. Prescribe as mmol
stop at discharge
 
   
Spironolactone
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Restricted Drug Restricted
Red
1 mg/kg bd initially
Oral
Potassium canreonate (Soldactone or Aldactone) 1-1.5mg/kg/dose (usually bd) can be given IV.

Soldactone dilution: 200mg vial, add 2 ml H20;
then take 1 ml of this ’Soldactone’ solution and add 9 mls 0.9% NaCl; this solution has 10mg ’Soldactone in 1 ml. Give the appropriate dose as slow bolus over 3 minutes.

Potassium canreonate also comes as ’Aldactone’. Vial is 200mg in 10 mls. to make up, take 1 ml (=20mg) of solution and dilute to 20mls with 0.9% NaCl. This solution is 1mg/ml. Give the appropriate dose as slow bolus over 3 minutes.
 
   
Sucrose 66%
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Working weight <750g - 0.05ml (31.25mg) max tds
750g-999g - 0.1ml (62.5mg) max tds
1000g - 1499g -0.2mls (125mg)
>1500g - 0.4mls (250mg)
 
   
Sytron (Sodium Feredetate)
(NNU only)
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Restricted Drug Restricted
Red
0.5 mls tds from 1 month if not on mostly formula feeds 
   
Tetracaine 4% (AMETOP®)
(NNU only)
View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green Specialist Initiation

Indication:

Local Anaestetic - Lumber Puncture(NeoClear)

Dose:

Apply contents of tube (or appropriate proportion)

Administration:

Apply to site of lumber puncture and cover with occlusive dressing; remove gel and dressing after 30 to 45 minutes for lumber puncture.

Monitoring:

Local skin reactions 

Storage & Supply:

Available on NNU as a stock item. Stored in Fridge

 
   
Tolazoline
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
1 mg/kg IV over 10 mins
then 0.2-2 mg/kg/hr Stock 25 mg/ml
Weight x 50 mg tolazoline diluted to 50 mls in 5% dextrose
1ml/hr = 1mg/kg/hr
 
   
Trimethoprim
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Treatment mature babies
4 mg/kg bd oral
Prophylaxis 2 mg/kg at night 
Link  BNF-C Monograph
   
Trometamol (THAM)
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Try 1.5mmol/kg (5ml) infused over 30mins and then reassess Usual stock is 0.3 Molar =0.3mmol/ml
Watch for respiratory depression
 
   
Ursodeoxycholic Acid
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
10mg/kg twice daily 
   
Vancomycin
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
15 mg/kg/dose bd infused over 1 hour
Start every 24 hours if <28 weeks.
Use 12 hourly if postmenstrual age >28/40 and 8 hourly if postmenstrual age >35/40.
Use with caution if renal impairment 500mg vial dissolved in 4.8 mls water NEEDS FURTHER DILUTION TO
5 mg/ml by mixing 1ml of this concentrated solution with 19mls 5% dextrose.
Levels: pre-dose(trough) 10-15 mcg/ml
 
   
Vitamin E (Tocopheryl Acetate)
(NNU only)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
  • 50mg once daily O/NG (not a /kg dose)
  • 50mg=75units 
  •    
    Vitamin K (Phytomendione)
    (NNU only)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
  • 1mg once daily O/NG (not a /kg dose)
  • Base Line clotting required and regularly monitor  
  •    
     ....
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Amber

    Medicines suitable to be prescribed in primary care after Specialist* recommendation or initiation. A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust D&TC(s). *Specialist is defined as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice.   

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (D&TC) * All drugs awaiting the production or approval of a shared care guideline default to RED   

    Cancer Drug Fund

    Cancer Drug Fund   

    Green

    Medicines suitable for routine use and can be prescribed within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.  

    Green Specialist Initiation

    These drugs should be initiated only by a hospital or specialist clinician (GPSi) but there is no requirement for additional monitoring over the general requirements for all medicines. Some may require short or medium specialist monitoring of efficacy or dose titration before transferring in Primary care. The GP should have all the information they require to support continued prescribing.   

    Green Specialist Recomendation

      

    Grey

    Grey - Medicines, which the Drug & therapeutics Committee has actively reviewed and does not recommend for use at present following a review of clinical and/or cost effective data. Grey (assessment in progress) - will be reviewed at a future D&T meeting. Grey (awaiting submission) - The D&T are awaiting a submission from an appropriate practitioner. If you wish to make a submission for this medicine to be added to the formulary please email drug.information@bthft.nhs.uk .   

    Non Formulary

    Not recommended for prescribing as initial therapy, but can be continued if patient already stable on treatment   

    Red

    Medicines which should normally be prescribed by specialists only. ** For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care   

    RED ULM

    Unlicensed Medication  

    netFormulary