Neonatal Intensive Care Drug Manual

Neonatal Intensive Care Drug Manual
Canberra Hospital
Contents:
INTRODUCTION .................................................................................................................................. 7
DRUG NAME ......................................................................................................................................... 8
ACETYLCYSTEINE (INHALATION THERAPY) ........................................................................... 9
ACETYLCYSTEINE (MUCOMYST) ............................................................................................... 10
ACICLOVIR ......................................................................................................................................... 11
ADENOSINE ........................................................................................................................................ 12
ADRENALINE (RESUSCITATION) ................................................................................................. 13
ADRENALINE (INFUSION, INHALATION) .................................................................................. 14
ALBUMIN............................................................................................................................................. 15
AMLODIPINE...................................................................................................................................... 16
AMPICILLIN ....................................................................................................................................... 17
AMPHOTERICIN B ............................................................................................................................ 18
AMPHOTERICIN B (LIPID COMPLEX) ........................................................................................ 19
ASPIRIN................................................................................................................................................ 21
ATENOLOL ......................................................................................................................................... 22
ATROPINE ........................................................................................................................................... 23
AZITHROMYCIN ............................................................................................................................... 24
BUCCAL GLUCOSE GEL 40%......................................................................................................... 25
BUDESONIDE ...................................................................................................................................... 26
CAFFEINE BASE ................................................................................................................................ 27
CALCIUM GLUCONATE .................................................................................................................. 29
CALCIUM CARBONATE SUSPENSION ........................................................................................ 30
CALCITRIOL ...................................................................................................................................... 31
CAPTOPRIL......................................................................................................................................... 32
CEFOTAXIME..................................................................................................................................... 33
CEFTAZIDIME PENTHYDRATE .................................................................................................... 34
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Canberra Hospital
CEPHAZOLIN ..................................................................................................................................... 35
CHLORAL HYDRATE ....................................................................................................................... 37
CHLORAMPHENICOL...................................................................................................................... 38
CIPROFLOXACIN .............................................................................................................................. 39
CLINOLEIC LIPID EMULSION ....................................................................................................... 40
CLONAZEPAM ................................................................................................................................... 41
CLOTRIMAZOLE ............................................................................................................................... 42
CO-TRIMOXAZOLE .......................................................................................................................... 43
CRYOPRECIPITATE ......................................................................................................................... 44
CUROSURF: PORACTANT ALFA ................................................................................................... 45
CYCLOPENTOLATE HYDROCHLORIDE EYE DROPS (0.25%) .............................................. 47
DEXAMETHASONE ........................................................................................................................... 49
DIAZEPAM .......................................................................................................................................... 51
DIAZOXIDE ......................................................................................................................................... 52
DIGOXIN .............................................................................................................................................. 53
DOBUTAMINE .................................................................................................................................... 54
DOPAMINE .......................................................................................................................................... 56
EPOPROSTENOL ............................................................................................................................... 57
ERYTHROMYCIN .............................................................................................................................. 58
ERYTHROPOIETIN ........................................................................................................................... 59
FENTANYL .......................................................................................................................................... 60
FERROUS SULFATE (FERRO-LIQUID) ........................................................................................ 61
FLECAINIDE ....................................................................................................................................... 62
FLUCLOXACILLIN............................................................................................................................ 63
FLUCONAZOLE ................................................................................................................................. 64
FLUMAZENIL ..................................................................................................................................... 66
FLUTICASONE (FLIXOTIDE) ......................................................................................................... 67
FOLIC ACID ........................................................................................................................................ 68
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FRUSEMIDE ........................................................................................................................................ 69
GANCICLOVIR ................................................................................................................................... 71
GAVISCON (ALGINIC ACID) .......................................................................................................... 72
G-CSF (GRANULOCYTE-COLONY STIMULATING FACTOR................................................. 73
GENTAMICIN ..................................................................................................................................... 74
GLUCAGON......................................................................................................................................... 75
HEPARIN.............................................................................................................................................. 77
HEPARIN CVC LOCK ....................................................................................................................... 78
HEPATITIS B IMMUNOGLOBULIN .............................................................................................. 79
HEPATITIS B VACCINE ................................................................................................................... 80
HYDRALAZINE .................................................................................................................................. 81
HYDROCHLOROTHIAZIDE ............................................................................................................ 82
HYDROCORTISONE ......................................................................................................................... 83
IBUPROFEN ........................................................................................................................................ 85
INDOMETHACIN ............................................................................................................................... 87
IMIPENEM/CILASTATIN ................................................................................................................. 89
IMMUNOGLOBULIN IV (INTRAGRAM®P): DRAFT .................................................................. 90
INDOMETHACIN ............................................................................................................................... 92
INFANRIX HEXA................................................................................................................................ 94
INFLORAN® ........................................................................................................................................ 95
INSULIN (ACTRAPID – FOR HYPERGLYCAEMIA)................................................................... 97
INSULIN (FOR HYPERKALAEMIA) .............................................................................................. 98
IPRATROPIUM BROMIDE............................................................................................................. 100
ISOPRENALINE ................................................................................................................................ 101
ISOVUE ............................................................................................................................................... 102
LABETALOL ..................................................................................................................................... 104
LACTULOSE ..................................................................................................................................... 105
LEVETIRACETAM (KEPPRA)....................................................................................................... 106
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LIGNOCAINE FOR SEIZURES ...................................................................................................... 107
LIGNOCAINE FOR LOCAL ANAESTHETIC, CARDIAC ARRHYTHMIA ............................ 109
MAGNESIUM SULPHATE .............................................................................................................. 110
MAGNESIUM ASPARTATE ........................................................................................................... 112
MEROPENEM ................................................................................................................................... 113
METOCLOPRAMIDE ...................................................................................................................... 114
METOPROLOL ................................................................................................................................. 115
METRONIDAZOLE .......................................................................................................................... 116
MICONAZOLE (TOPICAL GEL) ................................................................................................... 118
MIDAZOLAM .................................................................................................................................... 119
MILRINONE ...................................................................................................................................... 120
MORPHINE IV .................................................................................................................................. 121
MORPHINE ORAL ........................................................................................................................... 122
MYLANTA ......................................................................................................................................... 123
NALOXONE ....................................................................................................................................... 124
NEOSTIGMINE ................................................................................................................................. 126
NORADRENALINE .......................................................................................................................... 128
NYSTATIN (ORAL) .......................................................................................................................... 129
NYSTATIN (TOPICAL) .................................................................................................................... 130
OCTREOTIDE ................................................................................................................................... 131
OMEGAVEN 10% LIPID EMULSION........................................................................................... 132
OMEPRAZOLE ................................................................................................................................. 134
PANCREATIC ENZYMES/CREON................................................................................................ 136
PANCURONIUM ............................................................................................................................... 137
PANTOPRAZOLE ............................................................................................................................. 139
PARACETAMOL (DRAFT) ............................................................................................................. 140
PENICILLIN, BENZYL (PENICILLIN G) ..................................................................................... 143
PENTAVITE (MULTIVITAMIN PREP) ........................................................................................ 145
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PHENOBARBITONE ........................................................................................................................ 146
PHENYLEPHRINE HYDROCHLORIDE EYE DROPS (2.5%) .................................................. 148
PHENYTOIN ...................................................................................................................................... 149
PHOSPHATE SUPPLEMENT ......................................................................................................... 151
POTASSIUM CHLORIDE ................................................................................................................ 154
POVIDONE-IODINE (BETADINE) ................................................................................................ 155
PREDNISOLONE .............................................................................................................................. 156
PREVENAR 13 ................................................................................................................................... 157
PROPOFOL ........................................................................................................................................ 158
PROPANOLOL .................................................................................................................................. 159
PROSTAGLANDIN E1(ALPROSTADIL) ...................................................................................... 161
PROSTACYCLIN PGI2(EPOPROSTENOL) .................................................................................. 162
PYRIDOXINE .................................................................................................................................... 163
RANITIDINE ...................................................................................................................................... 164
RECOMBINANT FACTOR VIIA .................................................................................................... 165
RESONIUM A .................................................................................................................................... 166
RIFAMPICIN ..................................................................................................................................... 167
ROTAVIRUS VACCINE ................................................................................................................... 168
SALBUTAMOL - FOR I.V. ADMINISTRATION ......................................................................... 169
SALBUTAMOL (NEBULISED) ....................................................................................................... 170
SANDOGLOBULIN (NORMAL HUMAN IMMUNOGLOBULIN) ............................................ 171
SILDENAFIL ...................................................................................................................................... 172
SODIUM BICARBONATE ............................................................................................................... 175
SODIUM CHLORIDE 20% (NACL) ............................................................................................... 177
SOTALOL ........................................................................................................................................... 180
SPIRONOLACTONE ........................................................................................................................ 181
STREPTOKINASE ............................................................................................................................ 182
SUCROSE ........................................................................................................................................... 183
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SURVANTA: BERACTANT ............................................................................................................. 184
SUXAMETHONIUM CHLORIDE (SCOLINE) ............................................................................. 185
TEICOPLANIN .................................................................................................................................. 186
THEOPHYLLINE .............................................................................................................................. 187
THYROXINE ..................................................................................................................................... 188
TICARCILLIN/CLAVULANIC ACID ............................................................................................ 189
TOBRAMYCIN .................................................................................................................................. 190
URSODEOXYCHOLIC ACID (URSO) ........................................................................................... 191
VALPROATE ..................................................................................................................................... 192
VANCOMYCIN ................................................................................................................................. 193
VECURONIUM .................................................................................................................................. 195
VIGABATRIN .................................................................................................................................... 196
VITAMIN A (RETINOL) .................................................................................................................. 197
VITAMIN E (ALPHA-TOCOPHEROL) ......................................................................................... 198
VITAMIN K ........................................................................................................................................ 199
ZIDOVUDINE .................................................................................................................................... 200
ZOSTER IMMUNOGLOBULIN ...................................................................................................... 202
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Canberra Hospital
Introduction
Revision Date : 20 February 2015 Approved : Department of Neonatology
The following list is a compilation of drugs commonly and not so commonly used in
Neonatal Care. The list has developed over a period of years and is based on
experiences within this unit or on data collected from published reports in recent
perinatal literature.
The current revision includes data concerning drug compatibilities which have been
previously considered a problem but now which have been shown to be safe and
effective.
Some methods of administration may be considered new or novel but should not be
avoided for this reason. In general, recommendations are made on the best available
evidence. Should there be any discrepancies these should be brought to our attention.
Suggestions for change are welcome.
Entries in this manual should not be annotated or marked without the approval
of the Consultant in Charge as this will only serve to confuse and may lead to
mistakes or errors in administration.
Note that the following abreviations are used throughout this document:
WFI = Water for injection.

D5W = 5% Dextrose Water
D10W = 10% Dextrose Water
NS= 0.9% Normal Saline
This manual is constantly updated by the Dept of Neonatology and Pharmacy. Thank
you for your continued efforts in keeping this document up to date with the latest
evidence.
Professor Alison Kent and Dr Tejasvi Chaudhari,

Department of Neonatology
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Canberra Hospital
Drug Name
Revision Date : 09/01/2014 14:40:00 Approved : AK, JD
Indication : A brief description of the uses for the chosen drug
Dose : Single Dose amount
Interval : Dosage interval or number of doses per day
Route : Oral, intravenous, intra-arterial or other routes available
Total Daily Dose : Maximum recommended daily dosage
Comments : Description of action, precautions, side effects etc.
Supplied as : Company or trade name is not usually recorded and should

not be used in prescriptions. Amount usually found in
supplied units.
Dilution : Instructions for appropriate dilution. May differ from that
recommended by suppliers because has been adjusted for
use in small babies.
Stability : Refers to how long drug can be used after being
reconstituted or diluted.
Storage : Usual method and place of storage - cupboard, fridge,
freezer etc.
Incompatibility : Drug and diluent incompatibilities, comments on whether
can be given mixed with other drugs or solutions.
Serum Levels : Therapeutic range - if known
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Canberra Hospital
Acetylcysteine (Inhalation Therapy)

Indication : A mucolytic agent used as adjuvant therapy in patients with

thick or viscid bronchial secretions and mucous obstruction.
Dose : 1-2 ml of 100mg/mL or 200mg/mL solution
Interval : 1- 4 hourly as necessary
Route : Intratracheal via Endotracheal tube
Total Daily Dose : Use with care in small babies where fluids are restricted.
Comments : May be mixed with bronchodilators without loss off of

effect. Generally it is used on its own, and bronchodilators
are given pre mucomyst, so that the mucomyst can penetrate
further into the bronchioles.
Not for Injection
Supplied as : Acetylcysteine, 200mg/mL solution, 10 mL vial.
Trade name Mucomyst®
Dilution : Not required or can be diluted with an equal volume of
Water For Injection to make a 100mg/mL solution
Stability : Open vials may be stored in a refrigerator for up to 96 hrs.

Use diluted solution within an hour and discard any unused
diluted solution
Storage : Store at room temperature until vial is accessed, then in
refrigerator. Label vial as to the time of the first access.
Incompatibility : Not applicable
Serum Levels : Nil
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Canberra Hospital
Acetylcysteine (Mucomyst)
Revision Date : 18 June 2012 Approved : AK, JD
Indication : Cystic fibrosis, meconium plug syndrome related to IUGR
Dose : Order dose in terms of mLs of 50mg/mL solution

Rectal enema: 2-10 mL (max of 10mL/kg) of 50mg/mL
solution
Retention time of 30-45 minutes, but max effect if retained for
6 hours.
Interval : Daily, up to 6/24
Route : PR or via fistula/stoma
Total Daily Dose :
Comments : Give enema in a slow steady manner to avoid over distension

and observe abdomen for signs of distension.
Thought to act by disrupting disulphide linkages of
mucoproteins i.e. it breaks up the protein matrix and lowers the
viscosity of meconium.
Not for Injection
Supplied as : 200 mg/mL vial. Trade name Mucomyst®
Dilution : Dilute with water to make 50 mg/mL - take 1mL of solution

(200mg) from the vial and add 3 mL of Water For Injection to
make 200mg/4mL.
Stability : Prepare fresh solution for each dose and discard any unused
diluted portion. The vial can be reused for up to 96 hours.
Storage : Vials: protect from light. Store below 25°C
Compatibility : Not applicable
Incompatibility :
Serum Levels : Not required
Taken from RCH Paediatric Pharmacopoeia, SHPA Injectable Drugs Handbook
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Aciclovir
Indication : An antiviral agent active against Herpes Simplex (types 1

and 2), varicella zoster. Disease should be treated quickly
even if clinical signs are minimal or superficial.
Dose : 20 mg/kg
< 30 weeks daily
30-32 weeks 18/24 1st week of life
32 - 37 weeks 12/24
> 37 weeks 8/24
2-12 weeks of life 8/24

Interval : 8 hourly
Route : Intravenous infuse over 1 hour
Total Daily Dose : 30-60 mg/kg
Comments : Aciclovir triphosphate acts as an inhibitor of and substrate for herpes
DNA polymerase preventing further DNA synthesis. Must be infused
over 1 hour. If infused too rapidly may cause renal failure by
precipitation of crystals in the kidney and transient renal dysfunction.
Give adequate hydration to prevent precipitation of crystals in the renal
tubules. Monitor urine output and creatinine carefully. Monitor IV site
for phlebitis (has a pH of 10). If phlebitis occurs, then make the
solution more dilute. Treatment should continue for at least 10 days.
21 days may be needed for CNS disease.
Supplied as : Zovirax (and other brand names) 250 mg and 500mg vials
of powder for reconstitution. 250mg/10 ml vials of solution.
Dilution : 250mg and 500mg vials of powder are reconstituted with 10
ml and 20ml of WFI to give a solution of 25mg/ml. 1 ml of
this solution or of the ready prepared solution can be further
diluted with NS to a total of 5 ml to make a solution of
5mg/ml. Discard remainder of vial.
Stability : Solution stable for 24 hours at room temperature. Do not
put solution in refrigerator as crystals will develop and not
re-dissolve at room temperature.
Storage : Store at room temperature. 3 yr. shelf life. DO NOT
refrigerate.
Compatibility Compatible with Cefotaxime, 5% Dextrose, gentamicin,
lorazepam, potassium chloride, NS, metronidazole,
fluconazole, ampicillin, vancomycin.
Incompatibility : Do not give with TPN solutions, Dopamine, Dobutamine.
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Serum Levels : Reduce dose in renal failure and hepatic failure.
Adenosine
Revision Date: 09/01/2014 14:40:00 Approved : AK, JD
Indication : Rapid conversion of paroxysmal tachycardias to normal

sinus rhythm, and as an aid to the diagnosis of
supraventricular tachycardias.
Dose : Initial dose 0.1mg/kg, increasing by 0.05mg/kg to a

maximum of 0.35 mg/kg/dose
Interval : Every 1-2 minutes until termination of arrythmia
Route : Rapid bolus IV, over 1-2 seconds directly into a vein or at
the most proximal port available. Follow rapidly with a
saline flush.
Total Daily Dose : Not Applicable.
Comments : The half-life of adenosine is less than 10 seconds, thus

adverse effects are generally self-limiting. May produce
heart block and bronchospasm and may induce pulmonary
hypertension. Methylxanthines are competitive antagonists
of adenosine. Larger doses of adenosine may be required
when these drugs are used concurrently. Dipyridamole
enhances and prolongs the effect. Contraindicated in
adenosine deaminase deficiency. Side effects include
flushing, headache and nausea. Rarely may produce apnoea.
Supplied as : Vials (Adenocor) containing 6mg adenosine in 2 ml Normal

saline
Dilution : Use 1 ml with 9 ml of Normal Saline to make up a solution
with a final concentration of 0.3 mg/ml.
Stability : Single use only. Discard immediately after use.
Storage : Do not refrigerate. Keep at room temperature below 25’C
Incompatibility : No data

Green AP, Giattina KH. Adenosine administration in neonatal SVT. Neonatal Network1993;12:15-18.
Paret et al. Adenosine for the treatment of Paroxysmal SVT in full term and preterm infants. Am J Perinatol 1996 13:343-346
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Adrenaline (Resuscitation)
Indication : Cardiac resuscitation
Dose : IV = 0.01-0.03 mg/kg = 0.1-0.3 mls/kg of 1:10,000 solution

ETT = 0.05 – 0.10 mg/kg = 0.5-1.0 mls/kg of 1:10,000
solution
Interval : Stat. repeat if necessary
Route : IV, ETT
Dose used for 0.1-0.3 ml of 1:10,000 solution/kg body weight for IV

resuscitation : administration. May be repeated every 1-3 minutes. 0.5-
1.0ml/kg of 1:10,000 solution/kg body weight for ETT
administration.
Comments : Of value in cardiac arrest because of alpha-adrenergic properties.
Beta-mimetic use uncertain in resuscitation conditions. May
cause cardiac arrythmias, hypertension, tachycardia.
Supplied as : Adrenaline 1 in 10,000 (1 mg in 10 ml)
Dilution : Undiluted in resuscitation
Stability : Use immediately. Discard after opening.
Storage : Room temperature. Shield from light. Do not use if solution

is brown or turbid.
Compatibility: May be co-infused with TPN, amikacin, calcium gluconate,
cimetidine, dopamine, hydrocortisone, morphine,
vecuronium, dobutamine, heparin.
Incompatibility : Do not give with aminophylline, sodium bicarbonate,
phenobarbitone.
Serum Levels : Nil
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Adrenaline (Infusion, Inhalation)

Indication : Inotropic support where alpha-adrenergic properties are

desirable.
Croup or post-extubation stridor
Dose : IV infusion - 0.1-1 microg/kg/min by continuous infusion

Inhalation - 4 mls of 1:1000
Interval : Infusions
Inhalation – repeat if required
Route : IV, Inhaled
Comments : May cause cardiac arrythmias, hypertension, tachycardia.

