III
Threshold for Considering Photothera-ID'.­
for Gestation
10 11 12 13 14
A9.<:JcJ.ayS)
Z4
22 -­ ;950g
--<J- 751'I,OOOg
-­----­ --1__ I,001-1,9S$g
20
-0- 2,OOO·2,499g
__ 2,500.2,999g

16
'" .§. .---....-... ... .. ­ .. -"­
IX!
16

+-:w--·----­ ---··-···--·····-------------·­
14
12
__.___ for Exchange Transfusion
for Infants <: 35 weeks Gestation

g
II)

16
16
14
12
10
6
10 11 12 13 14
Age (da)/s)
Birth Weight Begin stop/Restart"
I Phototherapy I
7 days of age
I <750 9 I
12 hrs of age
I
TSB5mg/dl
I 751·1,000g 12 hrs of age
L
TSB5 mg/dl
*feeding Schedule *
SUGGESTED FEEDlNG SCHEDULES
Volume 5m:d In mllkolday
75HOOOg >27 w1<s Q! 1-_,-_--,_--,rPF2_O_"'..,E_BM__,-_-._-,--+_-,-PF2_4_or--,RlM,--,-:-:---t__+_---'r-_..,
> loo();j < 32 wks 20 I 30 40 I 60 80 100 I 120 120 140 160
1801·
2250g"
Nipple and
:!: 33 v.+.s q3h as
""""'""''1
PF20 or EBM P'F24 or FBM
40 I 60 120 I 160
EBM '"'expresse::l breast mllk= full strenQth unfortified human mUk
PF20 • =prernature formula 20=20 kcaVol Enfamll Preterm Upil Fonnula with Iron Of Similac Spe::iaJ Care Formula with Iron
.. fortilie:l breast milk with one packet Human Fortifier/25:c or human milk mtxed 1: 1 with Similac NallJral Care
PF 24 • premabJre formula 24",24 kcal/oz Enl'amU Prm!rm Upa Formula with Iron or Similac Spe::ial Care Formula with iron
-For Infants :>34-36 WI!eks gestation, ad lib feedings with a minim um volume for each feeding may be ordered.
Sodium Requirements: 2-3 mEq/kg/day
Potassium Requirements: 1-3 mEq/kg/day
Calcium Requirements: 1-2 mEq/kg/day
Glucose ReqUirements: 4-8 mg/kg/min
GIR: {Total cc/kg/day x % Dextrose (D10W = 0.1)} x 1000 = mg/kg/min of glucose
1440 minutes/day
In the first 24° oflife
Birth WelQht
Type
D10W
1501·2500g D10W
1001·15000 D10W
.:10009 D5W
D7.5W
D10W
Stop/Restart" I
Exchange
7·14davsofaoe . Transfusion I
TSB 5 mg/dl TSB:013 I
TSB 7 mg/dl TSB mg/dl I
0-24 hours after birth
Total Amount· Glucose Infusion Rate
A
60-80 4.2·5.6
80 5.6
80·100 5.6-6.9
100·120 3.5·4.2
100-120 5.2·6.3
100·120 6.9·8.3
"Total Amt=cdkgl24hrs "G I R - mglk.q/min
• Once phototherapy IS initiated, It should be continued for at least 24 hrs, regardless of bilirubin levels.
301036 Ot014 12
>14 e­
37\044 0107 12
>7 8
66
>45 All 6--
UsUtll tV ccr.cen'ration: 30 mg.m! (max lOOrnglmt for IV push only)
"Doses of 300-400 lng/kg/day 1IhO&t!d be re$8lved for pelients with If non-mcningi l ic:
infectiQl"la, UN 50 mgikgJdose
UTI ....tten PO c611oo1 be !)j'.-on: 2S mglkgldoM IV given 024h
Gentamicin QV IML
COI"recled Gestational
AM we.ks