Use in croup and post extubation stridor is for emergency,
transient (1-2 hrs) relief of partial obstruction. ECG monitoring
& continuous medical supervision is indicated. Not a substitute
for intubation, if intubation is indicated.
Supplied as : Adrenaline 1 in 1,000 (1 mg in 1 ml)
Dilution : Infusion - Add 1.5 mg per Kg of Adrenaline 1:1,000 to a

syringe and make up to 25 ml with D5W, D10W or NS.
Using this resulting concentration:
0.1 ml/ hr = 0.1 microg/kg/ min
Inhalation - use 1:1,000 ampoules undiluted.
Stability : Use immediately. Discard after opening. Continuous
infusion must be shielded from light.
Storage : Room temperature. Shield from light. Do not use if solution
is brown or turbid.
Compatibility: May be co-infused with TPN, amikacin, calcium gluconate,
cimetidine, dopamine, hydrocortisone, morphine,
vecuronium, dobutamine, heparin.
Incompatibility : Do not give with aminophylline, sodium bicarbonate,
phenobarbitone.
Serum Levels : Nil
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Canberra Hospital
Albumin
Indication : Intravenous albumin infusion is used in preterm and term

infants as a fluid bolus or to treat hypoalbuminaemia
Dose : 1] Fluid bolus - 4% albumin – 10 ml/kg

2] Hypoalbuminaemia - 20% albumin – 5-10 ml/kg (1-
2g/kg)
Interval : 1] May be repeated depending upon response
2] Daily depending upon response
Route : 1] Intravenous – infuse over 30 minutes
2] Intravenous – infuse over 4 hours, generally followed by
frusemide
Total Daily Dose :
Comments : Adverse effects may include circulatory overload,

hypotension, rigors and sodium overload.
Supplied as : 1] Human albumin 4% 4 g/dL

2] Human albumin 20% 2g/dL
Dilution : Nil required
Stability : Discard after use
Storage : Refrigerate – if not used must be returned to transfusion.

Protect from light
Compatibility : 5% Dextrose, 10% Dextrose, 0.9% Sodium chloride
Incompatibility : Cefotaxime, Ceftriaxone, Clindamycin, Dobutamine,

Adrenaline, Insulin, Penicillin, Phenytoin, Midazolam,
Vancomycin
Serum Levels : Nil
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Canberra Hospital
Amlodipine
Indication : Antihypertensive agent.
Dose : 0.1-0.4 mg/kg
Interval : Daily
Route : Oral
Total Daily Dose : Maximum dose 0.4 mg/kg/day
Comments : Amlodipine is a long acting dihydropyridine calcium channel

antagonist with resultant antihypertensive activity related to
smooth muscle relaxation. Adverse effects may include
hypotension, feed intolerance and alteration of liver function
tests, flushing, peripheral oedema and palpitations. Caution
when used in combination with other antihypertensives.
Caution when used with other medications metabolised via
CYP3A4 (eg erythromycin, antifungals).
Supplied as : 5 mg tablet
1mg/mL Suspension (made in pharmacy)
Dilution : Pharmacy will prepare a 1mg/mL suspension during normal
hours. For doses after hours, crush and disperse a 5mg tablet in
5mL of sterile water to make a 1mg/mL mixture. Shake for
even drug distribution immediately prior to drawing up dose
and discard remainder. Use immediately as amlodipine is very
sensitive to light.
Stability :
Storage : Store below 25 degrees Celsius (tablets and mixture).

Protect from light.
Incompatibility :
Serum Levels :
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Canberra Hospital
Ampicillin
Indication : Neonatal sepsis, meningitis and other infections.
Dose : 25 mg/kg for septicaemia

50 mg/kg for meningitis, GBS Sepsis.
Interval : 12 hourly <7 days after birth
8 hourly >7 days after birth
6 hourly > 4 weeks of age
Route : IV or IM.
Total Daily Dose : According to maturity
Comments : Slow intravenous infusion over not more than 100 mg/
minute
Supplied as : Ampicyn 500 mg
Dilution : Add 4.7 ml sterile water to vial (= 5 ml at 100 mg/ml). For

use dilute to 10 ml with Normal Saline (50 mg/ml) and
draw up required dose. Infuse slowly over 15 minutes.
Stability : Discard after reconstitution. Ampicillin is unstable in
concentrated solutions and should be used as soon as
practical.
Compatibility: May be co-infused with Calcium in saline, cimetidine,

chloramphenicol, heparin, morphine, sodium bicarbonate,
tolazoline, vancomycin.
Storage : At room temperature
Incompatibility : Do not give with Calcium and dextrose solutions,

dopamine, adrenaline, fluconazole, gentamicin or
hydralazine. Not compatible with TPN.
Serum Levels : Not required.
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Canberra Hospital
Amphotericin B
Indication : Fungal sepsis
This is a RED ANTIMICROBIAL and requires approval

from the Infectious Disease Team as per AMS SOP.
Dose : Candida species: 0.5-0.7 mg/kg
Aspergillus species: 1-1.5 mg/kg
Zygomyces species: 1.5 mg/kg
Prolonged febrile neutropenia: 1 mg/kg
Interval : 24 hourly
Route : IV only infuse over 4-6 hours
Total Daily Dose : 0.5-1.5 mg/kg
Comments : Amphotericin is derived from streptomyces nodosus. In its

crystalline form it is insoluble in water and is suspended in
a colloidal dispersion for IV administration. The drug is
toxic and causes renal impairment - notably
hypokalaemia(by increasing renal potassium loss), renal
tubular acidosis. Leucopenia and thrombocytopenia are less
common and maybe due to the primary infection. Monitor
serum creatinine, electrolytes, FBC. Test doses unnecessary
in children and may delay therapy. If in-line filters are used,
the mean pore diameter should not be less than 1 micron.
Supplied as : Fungizone Intravenous 50 mg powder for reconstitution.
Dilution : Single dose preparation from pharmacy. Reconstitute with

10 ml sterile water and shake until solution is clear. Dilute
with 5% dextrose by adding 0.2 ml to 9.8 ml giving a
solution with 0.1 mg/ml. Administer infusion over 4-6
hours. Protect entire line from light.
Stability : Vial for single use only. Discard remainder.
Storage : Refrigerate. Protect from light.
Compatibility: 5%, 10%, 20% Dextrose, Heparin, Hydrocortisone, Sodium

bicarbonate and Zidovudine.
Incompatibility : Do not mix with 0.9% NaCl, CaCl2, KCl, dopamine,

penicillin. Not compatible with TPN, give through separate
line. Calcium gluconate, gentamicin, ranitidine.
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Canberra Hospital
Serum Levels : Nil
Amphotericin B (Lipid Complex)

Indication : Fungal sepsis. Restricted to patients with or at risk of

developing renal failure, or in patients with infections
resistant to conventional amphotericin B.
from the Infectious Disease Team as per AMS SOP.
Dose : 2.5-5 mg/kg. Test dose unnecessary in children and may
delay treatment.
Route : IV only infuse over 1-2 hours. Infuse each 2.5 mg/kg over 1
hour.
Total Daily Dose : Up to 5 mg/kg
Comments : Amphotericin B is complexed to phospholipids. Decreases

overall toxicity and side effects of Amphotericin. A greater
concentration of Amphotericin is transported to the site of
infection. Higher doses are tolerated without side effects.
Monitor serum creatinine, electrolytes and FBC. Treat for at
least 14 days.
Supplied as : Abelcet 5 mg/ml vial.
Dilution : Normally made by pharmacy. Shake vial gently to ensure no

yellow sediment at bottom of vial. Using 5 ml syringe and
17 or 19 G needle withdraw 5 ml from vial. Replace needle
with 5 micron high flow filter needle provided with each
vial. Adjust volume to 1.25 ml (25 mg) and transfer it into a
25 ml syringe. Draw the 25 mg up to 25 ml with 5%D. Final
concentration = 1mg/ml. If the syringe is not used
immediately hold in refrigerator and shake vigorously prior
to use.
Stability : Single use vial. Discard any remaining solution.
Storage : In refrigerator. Protect from light.
Incompatibility : Not compatible with NS or TPN. Infuse through a separate

line. Flush with 5% D before and after dose.
Serum Levels : Nil
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Canberra Hospital
Compatibility: 5%D ONLY
*Available only as SAS drug from TGA. Can be used in Level 3 units only.
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Canberra Hospital
Aspirin
Indication : Antiplatelet agent for use in neonates with cardiac shunts e.g.
Blalock-Taussig shunt
Dose : 1 - 5mg/kg/dose1
Interval : Once Daily
Route : Oral
Total Daily Dose : Maximum dose 5mg/kg/day
Comments : Aspirin may cause gastrointestinal irritation with GI bleed. If

this occurs discussion should occur with the Cardiology team
managing the patient as to whether aspirin can be ceased or
addition of a H2 antagonist or proton pump inhibitor is
required.
Give with feeds to reduce gastric irritation.
May cause bronchospasm.
Solprin® and Disprin® brands - contain no sodium. Aspro
Clear® 300mg soluble tablets contain 6.5 mmoles sodium per
tablet – caution mother not to use Aspro Clear® brand after
discharge.
G6PD deficient patients are at risk of haemolysis.
Not used as an analgesic or antipyretic in neonates, infants or
children.
Supplied as : 300mg dispersible tablet
Dilution : Disperse a 300mg tablet in about 8mL of water for injection.

Wait for bubbles to subside and make up to a final volume of
10mL with extra WFI. Makes a 30mg/mL solution.
Give dose immediately and discard remaining solution.
Stability : Aspirin breaks down rapidly when exposed to moisture – use
immediately after removal from packaging2
Storage : Store tablets below 25 degrees Celsius
Incompatibility : Caution with NSAIDs and anticoagulants – increased risk of

bleeding
Serum Levels : Not applicable
21
Canberra Hospital
Atenolol
Indication : Hypertension, Beta-1-adrenergic blocking agent.
Dose : IV 0.02-0.05 mg/kg/dose every 5 minutes until response

(max 4 doses), then 0.1-0.2 mg/kg/dose 12 hourly if
necessary.
Oral 1-2 mg/kg/dose once daily (twice daily in severe
cases).
Interval : 12-24 hourly
Route : IV, Oral
Total Daily Dose :
Comments : May exacerbate asthma, cardiac failure and heart block.

Monitor for hypoglycaemia when commencing therapy.
Supplied as : Ampoules: 5mg in 10 ml (0.5 mg/ml)

Tablets: 50 mg
Dilution : Dose can be given undiluted as a slow bolus over 5 minutes
or diluted with NS to a suitable volume and given as an
infusion over 20 minutes.
Stability : Discard any unused solution.
Storage : Ampoules and tablets store at less than 30 degrees Celsius.

Diluted IV solutions protect from light.
Incompatibility : Amphotericin.
Compatibility: NS, 5%D, Y-site compatible with morphine, meropenem.

Serum Levels : Nil
22
Canberra Hospital
Atropine
Revision Date : 23 April 2014 Approved : TC, LZ, JD
Indication : 1. Sinus bradycardia, premedication to reduce secretions

during operative procedures or intubation.
2. Cardiac resuscitation
Dose : 1. 0.01 mg/kg (10 microg/kg) stat
= 0.1 mL/kg of diluted solution (see below)
2. 20 microg/kg stat
= 0.2 mL/kg of diluted solution (see below)
Interval : Dose can be repeated every 10-15min to achieve desired
effect
Route : IV, IM, SC
Total Daily Dose : Upto 40 microg/kg
Comments : May cause dry mouth, dilated pupils, increased intra-ocular

pressure, flushed, dry skin, bradycardia leading to
tachyarrhythmias, constipation.
Overdose may cause tachycardia, tachypnoea, hyperpyrexia,
restlessness. If massive, overdose will cause hypertension,
circulatory failure and respiratory depression.
Duration of action is 6 hours.
Supplied as : Atropine 0.6 mg/mL (600microg/1mL)
Dilution : Add 1mL of solution (600microg/1mL ampoule) to 5mL of

Normal Saline
Makes 600microg/6mL = 10 microg/0.1 mL
Dose = 10-20 microg/kg = 0.1-0.2 mL/kg
Stability : Discard after dilution
Storage : Room temperature, protect from light
Compatibility: Compatible for co-infusion with dobutamine, fentanyl,

morphine, KCl, ranitidine.
Incompatibility : Bromides, iodides, Na Bicarbonate, noradrenaline,
pentobarbitone.
Serum Levels : Nil
23
Canberra Hospital
Azithromycin
Indication : Azithromycin is macrolide subclass antibiotic used for the

treatment of community acquired pneumonias and
ureaplasma pneumonia. Use outside these indications may
require an ID approval code.
Dose : 5-10 mg/kg/day
Interval : Daily
Route : Oral
10mg/kg/dose daily for 7 days followed by 5mg/kg/dose for
another 7 days (total 14 day course) for ureaplasma
infection *
Comments : May cause gastrointestinal upset, raised LFT’s and renal
dysfunction. Can also cause candidal infection and
ototoxicity. May be associated with prolonged QT interval,
use with caution with other drugs that prolong QT interval1.
Give mixture on an empty stomach and separate dose from
antacids2.
Supplied as : Zithromax Powder for oral suspension 40mg/mL, 15mL
Dilution : Reconstituted in pharmacy to make a 40mg/mL oral

suspension.
Stability : Discard solution 10 days after preparation
Storage : Once reconstituted store below 30 degrees Celsius
Serum Levels : Nil
References: * Limited evidence, dose and duration to be reviewed once further

evidence published. (Use of azithromycin for the prevention of
bronchopulmonary dysplasia in preterm infants: a randomized,
double blind, placebo controlled trial. Paediatric Pulmonology
Ballard et al., 2011 46(2):111-8)
1. Australians Medicines Handbook 2013Macrolides – Azithromycin
2. Paediatric Pharmacopoeia Royal Childrens Hospital Melbourne
13th edition
24
Canberra Hospital
Buccal Glucose Gel 40%
Revision Date : Jan 2017 DTC Approved: 27/02/2017
Indication : Hypoglycaemia in the newborn population
Dose : 0.5mL/kg/dose
Interval : As required
Route : Buccal
Total Daily Dose : Can be repeated up to 4 times in a 48 hour period
Comments : -to be used in newborns if glucose if <2.6

-repeat BGL after ½ hour. If remains <2.6 repeat dose of
glucose gel can be given.
-Treatment Failure: If the BGL remains <2.6 after 2 doses of
Glucose gel, alternative treatment needs to be given.
-Recurrent Hypoglycaemia: If there is treatment response and
recurrent episode of hypoglycaemia (BGL <2.6) glucose gel can
be repeated. (Maximum 4 doses in a 24 hour period).
Supplied as : 37.5g tube
15g glucose in 37.5g oral gel
Dilution : Not required
Stability :
Storage : Room temperature
Incompatibility : Saliva- swab mouth with gauze before applying
Serum Levels : N/A
Compiled: November 2015 Review: November 2019
References:
1. Dextrose Gel for treating neonatal hypoglycaemia: a Randomised Placebo-Controlled Trial
(The Sugar Babies Study), Harris D, Weston P, Harding JE; Lancet 2013, published September
25
2. Outcome at 2 years after Dextrose Gel treatment for neonatal hypoglycaemia: Follow up of a
Randomised Trial. Harris D, Alsweiler JM, Ansell JM et al; J Pediatr Mar, 2016; 170: 54-59.e2
3. Hypoglycaemia- Infant Management, The Royal Women’s Hospital, Melbourne
4. Hypoglycaemia in a neonate, Royal hospital For Women, Sydney.
25
Canberra Hospital
5. Incidence of neonatal hypoglycaemia in babies identified as being at risk, Harris D, Weston P,
Harding J; Journal of Paediatrics 2012:787-91
6. Neofax on line accessed 21/12/16
Budesonide
Indication : Inhaled corticosteroid used in the treatment of chronic lung

disease of prematurity.
Dose : Nebuliser 250-500 micrograms 12 hourly
Route : Inhaled via nebuliser
Total Daily Dose : Nebuliser 500-1000 microgram
Comments : Avoid contact with eyes during nebulisation. Wash entire face
after use. Rinse mouth after use either by feeding or with a
moistened swab stick. Titrate to give effective control with the
lowest possible dose. Risk of systemic effects with higher
doses.
Supplied as : Budesonide nebuliser solution 500mcg/2 ml and 1000 mcg/2
ml
Dilution : Nil. If using a small volume, the dose can be diluted to an
appropriate volume (eg 2 mls) with normal saline.
Stability : Keep at room temperature
Storage : Store at room temperature
Incompatibility :
26
Canberra Hospital
Caffeine Base
Revision Date: 09/01/2014 14:40:00 Approved : AK, JD
Indication: Apnoea of prematurity, either for prophylaxis or active

treatment.
Dose Loading Dose: 10 mg/kg of Caffeine Base

Maintenance dose: 2.5 mg/kg/dose If indicated, can be
increased up to 5 mg/kg/dose. Higher doses may be considered
but must be approved by a Consultant.
Interval: Daily
Route: 1) Intravenous dose may be given as a slow push over 3-5

minutes
2) Intravenous dose may be given as an infusion by syringe
pump over 30 minutes.
3) Oral medication must be given with feeds.
Total Daily Dose: 2.5 mg/kg/day after the loading dose.
Oral maintenance doses given at 10:00am each morning
Comments: Maintenance dose should be started 24 hours after the loading dose. When
transferring from IV to oral dosing please remember that the oral dose is
given at 10.00am. Adverse effects include restlessness, vomiting and
tachycardia. Consider withholding the dose if heart rate >180/min.
Bronchodilator and CNS stimulant. Metabolised via liver by Cytochrome
P450 and so interacts with drugs which share the same metabolic pathway
(eg phenytoin, phenobarbitone, erythromycin, ciprofloxacin, ketoconazole
and others) Interconversion between theophylline and caffeine can occur in
premature neonates.
Caffeine Base 10mg/ml is equivalent to Caffeine Citrate 20mg/ml.
Supplied as: Caffeine Base solution 10mg/ml
Caffeine Base vial 10mg/ml
Dilution: Nil. Use directly.
Stability: Stable until expiry date
Storage: At room temperature
Compatibility: Compatible with: D5W, D50W NS, 20% Intralipid, Dopamine,

Calcium Gluconate, Heparin, Fentanyl, Potassium.
Incompatibility No information available
Serum Levels: Caffeine levels to be done if toxicity suspected or if doses

higher than those recommended are being considered for
persistent apnoeas. Trough (just prior to next dose) Therapeutic
levels 100-205 μmol/L (20-40 mg/L); Toxic levels > 250
μmol/L (> 50 mg/L)
27
Canberra Hospital
28
Canberra Hospital
Calcium Gluconate
Indication : 1] Resuscitation
2] Seizures due to hypocalcaemia
3] Hypocalcaemia
4] Daily maintenance
Dose : 1] 0.5 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)
2] 2.0 ml/kg of 1g/10 mL solution (2.2 mMol/10 mL)
3] 900 mg/kg/day (double daily maintenance)
4] continuous infusion over 24 hours. (10 ml of 1g/10 mL
solution added to 500 ml of maintenance fluids)
Interval : 1] stat, repeat if necessary, administer over 3-5 minutes
2] stat, repeat if necessary, administer over 15 minutes
3] continuous infusion over 24 hours.
4] continuous infusion over 24 hours.
Route : I.V.
Total Daily Dose :
Comments : May cause bradycardia, hypokalaemia, and/or hypotension if infusion

given too rapidly. Tissue necrosis and sloughing of tissue may occur if
extravasation occurs. Care is required when there is extra Vitamin D
intake.
Supplied as : 1g/10 mL solution (2.2 mMol/10 mL)
Dilution : 1] < 1 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with sterile water to a
total of 2 mls. 1-2 kg – dilute 0.5 ml/kg of 1 g/10 mL solution with
sterile water to a total of 2.5 mls. 2-3kg – dilute 0.5 ml/kg of 1 g/10mL
solution with sterile water to a total of 3 mls. > 3kg – dilute 0.5 ml/kg of
1 g/10mL solution with sterile water to a total of 4 mls.
2] < 1 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with sterile water to a
total of 4 mls. 1-2 kg – dilute 2.0 ml/kg of 1 g/10 mL solution with
sterile water to a total of 5 mls. 2-3kg – dilute 2.0 ml/kg of 1 g/10mL
solution with sterile water to a total of 6 mls. > 3kg – dilute 2.0 ml/kg of
1 g/10mL solution with sterile water to a total of 8 mls.
3] & 4] In peripheral I.V. infusion keep concentration  2 ml of 1g/10
mL solution to 100 ml of maintenance to prevent tissue burns.
Stability : Discard ampoules and unused portions after initial use.
Compatibility: Compatible with aminophylline, Adrenaline, Dobutamine,

Lignocaine, vancomycin.
Incompatibility : Sodium bicarbonate, Magnesium sulphate, cephalothin, streptomycin,
prednisolone. Contraindicated with digoxin except with extreme
caution.
29
Canberra Hospital
Serum Levels : Measure serum calcium as indicated.
Calcium Carbonate Suspension

Indication : Calcium deficient states needing supplementation.
Dose : 50 mg per dose
Interval : 6 hourly.
Route : Oral – not to be given with feeds or with oral phosphate.
Total Daily Dose : 5 mls
Comments : Use in early hypocalcaemic states associated with deficient

intake during periods of rapid growth. Use in chronic renal
failure must be monitored closely as hypercalcaemia may
occur. Concomitant administration with Vitamin D may
cause toxicity.
Supplied as : 40 mg/mL elemental calcium = 100 mg/mL of calcium
carbonate i.e. 50 mg of elemental calcium = 1.25 mL
Dilution : 200 mL bottle – please shake bottle well prior to extracting
dose
Stability : Preservative hydroxybenzoates.
Storage : Room temperature.
Incompatibility : Give at separate times to oral phosphate to prevent

precipitation and malabsorption.
Serum Levels : Monitor serum calcium.
30
Canberra Hospital
Calcitriol
Indication : Vitamin D deficiency - due to end organ unresponsiveness

either as a primary problem or secondary to chronic renal
failure.
Dose : 0.02 microg/kg/day
Interval : Daily dose increasing every 4-8 weeks by 0.02 mcg/kg

depending on response.
Route : Oral/ Sublingual.
Total Daily Dose : N/A
Comments : The most active form of Vitamin D. Hypercalcaemia is a

danger and the dosage should be adjusted to avoid
intoxication. Regular monitoring of serum calcium,
phosphate and ALP is necessary. Symptoms of overdose
include lethargy, weakness, ectopic calcification, etc.
Supplied as : Capsules : 0.25 microg calcitriol/ capsule
Liquid: 1microg/mL available on SAS (Special Access
Scheme)
Dilution : Not required. Remove fluid from capsule with syringe and
administer orally.
Stability : Use immediately.
Storage : Protect from heat and light.
Incompatibility : Not Applicable.
Serum Levels : N/A.
31
Canberra Hospital
Captopril
Indication : Hypertension
Cardiac Failure
Dose : Starting dose is 0.1 mg/kg, increasing in 0.1 mg/kg

increments until desired blood pressure achieved or cardiac
failure controlled.
Interval : 8 hourly for infants  1500 g
12 hourly for infants < 1500 g
Route : Oral
Total Daily Dose : Not known for newborns. May require up to 0.4-4
mg/kg/day in larger infants.
Comments : ACE inhibitor functions in cases of presumed hyper-
reninaemia. May cause hyperkalaemia particularly if used
in conjunction with potassium sparing diuretics or
potassium supplements. Can cause cough
Supplied as : A clear, colourless, plum flavoured syrup containing 5
mg/ml of solution.
When syrup is unavailable, disperse one tablet in water to
make a 1mg/mL mixture. Discard unused portion
immediately after preparation.
Dilution : Dilute 1 ml of syrup with 4 ml of water to make 1 mg/ml
solution. Administer immediately and discard remainder
after use.
Stability : may be kept up to 28 days after opening.
Storage :
Serum Levels : Not Applicable.
32
Canberra Hospital
Cefotaxime
Indication : Septicaemia and Meningitis caused by susceptible

organisms.
This is a restricted ORANGE ANTIMICROBIAL but
does not require approval if used in paediatrics when used
for the same indications as Ceftriaxone that are listed in the
AMS SOP.
Dose : 50 mg/kg
Interval : 12 hourly for infants < 1 week.

8 hourly for infants 1-4 weeks.
.
Route : I.V.
Total Daily Dose : 100 - 200 mg/kg/day.
Comments : Should be used with caution with aminoglycosides. May

cause a rash. CSF/Serum ratio 0.4-0.6. 35% protein bound.
Supplied as : 1 gram vials.
Dilution : Dilute with WFI. Add 3.6 ml to vial to give a solution of

250 mg/ml.
Stability : Discard after reconstitution.
Storage : Up to 2 years prior to reconstitution.
Compatibility: Compatible with Aciclovir, morphine, metronidazole, and

TPN.
Incompatibility : Aminophylline, Fluconazole, Sodium bicarbonate and
Vancomycin.
33
Canberra Hospital
Ceftazidime penthydrate
Indication : Gram negative and Gram positive infections. Specific for

Pseudomonal infections. Not MRSE, MRSA, Strep faecalis,
or other enterococci, Listeria or clostridia.
This is a restricted ORANGE ANTIMICROBIAL and can
only be used for the indications outlined in the AMS SOP
unless otherwise specified by the Infectious Disease team.
Dose : 30 mg/kg
Severe infection: 50 mg/kg
Interval : Age < 1 week: 12 hrly
Age  1 week: 8 hrly
Route : I.V.
Total Daily Dose : max 90 mg/kg
Comments : Beta-lactam antibiotic. Some renal toxicity noted. May

cause eosinophilia, transient rises in liver enzymes. Not
metabolised and is excreted unchanged in the urine.
Reduce dose in renal failure.
Supplied as : 1 or 2 gram vials.
Dilution : Usually made up in pharmacy. Single dose use. Use 1 gram

vial. Dilute in 10 ml water to give concentration of 100
mg/ml. Shake to dissolve. Bubbles of CO2 may be
disregarded.
Stability : Discard after use.
Storage : Room temperature before reconstitution.
Compatibility: TPN, Saline, Dextrose, Aciclovir, Aminophylline, Heparin,

Morphine, Sodium bicarbonate, Vancomycin.
Incompatibility : Fluconazole, Midazolam.
Serum Levels : Should not exceed 40 microg/ml. Not routinely measured.
34
Canberra Hospital
Cephazolin
Revision Date : 15 May 2015 DTC Approved: May 2015
Indication : For use in susceptible staphylococcal and streptococcal

infections, and UTI’s due to susceptible bacteria.1
Dose : 25 mg/kg/dose2
Interval2 : Corrected gestational

Post Natal age Dosage Interval
age
(days old) (hours)
(weeks)
0 to 28 12
≤29
>28 8
0 to 14 12
30 to 36
>14 8
0 to 7 12
37 to 44
>7 8
≥45 ALL 6
Route : I.V. – infusion over 15 minutes2,3
Total Daily Dose :
Comments : May be nephrotoxic in high doses or if concomitant renal

impairment, in which case the dose should be reduced.
Caution when used with other nephrotoxic drugs.
Each 1gram of cephazolin contains 2.1mmol of sodium
(48.3 mg).4
Supplied as : Vials containing 1g of cephazolin sodium.
Dilution : Reconstitute each 1g vial of cephazolin with WFI to make

total volume of 10mL (100mg/mL). Take 1mL of this
solution and further dilute to a total volume of 10mL with
normal saline (10mg/mL).2,3
Stability : Discard remainder after use.
Storage : Room temperature.4
Compatibility3,5: Dextrose 5%, dextrose 10%, sodium chloride 0.9%,

Dextrose-NS combinations
Aciclovir, hydrocortisone, insulin, midazolam, morphine,
sodium bicarbonate
35
Canberra Hospital
Incompatibility3,5 : Ampicillin, dopamine, dobutamine, benzylpenicillin,
calcium chloride, gentamicin, vancomycin
Note: incomplete list of compatibilities/incompatibilities,
contact pharmacy if any concerns.
Serum Levels : Nil
Compiled: May 2015 Review: May 2019
References: 1. Australians Medicines Handbook 2015 Cephalosporins –

Cephazolin
2. Neofax, accessed 3/3/2015
3. Australian Injectables Drugs Handbook, 6th Edition
4. Product Information, Kefzol, TGA approved 18/02/2010
5. Micromedex IV compatibility, accessed 3/3/2015
36
Canberra Hospital
Chloral Hydrate
Indication : Sedative and hypnotic agent.
Dose : Sedative: 8 mg/kg, Hypnotic, Premedication: 25-100 mg/kg
Interval : Sedative: 6-8 hourly; Hypnotic, Premedication: single dose
Route : Oral or rectal
Total Daily Dose : Maximum dose 100 mg/kg/day
Comments : Chloral hydrate and its active metabolites have very long half
lives in neonates, more so in premature infants (up to 40 hours).
Any baby who receives more than 50 mg/kg should be closely
monitored for adverse effects, in particular for respiratory
depression. Infants on regular sedative dosing may experience
accumulation. Side effects: respiratory depression, gastric
irritation, headache, ketonuria, hyperactivity occurs in 1-2% of
patients.
Supplied as : 500 mg/5 mL.
Dilution : For premedication give the dose undiluted 30 minutes prior to

the procedure followed by a feed to assist in sleep. For other
indications, oral irritation is reduced by diluting the dose with
water or milk. May be given rectally – dilute the dose with an
equal volume of olive oil.
Stability : Stable in room temperature until the expiry date indicated on
the bottle.
Storage : Keep in drugs of dependence cupboard.
Incompatibility :
Serum Levels :
37
Canberra Hospital
Chloramphenicol
Indication : Septicaemia, Meningitis
Dose : 25 mg/kg/dose
Interval 24 hourly for all infants 0-14 days and 15-30 days when < 2000
grams.
12 hourly for infants > 2000 grams and 0-14 days.
12 hourly for infants < 2000 grams and 2-4 weeks.
Route : I.V. infuse over 15-30 minutes.
Oral
Do not give I.M.
Total Daily Dose : 25 mg/kg/day < 2000 grams at any age.
25 mg/kg/day > 2000 grams and 0-2 weeks.
50 mg/kg/day > 2000 grams and 2-4 weeks.
Comments : Use with reference to microbiology department. Adjust dosage
when used with anticonvulsants and penicillin. The grey baby
syndrome occurs after 3-4 days - abdominal distension,
vomiting, pallid cyanosis, vasomotor collapse, irregular
breathing, and death within hours. Occurs with blood levels >
90 mg/ml. Oral suspension is restricted to use by Director of
Neonatology. SAS drug only
Supplied as : Chloromycetin sodium succinate 1.2 gram vials or oral
suspension of chloromycetin 30 mg/ml.
Dilution : Usually made up by pharmacy. Add 11.0 ml of sterile water to
vial, giving solution of 100 mg/ml for I.V. use only.
Stability : Discard remainder after use.
Incompatibility : Erythromycin, penicillin, cephalothin, gentamicin,

aminophylline, phenytoin, heparin, ampicillin. Compatible
with TPN.
Serum Levels : 10-25gm/ml.
38
Canberra Hospital
Ciprofloxacin
Indication : A synthetic carboxyquinolone derivative with broad-

spectrum antimicrobial activity. Only to be prescribed on
the direction of the consulting Neonatologist.
Dose : 5 - 10 mg/kg
Route : Oral, IV.
Total Daily Dose : 10 - 20 mg/kg
Comments : Bacterial action appears to result from interference with the

enzyme DNA gyrase. Not recommended in children under
12 years as causes defects in cartilagenous growth in rats.
May cause theophylline and caffeine toxicity.
Ciprofloxacin solution should be administered iv as a slow
infusion over a period of 60 minutes.
Supplied as : Ciprofloxacin minibags, 100mg/50mL or 200mg/100mL
Dilution : Not required. 2mg/mL minibag is ready to infuse.
Stability : Stable at room temperature.
Storage :
Incompatibility : Oral dose not absorbed if given with antacids.

No data available on incompatibility.
39
Canberra Hospital
Clinoleic Lipid Emulsion

Indication : Sterile fat emulsion for IV infusion for infants on TPN.