(m.=o..)
4
Interval
hours
36 go All
30 to 34
oto 7
>.
4
4
36
24

0107
>.
4
4
24
02
Usual IV concenllalion. 2 Iflglmf (max 10 mglml)
u{)o not draw tobr..mycin levels If Iha anticipated antibiotic course is <3 deys panding culture
results. If 1h8lapy is to continue >3 days. draw a peek and it 1f000gtliavei around the 3
d
dose.
renal impairment is suspected as rn8nife&lcd by an increeMd SCr or decreased UQP. draw a
trougt level prior to the 2..d dose and hold the dose unlil the trough leV81 is known. Therapf!utic
levels. Peak: Trough: <2pglml.
Vancomycin (IV) (ReseNe lor suapected or documerHed resistance 10 methicillinlnaf&illin: ch.nge \0
for MSSA infections
Corrected Gestelional
A""' ......

301036
10.. 1:;2
37 to 44
Postn....' .Age (hours)
Nomogram I· Risk zones for developing hyperbilirubinemia'"
!45

• '·00 nol dral\' vancomycin le'lels if the enlieipeted anlibioCic course is <3 days pending C4Jlwl& results. If
.
Ulelapy IS (0 continue >3 day!. draw only II b"ough level priOf to the 3'" dose. If renal impairment is
.-
uuspecled as manife&ted by all inaeased SO or <Mae.ed UOP. draw II trough level prior to the 2"'-: dose

hold the dMe until the trough le'0'81 ill known. Therapeutic trough leWis: 10-20J..!gfml.
Ususl '!V oone.ntrelion. 10 mgJml
Postnatal Age
davs
All
AU
0-14
>1 4
All
i
2» 2.42 r ob/am "",(IV. 1M)
.....+............... ...... ••••- :
Corrected Gastatio .....1 09yo' Life
,....

:t 1< . , ...........+...........:.... .­
All <29
251
--.: ...........:...... ..... (. -. ...
Oto 7
301034
>6

---i._m.. ".L.;;;p.:...>+.u
.
171
0107
!35
>. 1 -- -; # -, • :- -...
Uwa! IV concentration. 2 mg/rnl (mu 10 mgfml) .+
m=ose
15
15
15
,.
20

4
4
4
4
4
'n\eMlI
hom,
02




-

'"
24
'"
24
12
+

"00 not drOllw tobramycin le'lels if the anticipated antibioti c couree is <3 days pending culture

results. IIthetapy i s 10 continue >3 days, draw a peak and a bough level eround the 3'" CO$e.
6S
• ..... 01 k>"K=r (:;0« ::18 vJk lIr.d _
renal impaillnent is suspected as m.nlfesl8d by an increased SCI" or decreased UOP, draw a
bough level prior 10 the 2"" dose and hold tho dose until the bough level ia known. Therapeutic
levels: Peak: 5-121o'91ml: Trough:
r---+-- - - t,,/)I:nl., III me.ctutr> ,*1< (:c: 38'M1: + rios.l: f1'tl.."'t:>tS :'lf3!)':,'! fll wdl
o 1nJ,t.fll!t!l.l f..? ,...y. . • ••.
Totr-<lmyc:in for inhalation: 80mg Inh qBh (not weight baaed)
A!;'t'I tlfJf) 7(h .%I! 60ay& 70-;..),s
Caffeine Citrate (Cafcit®) (IV. PO)
A96 Loading dose: 20 mglkg of caffeine cill'ate
Maintenance dose: 5 mglkgfdoM Q24h; hlgherdo.s up to 10 mglkglday may be uaed for
Nomogram 2· Guidelines for photothe"'-pyfor InfantS 35 wks gestation
symptomatic patients.
(Aft&!" a division discussion of the availabl.a e'lidel\C6 from triala, it was decided thOlilroutine
drug levet monilorint; not indu:a.t6d.) l.vels wfI1 be ordered aa needed for poor
therapeutic r8spcnM or for aide effecl&.. U8Ual serum concenlllloon: S·25mcglml
Usual concentration IV and PO: 20 ffi9lml
Survenla® (ET)
4mllkg
May be Given Qeh )!: 4 doaea
Order b8aed on the patienra reaponsa. If required. give initial dose ASAP fOl
25 mglml
--
elood Component Thert:1pY
PRBCs: 20cc/kg over 4 hours (CMV·negative, irradiated, leukofiltered)
Platelets: 10-15 mLlkg for neonates < 10kg; 1 unitl10kg for infants> 10kg
o Expected increase is - 50,000/L (ideal recovery) ;
Post·transfusion count within 15-60 minutes may be beneficial
o Recommendations for use include:
Pits < 20-50 x 10
0
/L in stable premature infants
Pits < 50-100 x 10
9
/L in ill premature infants
Pits < 20 x 10
9
/L in stable term infants
Pits < 50 x 1 09/L in term infants wI active bleeding
Pits < 50 x 10
9
/L if invasive procedure is planned
Pits < 100 x 10
9
/L if on ECMO .
FFP: 10-15 mLlkg (for a 15-20% rise in coagulation factors)
o May be repeated 3x124 hrs if needed
o 15-30 mUkg for hemorrhages
o Indications: Replacement of clotting factors (OIC)
Whole Blood: Vol. of blood to be exchanged = Baby's Wt (in kg) x 85 x 2
o Indications: Exchange transfusion
Nutrition:

EstImated hecd5 fDr growth: goal is no-l50 kcaV/r::q/day & ] ,5-"1 91'110'15 protein/kg/dillY (preterm)
!it0rai1s 100-130 kCiIIVkg/dillV & 1,,£-2.2 gnltrs proteinllaj/day{term)
When ant.,.1 r.eds are.t:
. SO or 9Occ/kg dCUea5e lntnIpids to 2g,.""kg/day
UQcc:/ k'll dlscvnlinue both TPH and Imtaffpids
fortify breast rmk In PfenatUle babk!s wIth
.
R
Hwnan ,.tiCk FoftifleJ (t-M71 padcd : 25 m1 EeN =2'1 kallo: i

CI--
SJrmac Natural Cate--t/2 EBM: 112 fornw=22 keal/Ol
3
Ho t e.: . Ht·1F Is HOT "pproJll'latc hI( term Infants, you can .add wI iIInd nwlents to fe,., \'r'if,h standard e jjj !
.2 " powdered forniUla
]


S ;;.
AAP for Brust Fed Infants:
. tii
If baby b on breast milk alone (wtthout HMF)...
,.
U • was add 2 m:llron,lkg/day 8& 200 lU mrrin DJdit(
02:
Add 0..5 ni Poly-vt·sol ....llh 1100 for (nrar,ls <2500 q
Add 1 mI Poty·vI-sol ....Ji1h Iron rOf Wants >2500 9
S
& was now <'I rncnlhs of age, 200 IU vitamn DJday
& was term now >4 of <J9C, add 1 Inglron,lt9lday f( 200 IU vitan'tn O/day
(,)
J
0
1
0"'2

e
U baby ls on breast milk &: rOJmlJla•••
e;: E I
M
wo
Vitlmll1 0 add 200 IU vtlwn D/d<ry if Infant la.kes <SOO n\l. 01 formula/day 9
Iron for temllnfal'll'i, add IIT1J Iron/kg If Infant ukes <90 0( fOMt"t ub ;;
prcl elnllnfonU need II total 0(2 mg Iron/k9/day e T
Note: .Vl·SoI products Iron contain 400 IU 'o'ftamln D Dnd 10 rf9 fron per 1 mI :!.
.Jf babies >., moni.hs of a9C lake 2 servings/day of lIon rortifle.d cereal or no addlUanal
k on Is A
r
Jl
At Discharge.:
]]"
If blrtflwelght Is... send home on .' s
§
..
<1250 g folow up fonrr.rld (Enfaure. or Noo,l;lJre) E
US1'18S01jl folo\'l up formJla it dlschiHgc: wd!1ht Is ... 2500 grams
E
j I
8

0
>1650 9 still'.dard formula
Note: <I Hay also amskJer llW1g to/IrK" up fom"lU/a In th!!! hospital for JUemltvre Ihf'anb \-mo Me 9JCM'Inq 0
N
..
,veil and >3--1 kg
2
Q Auus Growtfl :
Wdght length Foe
"
J Prctefl11 « 2 kg) 10-20 g/lajJ<J", 0.B·1.1 clfW'WtA.Jc 0.S·1.0 cnVvIlc
Term (>2 kg and <3 mo. corrtttcd) 2(HO gJday 0.69·0.75 cmA'.-eek

0. 1· 0.6on,iwt •­ .!:!
.. Term mo. eorred.ed) 15-1,0 gJdWf ....0.5 (""weI!.Oc
E
Tel"' (6· 12 mo. corTCcted) 10, 1.5 g/day ...O.J i


NEONATALPARENTERALNUTRrnoN !
'"
EstImated need. for growth: 900II15 90· 115 Io:caI/kg/day & 2.7· 3.5 51ramo/k<J/day(prelrrm)
9oa11s BO· 1J() kcal/Io:g!day &. 1.S.] 51rftmS/kg/ dily (term)
fllIl!l
Use btrth WC5lht to Ilgwe fluid needs unti Ihfant's wdqhlls abave A dry weight 1llo1)' be used If
!)QUem is Avid overloaded. Dry weights need to be weak:y. llldl.:de aD IV TVrl,
enter.i4 fEeds. f'nedk:atlons., and lipid endsions In fbld a!cuIaUons.

Fl uid nHds. 0 ·24 hours of rife
61rthweighl (9) T\1>' (<</kg) GlJt
Sodium Bicarbonate (IV)
Gestation weeks Hemoglobin [g/dL mean ± SD
Hematocr it 1% mean ± SD)L
18-21 11 .7± 1.3
37.3± 4.3
22-25
12.2±1.6
38.6 ± 3.9
26-29 12.9± 1.4
40.9 ± 4.4
>36 16.5± 1.5
51 .0± 4.5
.;

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i

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E
N
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N.MI

.11

110

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Clan.
DISCMARQE CMECK LIST
TutlProceduralOrden
Cast Manl ars nollnad or ola"I1.1 dischalila

Fllmlfy c.ra coordlnal or tl ol Mad of pol.tllI.1
dlschar a
Ha alilis B v. cdna
Routln. Immuntzallons (II' .lIgJbl. (i!I 60 day')
C1rcumcl lion
S1ata scrlln
HU M t etlin ABRlfa IIcable
Eya aum (If applic able: <32 w..ks or "oograms)
I.al a HUS rr applicable: <1500g. 1500·2000g It'
v. nl ll,ltd; DOL .a0. 001. #90)
D. vt lopmt rllel tum and ECI f.r.rral Qr appllcabla:
<34wttks .nd 2000-9)-
Pfascrl plions (wrItI an on outpall<lnl prescriptions
and glVan 10 paraol, 4&-72 houlS bafora dlsch.rga.
10 ba tlilad PRI OR to dllCharg.) and Ins(rucllon, for
admlnlstralion lveo
Spacial formula Wl C Form complaltd aod spacial
rormul a .ducation ;1\I.n by dJ.IIUan or nuru
RSV prophytaXls or appllcabla)
Car seal avallabla
Car SlIIt Chall angt (It'.'ppllc,blt: <37wlllcs. <2500
t am, . or
Cara By Pllanl room rauIVad if nlld' d)
Clsch.flla summary complalad
Olschuga summary copl.s prinl.d 3
Ordtr 10 dl schar • homa written
ROP auideUnes
MID 10 I£[•• n ann!., t u m) bymak of Ilfa !WOO pnd dav 9' Irr.CQQL ) .
E
.•
-,
J
Corrwmnls
[S.. 1mmunlullons'
(Se c1ton 0 und.r
Infec1lous DlJusu)l
[S.. SUllnlo5l"
(StcUen C undar
Mlstallanaous)1
(S.. 'nlra,(anl.1
Hemorrhagt and
Pet1venlricllltr
l eukomatacla' (Se,lIon
A undar NturolOIN)]
[S.. ' mmuntlallom­
(Stellon 0 undar
Inf.c1lous Dlsn",)]
walght
< 1500
< 1500
< 1500
0( 1600
0( 1500
:s; 1500
> 1S00 g
""'" aga al blrl h
2'2 wuks
23 waak,
24 w"k,
25 w••ks
26 w..ks
27·l0 weakl
>30
G utal/onal
WOl9 WOl8 WOl7