Dose : Day 1: 1 g/kg/day
Day 2: 2 g/kg/day
Day 3 onwards: 3-3.5 g/kg/day
Interval : Daily
Route : IV infusion over 24 hours
Total Daily Dose :
Comments : Isotonic fat emulsion providing 9 kJ/ml. Needs to be

administered to NBM patients at least once weekly to prevent
essential fatty acid deficiency (EFAD). Particle size is less than 1
micron. Must not be used with in-line filters less than 5 microns.
Caution using in infants with sepsis. Long-term use – monitor
platelets, LFT’s, serum triglycerides.
Supplied as : Clinoleic 20% 100mL and 250mL bags.
The 20% fat emulsion is an isotonic emulsion of
approximately 80% olive oil and 20% soya oil. This
combination provides a ratio of 15% Saturated fatty acids,
65% Mono-unsaturated fatty acids and 20% Essential
Polyunsaturated fatty acids.
Dilution : Pharmacy will prepare a syringe for doses up to 50 mls (with a
10 ml overage) and bags for doses over 50 mls (with a 25 ml
overage). The dose will also be loaded with “Vitalipid N” (fat
soluble vitamins) 1 ml/kg and Soluvit N (water soluble vitamins)
1 ml/kg. The total volume to be infused per day:
1 g/kg/day = 5 ml/kg/day
2 g/kg/day = 10 ml/kg/day
3 g/kg/day = 15 ml/kg/day 3.5/kg/day = 17.5 ml/kg/day
Stability : 24 hours once prepared
Storage : Unopened bottles room temperature.

Syringes/minibags – keep in refrigerator until ready to use.
Protect from light.
Incompatibility :
Compatibility:
Serum Levels :
40
Canberra Hospital
Clonazepam
Indication : Seizures unresponsive to phenobarbitone and phenytoin.
Dose : Loading dose 50-100 microg/kg

Maintenance 15- 50 microg/kg
Continuous infusion- Loading dose of 100 microg/kg, followed by
an infusion of 10-30 microg/kg/hr. Once control is achieved,
convert to a daily dose.
Route : Loading dose IV

Maintenance orally.
Total Daily Dose : 0.1 mg/day (Tolerance may develop requiring higher dosing).
Comments : Half-life varies, as for elimination maturity and plasma levels are not helpful in
determining effect. Oral route of administration is preferred for maintenance.
Hyper-secretion of saliva and/or bronchial glands is a possible side effect. Note
that benzodiazepines tend to limit spread of electrical activity rather than
completely suppress a focus entirely. Concurrent treatment with phenobarbitone
or phenytoin has been shown to cause increased serum phenytoin levels and
reduced clonazepam levels. Drug tolerance occurs if treatment is continued for
any extended period of time. Dose must be gradually reduced when the drug is
withdrawn to reduce the risk of rebound seizures.
Supplied as : Parenteral Prep. vial 1 mg/ml.
Oral drops 2.5 mg/ml.
Dilution : For loading doses and maintenance doses use water for injection
and dilute to 2 ml for administration (500 microg/ml).
For infusion take the baby’s weight in mls (3.0kg = 3ml) of
Clonazepam solution (1000 microg/ml=1mg/ml) and make upto 25
ml with 5 % Dextrose or saline.
1 ml/hr.= 40 microg/kg/hr.
Stability : As per pharmacy.
Compatibility: Dextrose 2.5 %, 5% and 10 %. Sodium chloride 0.45 % and 0.9 %.
Incompatibility : Do not mix with any other drugs or TPN
Serum Levels : 60-150 nmol/l. (Not very well defined). Not routinely performed.
41
Canberra Hospital
Clotrimazole
Revision Date : 09/01/2014 14:40:00 Approved AK, JD
Indication : Fungal infection of the skin.
Dose : Thin smear, rubbed in gently.
Interval : With each diaper change.
Route : Topical.
Total Daily Dose :
Comments : Used in treatment of perineal candidiasis where Nystatin

has failed.
Should be used with caution in babies under phototherapy
as it can cause burns.
Supplied as : Clotrimazole 1%. May be combined with Hydrocortisone
to produce a lotion/cream with faster action in soothing
more aggressive rashes.
Dilution :
Stability :
Serum Levels :
42
Canberra Hospital
Co-trimoxazole
Indication : Pneumonia, UTI's, skin and wound infections. Coliform

meningitis, infections unresponsive to other regimes. UTI
prophylaxis. Pneumocystis Carinii Pneumonia (PCP)
Dose : Avoid in infants < 7 days.

Infection treatment – Oral 4 mg/kg/dose 12 hourly (0.5
ml/kg/dose)
General prophylaxis – 2 mg/kg/dose each night (0.25
ml/kg/dose)
PCP Infection – IV/Oral 5 mg/kg 6 hourly
PCP prophylaxis – 5 mg/kg/dose on 3 nights per week –
Monday, Wednesday, Friday
Route : Oral or I.V.
Total Daily Dose : 30 mg/kg/day sulphamethoxazole + 6 mg/kg/day

trimethoprim.
Comments : Risk of jaundice in first week of life. Doses expressed in
terms of trimethoprim content. Risk of kernicterus if used in
frist 4 weeks of life. Contraindicated in G6PD. Give with
feeds.
Supplied as : Oral Syrup – 1 ml contains 40 mg/8 mg
sulpha/trimethoprim respectively.
I.V. vial 5 ml contains 400 mg/80 mg sulpha/trimeth
respectively. Single dose preparation by pharmacy.
Dilution : Mix only with dextrose or dextrose-saline solutions. Mix 5
ml vial to 125 ml of solution (3 mg/ml and 0.6 mg/ml of
sulpha/trimeth). Give required dose over 10 minutes by
slow infusion.
Stability : Discard after single usage.
Storage : 8-25oC. Do not refrigerate. Discard if precipitation occurs.
Incompatibility : Usual precautions apply. No specific data.
43
Canberra Hospital
Cryoprecipitate
Indication : Cryoprecipitate is a concentrated preparation containing all of

the factor VIII, fibrinogen, fibronectin, factor XIII, and von
Willebrand factor found in Fresh Frozen Plasma.
Dose : 5-10mL/kg, starting at no more than 5mL/min
10mL/kg per infusion every 6 hours as needed
Interval : As required
Route : IV over half an hour
Total Daily Dose :
Comments : Use a new blood administration set with a 170-200micron filter

– do not piggy back onto other lines. Change administration set
every 12 hours for continuous infusions. At completion of a
transfusion, flush the line to ensure the patient receives the
entire dose.
Supplied as : Cryoprecipitate is issued thawed; there may be a delay of 20 to
30 minutes from the time of request until supply due to
thawing.
Dilution : Do not add any medication to the cryoprecipitate or to the
giving set.
Stability : There may be 2 expiry dates on the pack, one from the time of
freezing and the other from the time of thawing – use expiry
from time of thawing. Do not refreeze or refrigerate once
thawed.
Storage : Commence immediately or contact the transfusion service
provider for storage advice. Do not refrigerate once thawed.
Each cryoprecipitate pack should be completed within 4 hours
of removal from controlled storage or before the expiry time of
the pack or Tranfusion Compatibility Report (whichever is
sooner)
Incompatibility : Do not infuse with or through a line that has previously
contained calcium (such as Hartman’s solution) as it may cause
clotting of the infusion line. Cryoprecipitate should preferably
be ABO compatible.
Compatibility: 0.9% sodium chloride
Serum Levels : Repeat coagulation studies 4-8 hours post transfusion
44
Canberra Hospital
Curosurf: Poractant alfa

Indication : Respiratory distress due to definite surfactant deficiency and

hyaline membrane disease. Surfactant deficiency also occurs in
pulmonary hypoplasia and congenital diaphragmatic hernia.
Restricted to babies less than 28 weeks gestation, and infants of
any gestational age with severe meconium aspiration.
Dose : Curosurf: Treatment dose: 200mg/kg/dose (2.5ml/kg/dose). Up to
two repeat doses of 100mg/kg/dose (1.25ml/kg/dose) may be
administered 6-12 hourly. Max total cumulative dose is 400mg/kg
(5ml/kg).
Prophylactic dose: 100mg/kg/dose (1.25ml/kg/dose). Repeat
doses of 100mg/kg (1.25ml/kg) may be given 6-12 hourly after
the first dose, with max total cumulative dose of 400mg/kg
(5ml/kg)
Interval : Curosurf: 6-12 hourly
Route : Endotracheal tube.
Comments : Poractant alfa is a sterile non-pyrogenic pulmonary surfactant

obtained from porcine lung surfactant. It contains no
preservatives. Infants less than 30 weeks gestation are usually
given prophylactic surfactant at the time of birth, preferably
before the institution of the first mechanical breath. Infants > 30
weeks gestation are administered surfactant if they require IMV or
are on CPAP and  50% oxygen with the diagnosis of HMD on
CXR.
Given with a size 5 infant feeding tube directly down the ETT or
via the suction port of the Trach-care device.
Supplied as : Curosurf: 80mg/ml of poractant alfa. 1.5ml and 3ml vials.
Dilution : Curosurf: Nil required.

Should be given by experienced person (Neonatologist) or under
supervision of Neonatologist. Ventilator settings may need
adjustment during administration. Beware of blockage of ETT. If
possible avoid suctioning for 2 hours post dose administration.
Stability : Single vial often good for several administrations. Do not warm
whole vial. Draw up dose in syringe and warm slowly to room
temperature, refrigerate remaining preparation for next dose. Do
not shake the vial.
Storage : Curosurf: Refrigerate. Protect from light. Do not shake the vial.
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Canberra Hospital
Incompatibility : Do not mix with anything.
46
Canberra Hospital
Cyclopentolate hydrochloride eye drops (0.25%)

Revision Date : 5 December, 2019 DTC Approved: October 2016
Indication : Used in conjunction with phenyelphrine hydrochloride to

dilate the pupil for:
1] ROP examination.
2] Intraocular surgery
Dose : 1 drop of cyclopentolate 0.25% w/v in each eye, both
30mins and 15mins prior to examination
Apply pressure to the lacrimal sac during and for 1-2

minutes after instillation to minimise systemic absorption1,2
Interval : Every 15 mins
Route : Topical (Eyes)
Total Daily Dose : NA
Comments : -Used in conjuction with phenyephrine

-Eye specialist on call will telephone the Unit and give phone
instructions for eye drops to be given prior to his arrival in the unit
-Maximal effect 30-60 mins, duration 2-4 hours
-Systemic effects are those of anticholinergic drugs: Fever, tachycardia,
vasodilatation, dry mouth, restlessness, delayed gastric emptying and
decreased gastrointestinal motility, and urinary retention2
- Consider withholding feeds for 4 hours post administration2, 3
- Binds to melanin in the pupil; brown eyes may be less responsive to
action and require a greater dose
Supplied as : Minims® Cyclopentolate hydrochloride 0.5% w/v. Will be
diluted to cyclopentolate 0.25% in pharmacy
Dilution : Cyclopentolate 0.5% solution will be diluted with water for
injection to 0.25% with addition of citrate buffer in the
extemp area followed by sterilisation by filtration in aseptic
suite
Prepared solution will be transported and stored in NICU
Stability : For single use only. Discard any unused portion.
Storage : Refrigerate (2-8 degrees) for upto 28 days post manufacture.

Do not freeze.
Compatibility: NA (Not applicable)
Incompatibility : NA
Serum Levels : NA
47
Canberra Hospital
Compiled: October Review: October 2020
2016
References:
1. RPA and KEMH neonatal guidelines-online, 0.25% cyclopentolate, accessed
21/10/15
2. Neofax online. Accessed 21/10/15
3. Ozgun U1, Demet T1, Ozge KA1, Zafer D2, Murat S3, Mehmet Y1, Nilgun
K1. Fatal necrotising enterocolitis due to mydriatic eye drops. J Coll
Physicians Surg Pak. 2014 May;24 Suppl 2:S147-9
48
Canberra Hospital
Dexamethasone
Indication : Treatment of early or established chronic lung disease. To be

ordered by Consultant Neonatologist only.
Dose : For CLD:
0.2-0.3 mg/kg/day in two divided doses, then reduced every 48-72
hours by 0.1mg/kg/day.
Further dosing schedule to be determined by infant response and
requirements.
Route : I.V. or oral.
Total Daily Dose : According to protocol.
Comments : For CLD: Effects maximal after 36 hours of treatment. Massive diuresis,
dehydration and shock have been described. Close check on fluid balance and
electrolytes essential. GI haemorrhage documented. Hyperglycaemia and
hypertension more common side effects. Watch urine for gylcosuria.
Potentiates rickets of prematurity. May mask infection. Causes raised WCC
generally without a toxic film. Use of this regime is potentially dangerous and
should be under consultant supervision.
Increased risk of systemic candidiasis. Infants on Dexamethasone should be
treated with nystatin prophylaxis.
Supplied as : 4 mg/ml as dexamethasone sodium phosphate
Dilution : Add 3 ml NS or Dextrose to 1 ml dexamethasone

( 1 ml = 1 mg). Infuse over 1-2 minutes.
Compatibility: TPN, Dextrose, Normal Saline, Aciclovir, Amikacin,

Aminophylline, Fluconazole, Frusemide, Heparin,
Hydrocortisone, Morphine, Sodium bicarbonate.
Incompatibility : Vancomycin, Midazolam.
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Canberra Hospital
Dextrose - Increasing Dextrose Content of IV Bags

Revision Date : 29 October, 2010 Approved : AK, ZK
Starting Finished Volume to be Volume of 50%

Concentration Concentration Removed From Dextrose to be added
500 mL Bag to 500 mL bag
5% Dextrose 7.5% 28 mL 28 mL
10% Dextrose 12.5% 31 mL 31 mL
10% Dextrose 15% 62 mL 62 mL
10% Dextrose 20% 125 mL 125 mL
N/4 3.75% Dextrose 5% 13.5 mL 13.5 mL
N/4 3.75% Dextrose 7.5% 40.5 mL 40.5 mL
N/4 3.75% Dextrose 10% 67.5 mL 67.5 mL
N/2 2.5% Dextrose 5% 27 mL 27 mL
N/2 2.5% Dextrose 7.5% 52.5 mL 52.5 mL
N/2 2.5% Dextrose 10% 79 mL 79 mL

Example: To make a 500 mL bag of 12.5% Dextrose, you need a total of 62.5 g of dextrose in 500 mL.
469 mL of 10% Dextrose contains 46.9 g of Dextrose. 31 mL of 50% Dextrose contains 15.5 g of
Dextrose. When the 31 mL of 50% Dextrose is added to the bag, there is a total of 46.9 + 15.5 = 62.4 g
which = 12.48% Dextrose.
Calculations:
Volume of 50% = Volume of IV solution (500 mL bag) x the required increase in percentage
Dextrose required 50% Dextrose – the percentage of the base solution (i.e. 5 or 10%)
E.g. – Increase 500 mL 10% bag to 12.5%

Volume of 50% = 500 mL x 2.5%
50% - 10%
= 1250
40
= 31.25 mL (rounded down to 31 mL) of 50% Dextrose
50
Canberra Hospital
Diazepam
Indication : 1] Control of convulsions (Not recommended for neonates)

2] Sedation
Dose : 1] 0.2 mg I.V. up to 2 mg.

2] 0.1-0.8 mg/kg/24 hours
Interval : 1] Stat; repeat if necessary.
2] 0.1-0.8 mg/kg/24 hours
Route : I.M.
I.V. Slowly, not more than 2 mg/minute.
Total Daily Dose : Not more than 2 mg/kg.
Comments : May cause hypotension, jaundice, hiccoughs, and lethargy.

Caution when used with anaesthetic agents and alcohol.
Contraindicated in severe jaundice i.e. SBR > 150 mmol/L,
causes severe respiratory depression and prolonged
hypotonia.
Supplied as : 10 mg/2 ml ampoules.
Dilution : Should not be diluted with any substance as it will

precipitate. Administer over 5 minutes.
Stability : Discard unused portion.
Storage : Room temperature, protect from light.
Incompatibility : All other drugs in solution, including D5W and NS.
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Canberra Hospital
Diazoxide
Revision Date : 5th March 2009 Approved : AK, JD
Indication : Hyperinsulinaemic hypoglycaemia of the newborn.
Dose : 2-5 mg/kg/dose
Interval : 8/24
Route : Oral
Comments : Treatment of persistent or severe hypoglycaemia due to

hyperinsulinism. Positive responses are usually seen within 48
to 72 hours and occur in approx 50% of neonates. Sodium and
fluid retention is common, concurrent administration of
hydrochlorothiazide is recommended.
Supplied as : 25mg capsules. Capsules are only available under the SAS
scheme.
An ‘SAS Category A Form’ needs to be given to pharmacy
before supply can occur. See:
http://www.tga.health.gov.au/docs/pdf/unapproved/sascata.pdf
Dilution : Pharmacy will make a 10mg/mL mixture.
Stability : Mixture is stable for 30 days.
Storage : Capsules and mixture: room temperature, protect from light.
Incompatibility : n.a.
Serum Levels : n.a.
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Canberra Hospital
Digoxin
Indication : Cardiac arrythmias, Heart failure (controversial)
Dose : < 29 weeks - Loading dose 15 microg/kg

29 weeks – 1 month old – Loading dose 20 microg/kg
> 1 month old – 30-40 microg/kg
Give half of the loading dose stat, followed by a quarter of the
loading dose at 6-12 hours and the last quarter of the loading dose
at 12-18 hours.
Maintenance 3-5 microg/kg/dose 12 hourly
Interval : Maintenance 12 hourly
Route : I.V. - slowly over 5 minutes.

Oral with feeds
Total Daily Dose :
Comments : May cause vomiting and arrhythmias. Be aware of toxic signs. If used with
phenytoin profound bradycardia may result. Increased toxicity with adrenaline
and frusemide. Toxic signs on ECG include scooping of ST segment; inversion
of T waves; various degrees of heart block; arrhythmias. Care when used in
infants < 1500 gm. Adjust dose for renal failure. Ensure normal serum
potassium, as hypokalaemia increases the risk of adverse effects. Loading doses
are only necessary in the management of arrythmias. In other situations start with
maintenance dose. Do not use in patients with underlying Wolff-Parkinson-
White syndrome. When giving mixture orally with a syringe do not flush the
syringe after the dose – the drug left in the syringe may lead to toxicity if
repeatedly administered. For the treatment of life-threatening digoxin toxicity
use Digibind (Digoxin Immune Fab)
Supplied as : 50 microg/2 ml ampoules
50 microg/ml oral solution
Dilution : Dilute using 1ml of ampoule with 4ml NS or WFI. (= 5microgm/ml
) Administer over 5 minutes. Observe ECG during administration.
Compatibility: Compatible with cimetidine, heparin, lignocaine, KCl, TPN,

midazolam, NS, D5W, N/2 Saline, flucloxacillin, frusemide,
ranitidine.
Incompatibility : Fluconazole, dobutamine.
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Canberra Hospital
Serum Levels : Normal serum levels = 1-2 nmol/L. Sampling time at least 6 hours
after the dose. Approximate time to steady state is 1 week.
Dobutamine
Indication : Inotropic support without chronotropic effects of other drugs.
Dose : 1-20 microg/kg/minute (Maximum dosage 20 microg/kg/min.)
Interval : Continuous infusion only
Route : I.V.
Total Daily Dose :

Comments : Notably more beta effects than dopamine. Has less alpha effect and therefore
tends to produce a non-selective vasodilatation which may be useful in
pulmonary hypertension. At low doses dobutamine is four times more potent
in increasing cardiac contractility than dopamine, but dose not increase blood
pressure as might be expected. Dobutamine may be used in combination with
low dose dopamine to maintain renal, hepatic, and mesenteric blood flow.
Unlike dopamine, dobutamine dose not cause release of endogenous
noradrenaline, nor does it have any effect on dopaminergic receptors.
Supplied as : Dobutrex. Each vial contains 250 mg Dobutamine.
Dilution : Usually made up in pharmacy.

Add 15 mg per Kg of Dobutamine to a syringe and make up to
25 ml with D5W, D10W or NS.
1 ml/ hr = 10 microg/kg/min
Stability : Pink discoloration of solution indicates slight oxidation of the

drug but does not affect potency.
Compatibility : Dextrose, Normal Saline, TPN, Calcium gluconate, Calcium

chloride, Dopamine, Adrenaline, Fentanyl, Heparin, Insulin,
Isoprenaline, Magnesium sulphate, Potassium chloride,
Tolazoline, Vecuronium.
Incompatibility : Frusemide, diazepam, sodium bicarbonate, phenytoin.
Compatible with dopamine, Calcium gluconate, Adrenaline,
Isoprenaline, Ranitidine, morphine, TPN
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Canberra Hospital
Serum Levels :
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Canberra Hospital
Dopamine
Indication : 1] Hypotension due to impaired cardiac output.
Dose : 1] 5-20 microg/kg/minute. Starting dose is commonly 10

microg/kg/min. and varied according to response.
Interval : Continuous infusion.
Route : I.V.
Total Daily Dose :
Comments : Correct hypovolaemia prior to administration. Best given via

central line in dosage > 5 microg/kg/min as leads to
vasoconstriction and "white streaking" of peripheral vessels.
Extravasation may cause tissue necrosis and sloughing. May
treat with SC injection of site with phentolamine: 1 ml of
phentolamine 1mg/ml saline injected into affected area SC in 5
divided doses, changing needle with each injection.
Supplied as : 40 mg/ml - 5 ml ampoules.
Dilution : Usually made up in pharmacy.

Add 15 mg per Kg of Dopamine to a syringe and make up to
25 ml with D5W, D10W or NS.
1 ml/ hr = 10 microg/kg/min
Stability : Discard unused portion. Change infusion every 24 hours. May
be mixed with dobutamine, tolazoline
Compatibility : TPN, Dobutamine, Aminophylline, Calcium chloride, Fentanyl,

Heparin, Hydrocortisone, Midazolam, Morphine, Tolazoline,
Vecuronium.
Incompatibility : Sodium bicarbonate, and other alkaline solutions. Do not use
line for other stat drug administration as flush will lead to bolus
dosing. Compatible but not recommended to use in TPN.
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Canberra Hospital
Epoprostenol
Indication : Persistent pulmonary hypertension of the newborn

unresponsive to tolazoline and the usual ventilatory
strategies.
Dose : 2-20 nanograms/kg/minute.
Route : I.V. to central venous line.
Total Daily Dose :
Comments : Half-life is 3 minutes. Most potent vasodilator known. Use

is restricted – ICU availability only. Latent hypovolaemia
must be corrected before administering the medication.
Causes profound hypotension in cases where volume
loading is incomplete.
Supplied as : Epoprostenol sodium 500 g vial.
Dilution : Must be reconstituted in the solution provided. Draw up 10

ml of diluent and dissolve contents of vial. Draw up all of
solution and inject into the remainder of the diluent vial
(Total of 50 ml). This solution now contains 10,000
nanograms/ml (10g/ml).
Take ‘X’ ml. of this diluted solution and make upto 50 ml
with normal saline.
Strength Rate
‘X’ = Body Weight in kg. x 6
20ng/kg/min. @ 1 ml/hr.
Stability : The base solution is stable for 24 hours.
Storage : Refrigerated, protect from light.
Incompatibility : None known. Usual precautions apply.
Serum Levels :
57
Canberra Hospital
Erythromycin
Indication : Sepsis, particularly Chlamydia, Mycoplasma and

ureaplasma infections as well as H. influenzae.
Dose : Infection: 10 mg/kg.

Prokinetic dose: 2mg/kg
Interval : Infection: 12 hourly < 1 week old
Infection: 8 hourly > 1 week old.
Prokinetic dose: 8 hourly
Route : I.V. or oral.
Total Daily Dose : 30 mg/kg.
Comments : Oral dosage regimen usually adequate in infants tolerating

enteral feeds. I.V. dosage requires care in administration
and is reserved for infants not taking enteral feeds. May
induce vomiting. Heart rate and Blood Pressure must be
monitored closely during IV administration.
Supplied as : Oral suspension 250 mg/5 ml.
I.V. vials containing 300 mg.
Dilution : Made up in pharmacy I.V. dilution only. Dilute vial with 6
ml sterile water for injection and store for further use. After
initial dilution (50 mg/ml) dilute 1 ml further with 4 ml of
NS or D5W to final concentration of 10 mg/ml. Administer
over 60 minutes.
Stability : Discard remainder I.V. solution after use.
Suspension stable for 10 days after reconstitution. Observe
pharmacy directions.
Storage : Store suspension in fridge.
Compatibility : Normal Saline, TPN, Aciclovir, Aminophylline,

Chloramphenicol, Heparin, Hydrocortisone, Midazolam,
Morphine, Pentobarbital, Potassium chloride, Ranitidine,
Sodium bicarbonate.
Incompatibility : Dextrose solutions, Ampicillin, Fluconazole, Frusemide,
Metoclopramide.
Serum Levels :
58
Canberra Hospital
Erythropoietin
Revision Date : 09/01/2014 14:40:00 Approved AK, JD
Indication : Anaemia of Chronic Renal Failure and Prematurity.
Dose : 250-300 units/kg/dose.
Interval : 2 or 3 times weekly.
Route : I.V. infusion over 4 hours or s.c.
Total Daily Dose : N/A. Total weekly dose is 500-1400 Units per kg.
Comments : Currently licensed only for CRF. Approval from Janssen-

Cilag. Erythropoietin is a recombinant purified
glycoprotein which stimulates erythropoiesis. Half-life in
pre term neonates is about 12 hours. Watch for changes in
Hb, BP, and other vascular disease. Noticeable effects on
Hb and reticulocyte counts can occur over a period of 2
weeks. Weekly Hb should be checked until stable state
achieved (10-12 gm/dl). Dosage of HuEPO may need
adjusting according to the response over the first month or
so. An increase in appetite may lead to hyperkalaemia.
Iron supplements may be required to compensate for higher
Hb. Failure to respond may reflect other deficiencies or
loss and should be investigated.
Supplied as : 2000 units/ml ampoules.
Dilution :
Stability : Discard after opening.
Storage : 18 months at 2-8oC.
Incompatibility : Not compatible with anything. Do not mix.
Serum Levels :
59
Canberra Hospital
Fentanyl
Indication : Narcotic analgesia.
Dose : 0.5-5 microg/kg/hour

Stat doses for laser surgery/other procedures 1-2 mcg/kg
Route : I.V. only.
Total Daily Dose :
Comments : Short duration of action, rapid onset and potent. In large

doses causes "chest wall rigidity" – difficult to ventilate.
0.1 mg Fentanyl is equivalent to 10 mg Morphine (100
times more potent). Cardiovascular stability an advantage.
Half-life in neonates is variable and prolonged - 6 to 36
hours compared with 2 to 4 hours in children. Can cause
rapid development of tolerance and withdrawal symptoms
only after 3-5 days of usage.
Supplied as : Polyamp 50 microg/ml.
Dilution : Usually made up in Pharmacy.

Add ‘X’ ml of Fentanyl to 25 mls of Normal Saline or
Dextrose
Strength
‘X’ = Body weight in kg
1 ml = 2 microg/kg/hr, commence at 0.25-0.5 ml/hr
Stability : Diluted for infusion lasts 24 hours only.
Storage : DD cupboard
Compatibility : Compatible with TPN, Dextrose Dobutamine, Dopamine,

Adrenaline, Heparin, midazolam, hydrocortisone, morphine,
atropine, ranitidine, Sodium bicarbonate and vecuronium.
Incompatibility : Thiopental, phenobarbitol
Serum Levels : Generally not done.
> 1 ngm/ml = slight analgesia.
> 3 ngm/ml = effective concentration for postoperative pain.
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Canberra Hospital
Ferrous Sulfate (Ferro-Liquid)

Indication : Iron supplementation in prematurity.

To be prescribed for all infants < 32 weeks gestation or
birth weight < 1800 grams
Dose : 0.5 ml/kg day
Interval : Daily from 14 days (to 28) when on full feeds as tolerated.
Route : Oral. Preferable to give on an empty stomach to enhance

absortption.
Total Daily Dose : As Above.
Comments : Ferrous sulfate 150 mg/5 ml is equivalent to 30 mg of

elemental iron. Daily requirements are for 2.5 mg/kg/day to
a maximum of 15 mg/day. Breast fed infants should be
supplemented as soon as full breast milk feeds are
established or four weeks after birth. Infants fed on formula
do not usually need additional supplementation. Infants
who have had regular transfusions through the neonatal
period should have their iron status reviewed before
supplementation. Iron should continue until weaning from
breast-feeding or 12-15 months.
Supplied as : Ferro-Liquid 150 mg/5 ml (30 mg elemental iron/5 ml)
Dilution : Nil.
Stability :
Incompatibility : Do not administer with feeds.
Serum Levels : Assess serum iron, transferrin, ferritin, Hb, reticulocyte

count.
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Canberra Hospital
Flecainide
Indication : Supraventricular arrhythmias due to pre-excitation

syndromes and in the absence of structural heart disease.
Dose : 2 mg/kg
Route : I.V.
Total Daily Dose : 4 mg/kg
Comments : A membrane stabilising drug with a wide range of activity.

Has a slightly negative inotropic effect. May increase
serum digoxin levels. Infuse slowly over 10 minutes.
Supplied as : Ampoules, 10/mg/ml Tambocor
Dilution : 5 % glucose only
Stability : Usually made up in pharmacy. Discard after dilution
Incompatibility : Not to be mixed with chloride containing solutions.
Serum Levels : 200-1000 nanog/ml.
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Canberra Hospital
Flucloxacillin
Indication : Septicaemia, Skin infections.
Dose : 25 mg/kg/dose (50mg/kg/dose if required by Neonatologist)
Interval : 12 hourly for infants < 7 days.

8 hourly for infants 8 days-4 weeks
6 hourly for infants >4 weeks
Route : I.V.
Total Daily Dose : 50 to 100 mg/kg/day. (Maybe up to 200mg/kg/day in severe

infections)
Comments : Infuse over 15-30 minutes. Caution if given to babies of
mothers with known penicillin allergy. Activity decreased
by chloramphenicol and erythromycin. Hepatotoxic,
neutropenia after 5-6 days of use. May cause haemorrhagic
cystitis. Oral absorption very erratic in infants.
Supplied as : 500 mg vials
Dilution : Add 4.6 ml WFI to a 500 mg vial to make 100 mg/ml.

Further dilute to 10 ml with Normal Saline (50 mg/ml).
For infusion over 30 minutes.
Compatibility: Data not available.
Incompatibility : Aminoglycosides, TPN fluids.
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Canberra Hospital
Fluconazole
Indication : Fungal sepsis, especially Candida Albicans.

This is a restricted ORANGE ANTIMICROBIAL but
does not require approval if used for a suspected invasive
Candida infection in NICU patients.
Dose : For systemic infections:
Loading dose: 12 mg/kg/dose
Maintenance dose: 6mg/kg/dose
Severe infection or immunocompromised: 12 mg/kg/dose
Interval : < 2 weeks: every 72 hours
2-4 weeks: every 48 hours
> 4 weeks: every 24 hours
Route : IV infuse over 1 hour, or Oral
Total Daily Dose : 6 -12 mg/kg
Comments : Fluconazole is usually fungistatic in action and works by disturbing cell

membrane function in the yeast cell. It is rapidly and completely
absorbed from the GI Tract so change to oral as soon as possible. It
penetrates widely and has high urine concentrations. Good CSF
penetration is obtained. Elimination is mainly in urine. Fluconazole
should be administered for at least 4 weeks or two weeks after
symptoms have resolved for systemic infection. Note high sodium
content. (15mmol/100ml.).
Supplied as : Fluconazole IV solution 2mg/ml in 50 and 100 ml bottles.
Fluconazole oral mixture 10 mg/ml for reconstitution.
Dilution : None. Single dose unit made up in pharmacy
Stability : IV solution - discard remaining solution after. Do not reuse.

Oral solution – store reconstituted between 5-30 degrees
Celsius (not in refrigerator).
Compatibility: Dextrose, TPN, Aminophylline, Dexamethasone,

Dopamine, Dobutamine, Gentamicin, Heparin,
Hydrocortisone, Metronidazole, Midazolam, Morphine,
KCl, Phenytoin, Ranitidine, Vancomycin and Vecuronium.
Incompatibility : Ampicillin, Calcium gluconate, Cefotaxime, Ceftazidime,
Chloramphenicol, Digoxin, Frusemide, Imipenem and
Piperacillin.
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Canberra Hospital
Serum Levels : Not required. Reduce dosage in renal failure. Concomitant
administration with Cisapride is contra indicated. May
interfere with metabolism of Caffeine, Theophylline and
Midazolam. Check Drug levels during concomitant use.
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Canberra Hospital
Flumazenil
Indication : Flumazenil is a specific benzodiazepine antagonist used in

the reversal of overdose.
Dose : Loading dose 5 microg/kg every 60 seconds x8 max.

Maintenance 2-10 microg/kg/hr.
Route : I.V.
Total Daily Dose :
Comments : Benzodiazepines taken by the mother towards the end of

gestation are often responsible for evidence of poisoning or
withdrawal symptoms because of the long half-life of
diazepam, chlorazepate and others in the newborn. The
major metabolite, desmethyldiazepam has a longer half-life
than the parent molecule and will therefore have an effect
lingering for up to 2-3 weeks.
Supplied as : Flumazenil 0.1 mg/ml inj.
Dilution : Add ‘X’ mL of Flumazenil and dilute to make upto 20 mL

with normal saline.
‘X’ = Baby’s weight in kg.
@ 1 mL/hr. = 5 microg/kg/hr.
Stability : Room temperature.
Storage : Discard after opening. Solution should not need

administering longer than 12 hours.
Incompatibility : Do not mix with other drugs. Can be given with electrolyte
solutions.
Serum Levels :
66
Canberra Hospital
Fluticasone (Flixotide)
Indication : Inhaled corticosteroid used in the treatment of chronic lung

disease of prematurity.
Dose : Metered inhaler 50 mcg-100mcg 12 hourly
Route : Inhaled via spacer
Total Daily Dose : Metered inhaler 100-200 mcg
Comments : Shake canister well before use. Avoid contact with eyes. Wash
face after use. Rinse mouth after use either by feeding or with a
moistened swabstick. Titrate to give effective control with the
lowest possible dose. Risk of systemic effects with higher
doses.
Supplied as : Fluticasone 50 mcg/dose metered aerosol inhaler.
Dilution : Nil
Stability : Keep at room temperature
Storage : Store at room temperature
Incompatibility :
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Canberra Hospital
Folic Acid
Indication : Reduce likelihood of megaloblastic anaemia, leukopenia,

thrombocytopenia and growth retardation, or delayed CNS
maturation associated with folic acid deficiency.
To be prescribed for babies < 32 weeks gestation or < 1800
grams at birth.
Dose : 50 microg = 0.1 mL
Interval : Daily from 7 days of age when on full feeds
Route : Oral.
Total Daily Dose : Daily requirements are 50 microg. Weekly dosage will
satisfy overall needs.
Comments : Involved in the maturation of rapidly proliferating tissues
particularly bone marrow, gastrointestinal tract, etc. Do not
mix with other multivitamin preparations. Contains a
negligible amount of ethanol.
Supplied as : Folic acid solution 0.5 mg/mL = 50 microg/0.1 mL
Dilution : Nil.
Stability : As per pharmacy
Storage : At room temperature – do not refrigerate. Expiry as per the

bottle label.
Incompatibility : As Above. Separate from other vitamin administration.
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Canberra Hospital
Frusemide
Indication : Diuretic for pulmonary oedema and fluid overload.