X
EX.m .131 wttlcs 0s1n8la1. a or.1 a
WOL6

a <4 wttlcs
WOl5
(OOL
35--4'
tilth aVer Is
WOl<4
(OOL
29-34
(a.,,,l
It sedati"es
Rootine treatmenl of metabolic acldosia: 1·2 mEQIkg
s 1000 05 100·120 3.5· 4.2
Pain
Infuse over 1 hour
07.5 100·120 S.2· 6.3
In cases of sew,e reapirlltory ecidosis, II continuoua i nfusion may utilized :::hort torm.
010 1CXH20 6.9·BJ
Fentanyi (IV)
1001-1500 010 80·100 5.&-6.9
Continuous 0.s..1 mEqI'.<glhr
infusion dose Thia will be a large volume of fluid end Mit alao
1S01· 25OO DID 8. S .•
,ovide 0!.12 mE;/kg/davof Na.
St.ndard 2S mEq of sodium bic.ubonato in 50 cc of steri!e
>2S00 DID 60-80 4.2·S,o
concentration wat.r or D5W 0.5 mEQI'ml
MilqoolJtrlenb
Infusion r.l. mlhlr = I W1 It delir.ct daM mE h, It 2
Inl\latc by Goal P'ovldcs
IntnJJpld 1 q/Iq; 19lk51 3911aJ
D.utJose S·7 GIR 1·2 GIR 12 GUt J." kraVg
Protldn (Prunuol) ) ·2 g/kg 191k9 3·3.59,1(9 '! kcaVg R.espiratory
Albuterol (Inh) El ectrolytes:
Nabulizlld SOlution: 1. 25-2.5 mg in 3 ml NS 0 2..eh pm Sodium .
..,,,0"-_--,
infusion dose
Palienl
W8\(lht
Fot patlanls 0( 1.6kg For patl4lnts 1,6 k g
250 mierogtams in 500 micrograms in
5 (10
mlfur - pt wt (kg) x ml/h, - pl ....1 (kg) x
InfuSIOn ral e deslIed dose desired doe.
(mool1<a/mln + 5 mcgAo;n'min + 10
Usual IV ampule concenlJ'alion. SO microgramsfml
IV reqUirements: 2,) InCq Ua/kg 2·3 mEq I(Jkg (4 puffs MOl =2.5mg nebulized) •
Ev.lluale.uslng (utTenl tab data. In extnlmo callOS of a continuous inhalation may be utilized .hort 'arm for
l orazepam (Allvan®) (IV. PO)
p.1tienls 00 the ventilator or CPAP:
O.OS..().l mgNg/dose 04-61'1 pro
Calcium &.Phosphorus UwaliV concentralion: 2 mofml. uwel po concentration: 2 mglml
2.5 mgi&ollhr " 31 mg of in 100 ml NS (swdng doae)
5 mgfBm'lllr :I: 63 mg of .Ibulerolln 100 mt NS
U,l;ual rv rC!qulJ'erroC!.nls: J-1.S rr£q CJ/k9 ),2 mmol P04ft<91day
10 mr;1BmVhr 125 mg of IIlbutetol in 100 ml NS
Gtve standard Ca &. PO"' / 100 a: In rrost Inst<m:cs. Midazolam (Versed®) (IV. PO)
20 mglBmVhr =250 mo of albutflfol in 100 ml NS
For 1 m-b4 of PO., must. haY!! at least 1.31 mfq Ua andlor 1 ... 7 mEq of K In U'!e soluti:ln -rs line agent ·lolel3noo develop& repldly.
Racamic Epinephrine (Inh) Inlermit1ent Dosin : 0.05-0. 15 mQ/kgldo&e 0 2-4h P!n
Ma9neslum 0,5 ml of II 2.25". solution Continuous
Uwel rv Il!qUl:ef'nenh: 0.5-1 mEq ''',glkg Oexamelhaaone (IV, PO) intuaion dose
GlYo! SoIlIn:fard t1g /lCO« un/es.s mom ret'cNed "'9 durtnSl dei'-'ery. If rrom 1-;9, walt <l8·n hourr ..., Usual concantralion IV: 0.1 mglml (m. x 1mgfml). PO: 0. 1 mglml (mllx 1 mglml ) Patient
IhCl'l n.lrt standard "'.9/100 (C. The regimena have been ebJdied in randomized trials lot prevention of BPD: waiaht
Standard
Trace Ell';menb 1O-daylower dose Leper r-vimtn LW et Pediatrics 117:75-83. 2(08)
(nl'JSt marked on TflN fom1) mglkg 0241'1 x 3 days
For nlDst b"bles 0.10 mglkg 02<4n x 3 days
(witll:Jut 14cctrace·4): For babCe.s. \\11.11 elevlltl!d direct bll !rubln 0.05 mglkg 024h x 2 days Infusion late
PlbJO (with or \\<ftho\tt Neotn.c:e-4): For babies v.ilo ru.ve. re<elved enlefal nutlit.lon >30 days 0.02 mg,1lo 02.... x 2 dave;
1().60 microgt';!lm Sikglh
1.6 -3 kg > 3 kg
< 1.6 kg
3.5 mg in SCmI 7.5 mg in 5Om1 1.5 mg in 5Om1
D5W DSW D5W
0.03 mahnl) (0.07 m9i!D\"-ll l rl
mllhr =pl.....t (kg) mlitlr .. 1'1 wt (kg) It mill" - pt wt (kg)
It desired do.. dasired dON It desired dose
mCCWkQ/hf\ '" 70 m
m...."gJi,') . 33
Renal OyrlunctJon (without NeotnrM): For bablC!o "vith suspected rEllal dysfunction bo\ nol on U$UalIV \I1el concenltalion. 1 mgr'ml
V{lth &. l entil dysfunction Hatlc "tb lind 51lve line only Because of concerns ebout the long lerm !l!de cffecb of po3tnllbl dexamethasone in prelarm
infanta. currant practice is shifting to smaUer dosas and short ... courses. Consul! Vllth tho Morphine (lV. lM. PO)
atLending regllrding the pf8lerred dexamethasone regiman for Individual patient ..
Patient wei ht < 1.6 k
Slandard
1.5 mg in SOml
concentI.lioo