Maintenance therapy in chronic lung disease.
Dose : 1-2 mg/kg.
Interval : Stat, repeat if necessary but preferably not more than 12 hourly.
Route : I.M.
I.V. over 20 minutes at minimum.
Oral.
Total Daily Dose : Not more than 4 mg/kg.
Comments : Correct electrolyte imbalance before and after use. Competes with bilirubin
for albumin binding. Chronic usage may lead to excessive calcium loss, renal
calcification and chronic hypochlorhydria. Diuresis by means of increased
sodium loss in loop of Henle, therefore in chronic usage treat hyponatraemia
by reduction of dosage rather than sodium supplementation. Treatment with
KCl, rather than spironolactone, will prevent both hypokalaemia and
hypochloraemia. Potentially nephrotoxic and ototoxic, particularly when used
with aminoglycosides. Drug may precipitate at low pH. Caution with dextrose
solutions as pH is variable.
Supplied as : 20 mg/2 ml Ampoules.
10 mg/ml oral mixture
Dilution : Dilute 1 ml (10 mg) of ampoule up to 10 mls with NS = 1
mg/ml. Give by slow infusion at a rate not exceeding
0.05mg/kg/min (i.e. 20 minutes for a 1 mg/kg dose).
For infusion: Take 0.4 ml (10 mg/ml ampoule) x baby’s weight
(kg) and make upto total of 48 mls with NS 1 ml/hour =
2mg/kg/day.
Storage : Ampoules: Room temperature, protect from light.

Oral mixture: Refrigerator, only stable for 3 weeks once opened.
Compatibility : Normal Saline, Amikacin, Aminophylline, Ampicillin,
Adrenaline, Calcium gluconate, Dexamethasone, Heparin,
Hydrocortisone, Indomethacin, Potassium chloride, Sodium
bicarbonate, Tobramycin, Tolazoline Digoxin, Penicillin G.
Incompatibility : Morphine, midazolam, dobutamine, dopamine, gentamicin,
fluconazole.
Serum Levels :
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Canberra Hospital
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Canberra Hospital
Ganciclovir
Indication : An antiviral agent active against cytomegalovirus (CMV).

Ganciclovir is useful in immunocompromised patients with
CMV infections and has also been used in symptomatic
congenital CMV infection.
from the Infectious Diseases team.
Dose : 5 mg/kg/dose
Route : Intravenous infusion over one hour.
Total Daily Dose : 10 mg/kg
Comments : Possible side effects include thrombocytopaenia,

neutropaenia
Supplied as : Cymevene
Dilution : As per pharmacy only
Stability :
Storage : Use as prepared by pharmacy
Compatibility Compatible with
Incompatibility :
Serum Levels :
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Canberra Hospital
Gaviscon (Alginic acid)

Indication : Suppression of oesophageal reflux and control of gastro-

oesophagitis.
Dose : 0.5-1.0 g (0.25 - 0.5 Tsp.) in 60 ml of feed.

Liquid preparation 1-2 ml with feed 4 hourly.
Interval : As per feed schedule.
Route : Oral.
Total Daily Dose :
Comments : Solution reacts with gastric acid to form a viscous, frothy,

colloidal gel of alginic acid which floats on the feed surface
to provide protection against free reflux and the irritant
effects of gastric secretions on the oesophageal mucosa.
Note: Each 2-gram of powder contains 4 mmol sodium.
Supplied as : Infant Gaviscon Powder
Infant Gaviscon Liquid
Dilution : Give with feed when bottle-fed. Mix with 10-20ml EBM or
water if breast-feeding and give at end of feed. Do not use
hot water. Excess administration may result in a gel ball in
the stomach.
Stability : Mixed Gaviscon may be stored refrigerated for up to 12
hours.
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Canberra Hospital
G-CSF (Granulocyte-colony stimulating factor

Indication : Persistent pre-eclampsia associated neonatal neutropaenia.

Consider prophylactic G-CSF in VLBW baby, or mature
baby requiring intensive care, if neutropaenia persists by
age 72 hours postnatal.
Neutropaenia Refs: Mature baby: <1.8 at 72 hours
VLBW baby: <1.1 at 72 hours
Dose : 10 micrograms/kg/day
Interval : Once daily dose
Route : Intravenous infusion (given over 30-60 minutes) or

Subcutaneous injection.
Total Daily Dose :
Comments : G-CSF is a cytokine, which regulates the proliferation of

immature granulocyte hematopoietic cells as well as the
function of mature cells of the granulocyte lineage.
Its benefit in treatment of sepsis-associated neutropaenia,
where endogenous G-CSF levels may be high, is as yet
unproven.
Supplied as : Filgrastim 300 microg (in 1ml)
Dilution : Usually prepared in Pharmacy.

Filgrastim can be diluted with Glucose 5% or albumin 0.2% to achieve a
suitable volume for injection of the very small dose. Filgrastim
concentrations >15microg/ml can be diluted with D5W, while those
<15microg/ml are diluted with albumin 0.2%. (Albumin is required
because of problems of adsorption of Filgrastim with plastics).
Stability : Avoid vigorous shaking. Prior to injection, allow to come
to room temperature.
Storage : Refrigerator at 2º to 8ºC
Incompatibility :
Serum Levels :
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Canberra Hospital
Gentamicin
Indication : Systemic and CNS infection.
Dose : 2.5 mg/kg < 30 weeks gestation at time of administration

3.5 mg/kg 30-35 weeks
5 mg/kg > 35weeks gestation
7.5 mg/kg Term infant > 7 days of age
Interval : 24 hourly – > 26 weeks gestation
36 hourly - < 26 weeks gestation
Route : I.V. over 30 minutes. (No faster than 1mg per minute)
I.M.
Total Daily Dose : Gestation dependent
Comments : Frequent serum levels required. Not ototoxic or

nephrotoxic when used at recommended doses for 7-10
days. Reduce dosage when renal function is impaired and
when on frusemide. Requires ID approval code for courses
longer than 5 days, with the exception of suspected NEC,
for which 7 days are approved.
Supplied as : 10 mg/1 mL vial.
80 mg/2 mL ampoule
Dilution : Do not dilute for I.M. use.
With the 10 mg/mL vial dilute the 1 mL with 9 mLs of NS,
D5W, or D10W to a solution of 1 mg/mL.
With the 80 mg/2 ml ampoule take 0.25 mL using a 1
mL syringe and dilute with 9.75 ml of NS, D5W, D10W
in to a 10 mL syringe to make a solution of 1 mg/mL
Stability : Vial 24 hours in refrigerator. Ampoule discard immediately.
Compatibility Aciclovir, cimetidine, clindamycin, dopamine, morphine,

TPN, ranitidine, tolazoline.
Incompatibility : Amphotericin B, frusemide, penicillin, cephalosporins,
chloramphenicol, heparin.
Serum Levels : Levels every 2nd dose for 36 hourly administration and
every 3rd dose for 24 hourly administration unless
otherwise indicated. DO NOT GIVE NEXT DOSE
UNTIL LEVELS ARE BACK. Take levels earlier if there
is a decrease in urine output or creatinine rises.
Normal range: Pre dose < 1.0 microg/ml
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Canberra Hospital
Glucagon
Indication : Hypoglycaemia.
Dose : 0.02 mg/kg/ dose. (Note 1mg = 1 unit: prescribe in mg).

Maximum dose- 1 mg.
Continuous infusion- 10-50 microg/kg/hour
Interval : Stat, repeat 6-12 hourly if necessary.
Route : SC, IM, IV
Total Daily Dose :
Comments : Maximally effective in hyperinsulinaemic states. Role in

IUGR babies controversial, although it may prove to be
useful in such a situation by stimulating gluconeogenesis.
Patient should receive glucose IV and not glucagon if in a
chronic hypoglycaemic state.
Supplied as : 1 mg vials with 1 ml diluent.
Dilution : Add 1 ml of diluent to vial.

For infusion-
Add up 1 mg/kg body weight of glucagon to make up 10 ml
with dextrose solution.
0.1 ml/hr = 10 microg/kg/hour
Stability : Discard vial after use.
Storage : Room temperature. Powdered vial should be protected from

light.
Incompatibility : Data not available. Precipitates with chloride containing
solutions.
Compatibility: NS, 5%D
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Canberra Hospital
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Canberra Hospital
Heparin
Indication : All I.A. and Central I.V. lines.
Dose : 0.5-1 unit per ml of solution.
Route : I.A.,Central I.V.
Total Daily Dose :
Comments : Overdose - cease treatment; transfuse with fresh whole

blood if required. Give protamine sulphate 1 ml per 100
units of heparin. Causes prolonged clotting time and APTT,
therefore monitor APTT. Can cause thrombocytopaenia on
rare occasions.
Supplied as : 1,000 Units per 1 ml ampoule.
Dilution : Usually made up in pharmacy. As for dosage.
Stability : Discard unused portion. Change infusion every 24 hours.
Compatibility : Compatible with dopamine, adrenaline, fentanyl, frusemide,

morphine, TPN, ranitidine, tolazoline. Also compatible with
Dextrose containing solutions and normal saline.
Incompatibility : Hydrocortisone, dobutamine, Vancomycin and all
antibiotics, phenytoin.
Serum Levels : Monitor clotting time. Only done if toxicity suspected.
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Canberra Hospital
Heparin CVC Lock

Revision Date : 12 July 2012 Approved : AK, JD
Indication : To maintain patency of secondary lumens on central venous

catheters and to allow blood sampling from central line
Dose : Time between access:
1] < 6 hours – 1.5 mls - Normal saline
2] < 24 hours – 2 mls daily – 50 units heparin in 5 mls
3] > 24 hours – 2 mls weekly – 1000 units heparin in 10 mls
Interval : 1] 4-6/24
2] daily
3] weekly
Route : IV
Total Daily Dose :
Comments : Always remove heparin lock before accessing the catheter to

ensure heparin is not injected into the patient and to remove
previous heparin lock before administration of next heparin
lock. All clamping is to be done on the cuffed area of the tube.
Supplied as : 1] Normal saline 10 ml ampoule
2] 50 units heparin in 5 ml ampoule
3] 1000 units in 1ml ampoule
Dilution : 1] Normal saline 10 ml ampoule – no dilution required
2] 50 units heparin in 5 ml ampoule – no dilution required
3] 1000 units in 1ml ampoule – dilute 1 ml ampoule with 9 mls
of normal saline (100 units per ml)
Stability :
Compatibility:
Incompatibility :
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Canberra Hospital
Hepatitis B Immunoglobulin
Revision Date : 09/01/2014 14:40:00 Approved: AK, JD
Indication : To reduce the exposure in babies born to mothers who are

HBsAg positive or who are in close family contact with
HBsAg positive individuals or have a significant exposure
soon after birth.
Dose : 1.0 ml (100 IU)
Interval : Once only.
Route : I.M.
Total Daily Dose :
Comments : Given at the same time, but in the opposite limb, as

Hepatitis B Vaccine and preferably with in 12 hours after
birth but may be given within 72 hours. If Hepatitis B
Immunoglobulin is to be given due to exposure it must be
given within 7 days of the documented exposure.
Supplied as : Hepatitis B Immunoglobulin CSL: Supplied from blood
bank.
Dilution : Nil
Stability :
Storage : At 2-8oC.
Compatibility : Not Applicable.
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Canberra Hospital
Hepatitis B Vaccine
Indication : Protection against Hepatitis B Virus.
Dose : 0.5 ml
Interval : Birth, 2, 4 and 6 months and booster at 12 months.
Route : I.M. Give into anterior thigh, not buttocks at birth. Given at
the same time as Vitamin K. Hep. B in Left thigh and Vit. K
in right thigh. Subsequent doses are given in the form of
Infanrix Hexa: (Diptheria; Tetanus; Acellular Pertussis;
Hepatitis B; Haemophilus Influenzae type B (Hib); and
Inactivated Poliomyelitis)
Total Daily Dose : Not Applicable.
Comments : Part of standard immunisation schedule valid from

1.7.2007. Note all babies are given Hep B and Vitamin K at
birth. For longer stay babies, the new schedule includes
combination vaccine for all subsequent immunisations. See
http://www.health.gov.au/internet/immunise/publishing.nsf/Content/home
Supplied as : Engerix-B, Ready to use vials.
Infanrix Hexa pre-filled syringe/pellet vial combination.
Dilution : None required for Engerix B. Shake vigorously before use.
Infanrix Hexa requires reconstitution – see separate entry
for detailed instructions.
Stability : Engerix B: 2 years.
Storage : Stored in pharmacy until required. Give as soon as possible

after arrival in CNC.
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Canberra Hospital
Hydralazine
Indication : Initial treatment of hypertension. Useful as it preserves

renal blood flow.
Dose : 0.1-0.2 mg/kg. Oral dosage is about twice that of required iv

dose.
Infusion 4-6 microg/kg/min
Interval : 6-8 hourly.
Infusion
Route : I.V.
Oral
Total Daily Dose : Titrate dose as per response.
Comments : May increase heart rate. Always start with a lower dose and
increase the dose depending upon the response. Exerts
effect by directly relaxing vascular smooth muscle tone and
lowering peripheral vascular resistance.
Supplied as : Apresoline ampoules containing 20 mg Hydralazine HCl
powder.
Dilution : Dissolve powder 1 ml water for injection. Add 1 ml of drug
to 9 ml of Normal Saline to make up a solution of 2 mg/ml.
Give slowly over 5-10 minutes.
Add 9 x Xmg of drug (4.5 x Xml of the solution) where X
is the weight in kg, to a syringe and make up to 25 mls with
NS. 1 ml/hour = 6 microgram/kg/min
Storage : Room temperature. Do not store powdered ampoules in

refrigerator.
Compatibility : Normal Saline, Dobutamine, Heparin, Hydrocortisone and
potassium chloride.
Incompatibility : 5% and 10% Dextrose, Aminophylline, Ampicillin,
Frusemide and phenobarbital.
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Canberra Hospital
Hydrochlorothiazide
Indication : Diuretic. Used for congestive heart failure and in long term
management of chronic lung disease. May improve
pulmonary function in patients with BPD.
Dose : 1-2 mg/kg.
Route : Oral.
Total Daily Dose : 2-4 mg/kg.
Comments : Thiazide diuretics increase loss of sodium, potassium,

magnesium, phosphorous and chloride ions from the
kidney. The excretion of calcium is reduced and its use is
therefore favoured in chronic lung disease where diuretic
associated renal calcification is common.
Displaces bilirubin from albumin binding sites.
Can cause hyperglycaemia by inhibiting the release of
insulin from pancreas.
Supplied as : Pharmacy can make 1mg/mL mixture during normal
business hours. After hours, Hydrochlorthiazide 25 mg
tablets are kept as ward stock.
Dilution : Not required for mixture.
Disperse one 25 mg tablet in 10 mL of water for injection to
make 2.5 mg/ml solution.
Stability : Mixture: 30 days
Tablets: see manufacturers expiry date on label.
Storage : Mixture: keep in refrigerator.
Tablets: room temperature. Discard solution made from
tablets immediately after use.
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Canberra Hospital
Hydrocortisone
Indication : 1] Shock
2] Intractable hypoglycaemia.
3] Physiological replacement
Dose : 1] 2-4 mg/kg every 4-6 hours

2] 2.5 mg/kg increased to 7.5 mg/kg
3] 0.3 mg/kg/dose 8 hourly
Interval :
Route : I.M.
I.V. slowly over one minute.
Total Daily Dose :
Comments : Typical corticosteroid. May cause Cushings Syndrome, protein

catabolism, electrolyte imbalance, hyperglycaemia, osteoporosis,
convulsions, increased bleeding tendency, growth retardation. May
mask infection. The dose recommended here is based on the
physiological secretion of corticosteroids (20-40mg/m2/day).
Hydrocortisone increases the expression of adrenergic receptors in the
vascular wall, thereby enhancing vascular reactivity to other vaso-active
substances like Noradrenaline and angiotensin. Response to
hydrocortisone can be seen as early as 30 minutes. Prolonged usage can
result in suppression of Pituitary Adrenal Axis. Hence, weaning after
prolonged therapy should be gradual.
Supplied as : 100 mg vial.
Dilution : Dissolve powder in 2ml WFI. May be further diluted to 20

ml (to give solution 5mg per ml). Give over 1minute.
For infusion: baby’s body weight in kg = X
Take X ml of hydrocortisone (5 mg/ml) and make up to 25
ml using
10 % Dextrose.
Using this resulting solution: 0.5 ml/hr = 0.1 mg/kg/hr.
Stability Discard remainder after use.
Compatibility : Dextrose and Saline solutions, TPN, Dopamine, Fentanyl,

Morphine.
Incompatibility : Adrenaline, heparin, diazepam, vancomycin.
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Canberra Hospital
Serum Levels :
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Canberra Hospital
Ibuprofen
Revision Date :28 January 2017 DTC Approved: March 2017
Indication : Treatment of a haemodynamically significant patent ductus

arteriosus in preterm newborn infants less than 34 weeks of
gestational age.1
Dose : Oral – 10 mg/kg first dose, 5 mg/kg for two further doses 24
hours apart.2
IV - 10 mg/kg first dose, 5 mg/kg for two further doses 24 hours
apart. 3
Double strength dose may be prescribed for IV formulation (not
oral) – 20 mg/kg first dose followed by two further doses of 10
mg/kg 24 hours apart.4
Interval : 24 hourly, administered orally or as a short infusion over 20
minutes
Route : Oral or intra-gastric
IV
Comments : -RCTs comparing ibuprofen with indomethacin show equivalent PDA closure
rates of about 75% with less side effects.1
-One RCT (n=70) comparing intravenous standard dose (10, 5, 5mg/kg) with
higher dose (20,10,10mg/kg) showed better closure rate with higher dose (63%
vs 86%, p=0.042) with no increase in side effects.4
-Three RCTs (n=236) showed significantly better closure rate with oral
compared to intravenous ibuprofen at standard dose (86% vs 63%, p<0.001)
with no difference in side effects.1
-Oral or IV ibuprofen could be used as first line treatment of PDA in preterm
infants
-Transient renal insufficiency may occur. Strict attention to fluid balance
essential. Monitor urine output and Serum electrolytes. Discuss dosage
with Neonatologist if UO < 0.5 mL/kg/hr &/or Se Cr > 150 micromol/L.
Hyponatraemia is usually a result of fluid retention not sodium loss. This is an
indication to further reduce maintenance fluids If anuria or manifest oliguria
occurs after the first or second dose, the next dose should be withheld until
urine output returns to normal levels.
-Upper GI bleeding or perforation may occur
-Rare reports of sudden onset hypoxia with PPHN.5
-Contraindications: active bleeding, thrombocytopenia or coagulopathy,
necrotising enterocolitis, significant renal dysfunction, ductal dependant
congenital heart disease, significant jaundice, as ibuprofen may displace
bilirubin from serum albumin
-Precautions: caution using other nephrotoxic drugs such as aminoglycosides
or frusemide. Dose may need modification if renal function is affected.
Fluconazole may reduce metabolisom of ibuprofen, increasing its
concentration. Action of diuretics is reduced. An association between
indomethacin, systemic steroids and GI perforation has been described. While
this has not been described for ibuprofen, caution should be applied in using
together with systemic steroids
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Canberra Hospital
Supplied as : Oral: Fenpaed® (Ibuprofen100 mg/5 mL suspension - 20mg/mL).6
IV: 'Pedea'® (Ibuprofen Sodium Salt 5 mg/mL ampoule).
IV Ibuprofen is unregistered in Australia. A ‘Category A’ SAS
form and a patient consent form must be completed for each
course. The SAS form must be returned to pharmacy. The patient
consent form should be kept in the patient notes. The blank forms
are kept with the medication in the clean utility room.
Administration : Oral: preferably give with feeds. If baby is not on enteral feeds or
EBM is not available give dose via intra-gastric tube and flush
with 1 mL water for injection.
IV: Do not use if particulate matter is observed. Administer dose

within 30 minutes of preparation and discard any unused portion.
Avoid extravasation.
Give undiluted or dilute to an appropriate volume with sodium
chloride 0.9% or glucose 5% and infuse over 20 minutes.
When dilution is to be carried out, due to the small dosing volume
of ibuprofen, to avoid over dosage involved with administration
of the ‘dead space’ volume, the dose should be drawn up into a
syringe and transferred to a second syringe, before dilution with
sodium chloride 0.9% or glucose 5%. Dilution of 2mL ampoule
in 8mL sodium chloride 0.9% or glucose 5% will give a
solution of 1mg/mL.
Stability : Oral: according to the expiry date on the bottle
IV: Use once only and discard any residue.
Compatibility: sodium chloride 0.9%, glucose 5%
Incompatibility : Regard all other intravenous solutions as incompatible. Always

flush line with sodium chloride 0.9% or glucose 5% before and
after administration.
Compiled: January 2017 Review: January 2019
References:
1. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low
birth weight infants. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.CD003481.
2. Erdeve O, Yurttutan S, Altug N, Ozdemir R, Gokmen T, Dilmen U, Oguz SS, Uras N. Oral versus
intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low
birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F279-83.
3. Hirt D, Van Overmeire B, Treluyer JM, Langhhendries JP, Marguglio A, Eisinger MJ, Schepens, P, Urien S.,
An optimized ibuprofen dosing scheme for preterm neonates with patent ductus arteriosus, based on a
population pharmacokinetic and pharmacodynamic study. Brit J Clin Pharmaco 2008;65:629-36
4. Dani C, Vangi V, Bertini G, Pratesi S, Lori I, Favelli F, et al. High-dose ibuprofen for patent ductus
arteriosus in extremely preterm infants: A randomized controlled study. Clinical Pharmacology and
Therapeutics 2012;91(4):590-6.
5. Gournay V. Savagner C. Thiriez G. Kuster A. Roze JC. Pulmonary hypertension after ibuprofen prophylaxis
in very preterm infants. Lancet. 2002:359(9316):1486-8
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Canberra Hospital
6. Product Information: Fenpaed. "http: http://www.drugs.com/uk/fenpaed-100mg-5ml-oral-suspension-
leaflet.html"
Indomethacin
Revision Date :October 2016 Approved: October 2016
Indication : Closure of Patent Ductus Arteriosus (PDA) where ibuprofen

has failed or unavailable
Dose 1,2,3,4 : Age at 1st 2nd 3rd dose

first dose:
<48h 0.2mg/kg 0.1mg/kg 0.1mg/kg
2-7 days 0.2mg/kg 0.2mg/kg 0.2mg/kg

>7 days 0.2mg/kg 0.25mg/kg 0.25mg/kg
Longer treatment course may be used. 0.1-0.2mg/kg daily

for 5-7 days.
Maximum 2 courses (3 IV doses per course)1
May consider 12 hourly dosing for a 3 dose course
Route : IV
Total Daily Dose :
Comments : -A prostaglandin synthetase inhibitor with profound renal effects.

Strict attention to fluid balance essential. Monitor urine output (UO)
and serum electrolytes.
Discuss dosage with Neonatologist if UO < 0.5mL/kg/hr &/or serum
creatinine > 150 micromol/L. Hyponatraemia is usually a result of fluid
retention not sodium loss. This is an indication to further reduce
maintenance fluids.
Contraindicated for infants with platelet count < 80,000/L or in infants
with ductal dependent congenital heart disease.
-Caution when used with frusemide and other nephrotoxic drugs such as
aminoglycosides.
-Caution when used with steroids (risk of spontaneous intestinal
perforation)
Side effects: Renal impairment ( Modify the use of aminoglycosides during Indomethcin use)
Hypoglycaemia (monitor BGL)
Platelet dysfunction
Hyponatraemia (secondary to fluid retention)
GI perforations/NEC (consider NBM or trophic feeds)
Rapid infusion associated with reduction in organ blood flow
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Canberra Hospital
Contraindications : Active bleeding
Thrombocytopenia
Coagulation defects
NEC
Congenital heart disease, PPHN
Significantly impaired renal function
Supplied as : Indomethacin Agila 1mg per vial.
Dilution : Reconstitute vial with 2mL of sodium chloride 0.9% or

sterile water – solution = 0.5mg/1mL. Further dilution not
recommended by manufacturer due to stability issues7.
Infuse over 30 minutes6.
Stability : Use immediately after reconstitution.
Storage : Store below 25°C. Protect from light
Compatibility : Water for injection, glucose 2.5%, glucose 5%, sodium

chloride 0.9%, Frusemide, Insulin, Nitroprusside, Potassium
chloride and Sodium bicarbonate.
Incompatibility : Glucose 10% & & Glucose 7.5%, calcium gluconate,
dobutamine, dopamine, cimetidine, gentamicin, tobramycin
and TPN/ lipid solutions
Serum Levels : Not clinically useful.
Compiled: October Revision: October 2020

2016
1.
Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application
2.
http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/PDA_2014_guideline.
pdf
3.
Tammela O, Ojala R, Iivainen T et al. Short vs Prolonged indomethacin therapy for patent
ductus arteriosus in preterm infants. J Pediatr 1999;134:552-557.
4.
Herrera CM, Holberton JR, Davis PG. Prolonged versus short course of indomethacin for
the treatment of patent ductus arteriosus in preterm infants. Cochrane Database of Systematic
Reviews 2007, Issue 2. Art. No.: CD003480. DOI: 10.1002/14651858.CD003480.pub3
5.
NeoMed, August 2015
6.
Colditz P, Murphy D, Rolfe P, Wilkinson AR. Effect of infusion rate of indomethacin on
cerebrovascular responses in preterm neonates. Arch Dis Child. 1989; 64: 8-12.
7. Indomethacin Agila (indomethacin) Australian approved product information. Dandenong

South Vic: Agila Australasia Pty Ltd. Approved 2nd April 2014
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Canberra Hospital
Imipenem/Cilastatin
Indication : Carbapenem antibiotic/renal dipeptidase inhibitor. Potent

broad spectrum antibiotic.
from the Infectious Diseases team.
Dose : Dose refers to imipenem component
Neonates Wk 1: 25 mg/kg/dose 12 hourly
Wk 2-4: 25 mg/kg/dose 8 hourly
Infants Usual: 15 mg/kg/dose 6 hourly
Severe infection: 25 mg/kg/dose 6 hourly
Interval : As above
Route : I.V. only. 20-30 minute infusion.
Total Daily Dose :
Comments : May precipitate convulsions in patients with CNS disease.

Generalised convulsions have been reported in patients who
received Ganciclovir concomitantly.
Supplied as : Vials containing Imipenem 500mg/Cilastatin 500 mg

Trade Name - Primaxin
Dilution : During Pharmacy open hours Pharmacy will provide
syringes. When necessary to prepare on the ward
reconstitute the vial with 9.2 ml WFI to form a suspension.
Shake vial well and immediately withdraw 1 ml of
suspension. Further dilute to 10 ml with NS. Agitate syringe
until solution becomes clear. Concentration for
administration must not exceed 5 mg/ml.
Stability : Discard unused solution and suspension.
Storage : Powder vials store at below 30 degrees Celsius. Syringes

from pharmacy may be stored for up to 2 days in the
refrigerator.
Compatibility : NS, 5% Dextrose, 10% Dextrose, Y Site compatible:
Aciclovir, Aztreonam, Cefepime, Insulin, TPN
Incompatibility : Y Site: Amphotericin, Fluconazole, Midazolam, Sodium
bicarbonate
Serum Levels :
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Canberra Hospital
Immunoglobulin IV (Intragram®P): Draft

Revision Date : 5 December, 2019 Approved: TC
Indication : Isoimmune haemolytic disease (Rh, ABO, Other)1

Neonatal alloimmune thrombocytopenia (NAIT)
Replacement of IgG in chylothorax
Neonatal haemochromatosis
Dose : 0.5-2 g/kg, depending upon the indication.
Isoimmune haemolytic disease: 0.5-1g/kg1,2
NAIT: 1g/kg/day for 2 days1
Chylothorax: 0.5-1g/kg
Neonatal haemachromatosis: 1g/kg3
Interval : Stat dose, which may be repeated in 12 hours in isoimmune
haemolytic disease.
Route : I.V. only, infuse over 4 hours.
Total Daily Dose : 2g/kg/day
Comments : -IVIg is issued in accordance with the criteria for the clinical use of
intravenous immunoglobulin in Australia. The medical officer requesting
IVIg will be required to complete and submit a 2 page ‘Authorisation
Request Form’ to the Australian Red Cross Blood Service for authorisation.
This form could be downloaded from www.blood.gov.au/Ig-governance.
Once authorised, IVIg would be issued from Canberra Hospital Blood
Bank.4
-The dose of Intragam P is not clearly defined and the drug is expensive and
in short supply. Dosages should be rounded down to whole vials and we
should not require more than 1 x 50ml vial (3g) per dose.
-Passively acquired antibody can interfere with the response to live attenuated
vaccines, therefore administration of such vaccines (eg rotarix, oral polio, BCG)
should be delayed for approximately 3 months after passive immunity
-Generally a dose of 0.5-1 g/kg is given over 4 hours. The rate should be started
slowly and gradually increased after 15 minutes if no reactions occur. Too rapid
a rate may cause flushing and changes in heart rate and BP. Adverse reactions
include vomiting, chest pain, rigors, arthralgia for 24 hours.5
Supplied as : Intragam®P 6% solution, 10 ml, 50 ml, 200 ml.
Dilution : May be infused undiluted. May be diluted with up to two

parts NS or D5W.5
Stability : Vial for single use only.
Storage : Store at 2-8 degrees Celsius (Refrigerate, DO NOT

FREEZE). Once removed from refrigeration, store below 25
degrees Celsius for up to 3 months. Protect from light.5
Compatibility : Hospital policy requires that blood products not be mixed
with other drugs and infused separately
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Canberra Hospital
Contraindications : Anaphylaxis to human immunoglobulin preparations.5
Serum Levels : NA
Compiled: February Review: February 2018

2015
References:
1. Paediatrics and Neofax ®. Application Version: 7.1.2.2014-Q4
2. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of
gestation. Pediatrics 2004; 114; 297
3. Rand EB, Karpen SJ, Kelly S et al. Treatment of neonatal hemochromatosis with
exchange transfusion and intravenous immunoglobulin. Journal of Pediatrics, 2009,
vol. 155, no. 4, pp. 566–571
4. National blood authority, Australia. Website- http://blood.gov.au/Ig-governance
5. Intragram®P product information. Available at-
http://www.csl.com.au/docs/146/668/Intragam%20P%20AU%20PI%2014.00%20(Su
pplied).pdf. Accessed 18/2/15
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Canberra Hospital
Indomethacin
Revision Date :October 2016 Approved: October 2016
Indication : Closure of Patent Ductus Arteriosus (PDA) where ibuprofen

has failed or unavailable
Dose 1,2,3,4 : Age at 1st 2nd 3rd dose

first dose:
<48h 0.2mg/kg 0.1mg/kg 0.1mg/kg
2-7 days 0.2mg/kg 0.2mg/kg 0.2mg/kg

>7 days 0.2mg/kg 0.25mg/kg 0.25mg/kg
Longer treatment course may be used. 0.1-0.2mg/kg daily

for 5-7 days.
Maximum 2 courses (3 IV doses per course)1
May consider 12 hourly dosing for a 3 dose course
Route : IV
Total Daily Dose :
Comments : -A prostaglandin synthetase inhibitor with profound renal effects.

Strict attention to fluid balance essential. Monitor urine output (UO)
and serum electrolytes.
Discuss dosage with Neonatologist if UO < 0.5mL/kg/hr &/or serum
creatinine > 150 micromol/L. Hyponatraemia is usually a result of fluid
retention not sodium loss. This is an indication to further reduce
maintenance fluids.
Contraindicated for infants with platelet count < 80,000/L or in infants
with ductal dependent congenital heart disease.
-Caution when used with frusemide and other nephrotoxic drugs such as
aminoglycosides.
-Caution when used with steroids (risk of spontaneous intestinal
perforation)
Side effects: Renal impairment ( Modify the use of aminoglycosides during Indomethcin use)
Hypoglycaemia (monitor BGL)
Platelet dysfunction
Hyponatraemia (secondary to fluid retention)
GI perforations/NEC (consider NBM or trophic feeds)
Rapid infusion associated with reduction in organ blood flow
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Canberra Hospital
Contraindications : Active bleeding
Thrombocytopenia
Coagulation defects
NEC
Congenital heart disease, PPHN
Significantly impaired renal function
Supplied as : Indomethacin Agila 1mg per vial.
Dilution : Reconstitute vial with 2mL of sodium chloride 0.9% or

sterile water – solution = 0.5mg/1mL. Further dilution not
recommended by manufacturer due to stability issues7.
Infuse over 30 minutes6.
Stability : Use immediately after reconstitution.
Storage : Store below 25°C. Protect from light
Compatibility : Water for injection, glucose 2.5%, glucose 5%, sodium

chloride 0.9%, Frusemide, Insulin, Nitroprusside, Potassium
chloride and Sodium bicarbonate.
Incompatibility : Glucose 10% & & Glucose 7.5%, calcium gluconate,
dobutamine, dopamine, cimetidine, gentamicin, tobramycin
and TPN/ lipid solutions
Serum Levels : Not clinically useful.
Compiled: October Revision: October 2020

2016
1.
Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application
2.
http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/PDA_2014_gui
deline.pdf
3.
Tammela O, Ojala R, Iivainen T et al. Short vs Prolonged indomethacin therapy for
patent ductus arteriosus in preterm infants. J Pediatr 1999;134:552-557.
4.
Herrera CM, Holberton JR, Davis PG. Prolonged versus short course of
indomethacin for the treatment of patent ductus arteriosus in preterm infants.
Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003480. DOI:
10.1002/14651858.CD003480.pub3
5.
NeoMed, August 2015
6.
Colditz P, Murphy D, Rolfe P, Wilkinson AR. Effect of infusion rate of
indomethacin on
cerebrovascular responses in preterm neonates. Arch Dis Child. 1989; 64: 8-12.
7. Indomethacin Agila (indomethacin) Australian approved product information.

Dandenong South Vic: Agila Australasia Pty Ltd. Approved 2nd April 2014
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Canberra Hospital
INFANRIX hexa
Indication : Primary immunisation of all children from 2 months of age

against diptheria, tetanus, pertussis, hepatitis B, poliomyelitis and
haemophilus influenzae type b.
Dose : 0.5 ml
Interval : Immunisation schedule: 2, 4 and 6 months of age.
Route : IM to anterolateral aspect of the mid thigh for infants under 12

months. For children over 12 months, the deltoid region of the
arm is used.
Comments : The vaccine must NEVER be administered intravenously.
INFANRIX hexa vaccines must not be mixed with other vaccines
in the same syringe. INFANRIX hexa vaccines may be given on
the same day as any of the other standard childhood vaccines, but
at a separate site.
Supplied as : INFANRIX hexa is supplied in two parts. A turbid white
suspension in a pre-filled syringe containing 5 of the 6 vaccines.
A second vial containing a lyophilised pellet of Hib vaccine.
Dilution : The pre-filled syringe should be shaken well to obtain a
homogeneous suspension. The entire contents of the pre-filled
syringe are added to the vial containing the Hib pellet. After
addition of the liquid component to the pellet the mixture should
be shaken well until the pellet is completely dissolved. The final
product may appear cloudy.
Stability : After reconstitution, the vaccine should be injected promptly.
However, the vaccine may be kept for up to 8 hours at room
temperature.
Storage : Store between 2-8 degrees Celsius. Freezing destroys the vaccine.
Protect from light.
Incompatibility : Do not mix with any other preparation.
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Canberra Hospital
Infloran®
Revision Date : 15 May 2015 DTC Approved: 29/5/15
Indication : Prevention of necrotising enterocolitis (NEC) in infants at

high risk of NEC i.e. < 32 weeks gestation and/or < 1500
grams.1,2
Dose : 125 -250 mg. 3, 4
Interval : Once daily
Route : Oral
Total Daily Dose : 250 mg
Comments : -Consent: Infloran is not a registered product in Australia.