l mllhr '" pi wt (kg)
mllhr - 1'1 wt (kg) x
dulred dose
mcafKalhr + 150
Intermillenl Coal : 0.05-0.2 mCl1c.Q/doae Q4-eh Dm
(must be on TPN form)
ContinlJOUS
10-20 microoramsfkQ!h
",fusion dose
peripheral Ilne$: 0.1 mglkgldoa.IV or PQ012t1 x 5 do... (Qiv. 2 doses prior 10 eehllduilld exlubation)
For airway edem. !n infants v.t.o hevo previously f. ilad exlubatJon (nol V\411 studied)' All cenl13l KOOS and lool) 0.2S -
>3k 1.6-3
7.5 mg in !5Om1 3.5 mg in saml
Methylpreni.olo:'le (IV)
For acute eXllGorbalions of reacbVe airway diMliM
ca 2.0 "9=1rrEq=O.5 1'11·101
1 motkg1dosc 012h x 2 doses then 0.5 mgikgldO .. 0 I 2h x 4 days
mlfhr " plwt(kg»)C
!·1g 12 rrg=1 rrEq::.O.51'Ti>1O\
A onc·time do!;O of 10 mg/kg may be uaed pre-operative!y for palienl£ undergoing &urgary
I"fusionr.'e It desired dose
,.Ia 2J mEq=1 m' )oj
wiln
mCQI'k.aIhr) + l3
I: 3911"9=1 rr£q=1mf-'.o1
Usual concontration: 4 mglmf
Uau.IIV VlSI concentrlltx)J'! 2 mglmI
a 31 n'9- 1 nilOl