Parents of eligible babies should be given parent
information sheet and medication should be charted by the
authorised prescriber only after informed written consent is
obtained. The original of the signed consent form should be
filed in the patient notes
-Dosing: For preterm neonates who are on minimal enteral
feeds (1mL 4hrly) the daily dose is half capsule per day (1
mL of reconstituted volume after dissolving capsule in
2mL of milk) given as a single dose irrespective of the
gestation at birth. Once the neonate is on 3mL 2hrly, the
supplementation dose will be one capsule (reconstituted
in 2mL of milk) per day given as a single dose
-Probiotics should be stopped during periods when the
enteral feeds are stopped (at the discretion of
Neonatologist). Supplements could be recommenced 24
hours after restarting feeds
-Probiotics should be discontinued at 34 weeks corrected
gestational age or prior to discharge or transfer to other
hospital, whichever is earlier. Probiotics should be
continued till 38 weeks in the growth restricted group
(≥32 weeks, <1500grams). Probiotics will be ceased at any
time the parents wish to withdraw consent for any reason.
Supplied as : Infloran® capsule, 250 mg/capsule (contains Lactobacillus
acidophilus [109 colony-forming units, NCDO 1748;
National Collection of Dairy Organisms] and
Bifidobacterium bifidum [109 colony-forming units,
NCDO 1453; National Collection of Dairy Organisms,
Reading, United Kingdom])4, 5
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Canberra Hospital
Dilution : Contents of one capsule of Infloran is dissolved
in 2 mL of mother’s expressed breast milk or
formula (1mL = 125mg). To be administered with
routine feeds.
Stability : Discard unused portion
Storage : Refrigerate 2 - 8oC. Do not freeze
Incompatibility : Do not mix with any other drugs
Serum Levels : Not Applicable
Compiled: May 2015 Review: May 2019
References:
1. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in
preterm infants. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.:
CD005496 DOI: 10.1002/14651858.CD005496.pub4
2. Wang Q, Dong J, Zhu Y. Probiotic supplement reduces risk of necrotizing
enterocolitis and mortality in preterm very low-birth-weight infants: an updated meta-
analysis of 20 randomized, controlled trials. J Pediatr Surg. 2012;47:241-8.
3. Deshpande G, Rao S, Keil A, Patole S. Evidence-based guidelines for use of
probiotics in preterm neonates. BMC Medicine. 2011; 9 92-105
4. Lin H-C, Hsu C-H, Chen H-L, Chung M-Y, Hsu J-F, Lien R-i, Tsao L-Y, Chen C-
H, Su B-H. Oral probiotics prevent necrotizing enterocolitis in very low birth weight
preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008; 122
(4):693-700
5. Infloran product information. Natural Medicines Comprehensive data base:
Available at
http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=nd&pt=103&i
d=70621 (Accessed: 8th Jan 2015)
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Canberra Hospital
Insulin (Actrapid – for hyperglycaemia)

Indication : Hyperglycaemia.
Dose : 1] 0.1 units/kg.

2] 0.01 – 0.1 units/kg/hour Continuous infusion
Interval : 1] Hourly until blood sugar level < 8 mmol/L.
2] Continuous infusion over 24 hours.
Route : 1] S.C. or I.V.
2] I.V- as a 5 minute bolus.
Total Daily Dose : Up to 3 units/kg/day.
Comments : Used for the treatment of hyperglycaemia, usually in infants less

than 1200 grams, on total or partial parenteral nutrition.
Insulin has a tendency to bind to binding sites in plastic. Dilution
with Gelofusine reduces the amount of insulin adsorption to plastic
infusion materials.
When used with Gelofusine, Insulin must be thoroughly mixed to
avoid the possibility of Insulin floating on top of the solution.
Tubing must be pre-conditioned for one hour prior to beginning the
infusion to saturate the insulin binding sites. This should be
followed by flushing the apparatus with 5 mL of Insulin solution.
Insulin is NOT to be administered through any filter.
Supplied as : Actrapid - Soluble insulin: 100 units per mL vial.
Dilution : Usually made up in pharmacy. Dilute 1mL (100 units/mL) of

Insulin to 10 mLs with Gelofusine then take 5 units/kg from this
solution and further dilute to 50 mL with Gelofusine (Read
comments). Write the pharmacy order as 5 units/kg in 50 mL
gelofusine.
(0.1 Unit/kg/hr. = 1 ml/hr).
Stability : Infusion stable for 24 hours only.
Storage : Refrigerate, do not freeze.
Incompatibility : Aminophylline, chlorthiazide, dopamine, phenobarbitone,

phenytoin, thiopentone sodium.
Compatibility: Dextrose solutions, TPN, dobutamine, morphine, heparin,
indomethacin, gentamicin, midazolam, vancomycin.
Serum Levels :
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Canberra Hospital
Insulin (for hyperkalaemia)

Revision Date : 03/07/2014 Approved: TC, LZ, JD
Indication : 1. Severe hyperkalaemia (K+ >7 mmol/L), significant ECG

changes, cardiac arrhythmias
2. Moderate hyperkalemia (K+ >6.5 mmol/L), maintenance
infusion following bolus
Dose : 1. 0.15 units insulin/kg per 0.5g glucose/kg in either 10%, 25%
or 50% dextrose (see dilution below)
2. 0.15 units insulin/kg per 0.5g glucose/kg/hr (see dilution
below)
Interval : 1. Bolus injection over 10 minutes
2. Continuous infusion. Gradually wean infusion when
hyperkalaemia is resolving (K+ <5.5mmol/L)
Route : Intravenous route depending on access
Insulin/glucose 10%: peripherally
Insulin/glucose 25% and 50%: centrally
If there is only peripheral access, insulin/glucose 25% may be
given peripherally due to the urgency of treatment
Total Daily Dose :
Comments : -Insulin enhances the cellular uptake of potassium, which decreases the
concentration of potassium in the blood. This is only a temporising
measure to lower the serum potassium levels acutely, while awaiting
more definitive measures.
Bolus injection is usually reserved for emergency treatment of
cardiac arrhythmia associated with hyperkalemia.
Measure blood glucose concentrations every 15 – 30 minutes after
starting the insulin infusion and after changes are made to the infusion
rate. When stable, the glucose can be checked at 2 hour intervals. Aim
for normal BSL between 3-10mmol/L. Watch for late hypoglycaemia.
Monitor potassium levels every 30-60 minutes on blood gases initially

and if stable then check at 2 hour intervals. Repeat formal lab potassium
levels every 4-8 hours until hyperkalaemia has resolved. Gradually
wean insulin when hyperkalemia is resolving (K+ <5.5 mmol/L)
Insulin has a tendency to bind to binding sites in PVC. The IV line must
be primed with the insulin infusion solution and allowed to stand for one
hour, then flushed with at least 10 mLs of the insulin solution prior to
connecting to the infant. This will saturate the insulin binding sites in
the line and prevent erroneous changes to the concentration of the
solution during the subsequent infusion. In an emergency, omit the one
hour conditioning but still prime and flush the line prior to connecting.
Insulin is NOT to be administered through any filter
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Canberra Hospital
Supplied as : Actrapid® neutral insulin injection:
100 units per mL, 3mL vial.
Dilution Can be made up in pharmacy during working hours. Pharmacy
will connect and prime tubing to the syringe/bag.
Bolus injection
Step 1: Transfer 100 units (1 mL) of insulin from an insulin
syringe into a 10mL syringe and make up to 10mL using sodium
chloride 0.9%. This gives a 10 unit in 1mL solution
Step 2: Three options - choose the appropriate concentration

of dextrose
10% Dextrose option a:
Add 15units (1.5mL) of the 10u/mL insulin solution into a
500mL bag of 10% dextrose. Invert the bag several times to
ensure thorough mixing of insulin throughout the solution
Bolus dose = 5mL/kg over 10 minutes
5mL/kg provides 0.15u/kg of insulin and 0.5g dextrose/kg
25% Dextrose option b:
50% Dextrose option c:
Step 3: Do not hang the dextrose/insulin bag. Load an adequate

volume from the bag into a syringe (eg 25mL). If time permits,
prime and flush the line as described under comments
Continuous infusion
Choose the appropriate dextrose concentration and make up a
dextrose/insulin bag according to step 2 above. Use the solution
to load a 25mL or 50mL syringe. Prime and flush the line as
described under comments
10% dextrose/insulin solution:
A rate of 5mL/kg/hour provides 0.15u/kg/hr of insulin and 0.5g
dextrose/kg/hr
dextrose/kg/hr
dextrose/kg/hr
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Canberra Hospital
Stability : Discard after use
Storage : Refrigerate, do not freeze
Incompatibility : See hyperglycaemia protocol
Ipratropium Bromide
Indication : Anticholinergic Bronchodilator.
Dose : 50 microg
Route : Nebuliser.
Total Daily Dose : 200 microg
Comments : Inhibits cholinergic bronchoconstriction. Onset of action is

3-5 minutes. Peak action 1-2 hours after dose and persists
for up to 6 hours. Used in severe BPD in which there is an
element of wheeze. Used in conjunction with Salbutamol.
Supplied as : Nebuliser solution 250 microg/ml.
Dilution : Dilute with 2 ml NS. Use gas flows at required oxygen

concentration between 4-6 l/min.
Stability : Discard after dilution.
Storage : Use as soon as possible after opening and discard after 28

days.
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Canberra Hospital
Isoprenaline
Indication : Hypotension due to impaired cardiac output. Both inotropic

and chronotropic. Has peripheral vasodilator action and is
therefore useful in patients with PPHN.
Dose : 0.05 – 2.0 microg/kg/min.
Interval : Continuous infusion. Double rate every 2-5 minutes until

response is obtained. It also has to be titrated against the
heart rate. Max 2 microg/kg/hr.
Route : I.V.
Total Daily Dose :
Comments : May cause tachycardia, arrhythmias, cardiac enlargement,

focal myocardial ischaemia and rarely pulmonary oedema.
Hypoglycaemia can occasionally be seen with Isoprenaline
usage.
Supplied as : 200 microg/ml.
Dilution : Stable in D5W, D10W, NS.
Take 7.5 ml/kg of Isoprenaline(200 microg/ml solution) and
make upto 50 ml with the base solution. This gives a
strength of 30 microg/ml solution.
0.5 microg/kg/min at 1 ml/hour.
Stability : Discard unused portion after opening. Change I.V. solution
every 24 hours.
Storage : Refrigerated.
Compatibility : TPN, Aminophylline, Dobutamine, Heparin,

Hydrocortisone, Potassium chloride and Vecuronium.
Incompatibility : Frusemide, Sodium bicarbonate.
Serum Levels : Use extreme caution if patient has high serum digoxin
levels. Must not flush line for other drugs because of risk of
bolus effect. An alternative IV/IA line is needed.
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Canberra Hospital
Isovue
Indication : Checking placement of central catheters (i.e. {PICC lines,

etc)
Dose : 0.5ml
Interval : Once only
Route : Intravenously instilled into the central line
Total Daily Dose :

Comments : Sterile gloving and gowning by Neonatal Registrar required.
X-Ray plate needs to be in place before procedure begins.
Registrar injects 0.5 ml of Isovue, and as the last 0.1ml is
being injected the x-ray should be taken. Use a 1 mL
syringe. Following the x-ray, flush with 1 ml of Normal
Saline.
The position of the line must be confirmed before commencing
maintenance infusions.
Isovue injection is a nonionic, radiopaque contrast medium for
intravascular administration. Contraindicated in known hypersensitivity
to iopamidol and thyrotoxicosis. Caution in patients with reduced renal
or hepatic function. Isovue is excreted primarily by the kidneys. Fatal
reactions have been associated with the administration of water soluble
contrast media, most of which have been attributed to chemical, allergic
or idiosyncratic effects. It is of utmost importance that a course of action
be carefully planned in advance for the immediate treatment of serious
reactions, and that adequate and appropriate facilities and personnel be
readily available in case of a severe reaction.
Supplied as : Isovue-300 (iopamidol injection 61%) provides iopamidol
612 mg with trometamol 1 mg and sodium calcium edetate
0.39 mg, and contains approximately 0.037 mg (0.002 mEq)
sodium and organically bound iodine 300 mg/mL
Dilution : None required.
Stability :
Storage : Store below 30 degrees C. Protect from light
Incompatibility : Do not mix with any other iv fluids.
Serum Levels :
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Canberra Hospital
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Canberra Hospital
Labetalol
Indication : Hypertension.
Dose : Commence initially at 1-2 mg/kg/dose .
Interval : 6-12 hourly.
Route : Oral
Total Daily Dose : Up to 10 mg/kg/dose can be given 6 hourly

Comments : Alpha-beta blocking agent. Contraindicated in asthma. Use
with caution, if at all, in patients with cardiac failure and
conduction disorders.
Supplied as : 100 mg and 200 mg tablets.
Dilution : Pharmacy will prepare powders.
Stability :
Incompatibility :
Serum Levels :
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Canberra Hospital
Lactulose
Indication : 1) Hepatic encephalopathy

2) Second line (after poloxalkol – coloxyl drops) for a
laxative
Dose : 1) 1 ml/kg
2) 0.5 ml/kg
Interval : 1) 6 hourly
2) 24 hourly
Route : Oral.
Total Daily Dose : 1) 4 ml/kg/day

2) 0.5 ml/kg/day
Comments : May take 24-48 hours for defecation to occur. May be more
palatable when mixed with water or milk.
Supplied as : 3.3g/5ml.
Dilution :
Stability :
Incompatibility :
Serum Levels :
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Canberra Hospital
Levetiracetam (Keppra)
Indication : Intractable seizures.
Dose : 10 mg/kg per dose, increase 10 mg/kg once per week until
seizures controlled
Interval : First 28 days of life – daily
≥ 29 days of life – 12 hourly
Maximum of 30 mg/kg/dose
Route : IV or PO
Comments : Sedation and irritability have been reported in neonates and young
infants. When discontinuing therapy wean slowly to minimise risk
of seizure recurrence. Trough serum levels are generally not
measured. Therapeutic concentrations 10-40 mcg/mL. Keppra® is
renally cleared so dosage should be adjusted in patients with renal
failure. Mechanism of action thought to involve intraneuronal Ca
levels, GABA and the synaptic vesicle protein 2A. Conversion
from iv doses to oral doses can be done directly without titration.
Supplied as : Keppra® injection for IV use – 500 mg in 5 mLs (100 mg/mL)
Keppra® oral solution – 100 mg/mL
Dilution : Dilute iv doses to 5mg/mL to administer. Take 1mL of Keppra®
100mg/mL and 19 mL of 0.9% NaCl or 5% Dextrose, making
100mg/20mL (=5mg/mL).
Administer iv doses slowly over 15 minutes.
Stability : IV ampoules - use once only and discard any residue.
Where practical, the Pharmacy IV room will prepare the doses in
syringes.
Storage : IV ampoules - Room temperature.
Oral solution – Room temperature
Compatibility : Normal saline, Hartmann’s, 5% Dextrose
Incompatibility :
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Canberra Hospital
Lignocaine for seizures

Indication : Persistent clinical and/or electrical seizure activity unresponsive

to phenobarbitone and midazolam.
Dose : Loading dose – 2 mg/kg over 10 minutes
6 mg/kg/hour for 6-12 hours depending on seizure response
4 mg/kg/hour for 12 hours
2 mg/kg/hour for 12 hours
Interval : Infusion
Route : IV
Total Daily Dose : Note - levels above 9mg/L are less often encountered when
6mg/kg/hour is used for 6 hours rather than 12 hours.
Comments : Lignocaine stabilises all potentially excitable membranes and prevents the initiation
and transmission of nerve impulses. Lignocaine is metabolised in the liver.
Metabolites (which may be posess activity) are renally extcreted. Phenytoin,
phenobarbitone, primidone and carbamazepine appear to enhance the metabolism of
lignocaine possibly due to an induction of microsomal enzymes, but the significance
is unknown. Phenytoin and lignocaine have additive cardiac depressant effects.
Constant ECG monitoring is essential during intravenous administration of
lignocaine. If signs of excessive depression of cardiac conductivity (e.g.
prolongation of the PR interval or QRS complex), aggravation of arrhythmias or
other severe reactions occur, lignocaine should be promptly discontinued. Patients
with reduced hepatic blood flow or function, and those on prolonged infusions of
lignocaine will have a longer half-life and a lower clearance. During congestive
cardiac failure, clearance will be reduced and in renal failure, accumulation of
lignocaine may occur. Such instances will require a reduction in dosage. Lignocaine
may increase ventricular rate when it is administered to patients with atrial
fibrillation. Ischaemia or necrosis may occur in patients with hypertensive vascular
disease or with an exaggerated vasoconstrictor response. Contraindications: Known
hypersensitivity to local anaesthetics of the amide type. Use with caution in hepatic
disease, renal disease, congestive cardiac failure, marked hypoxia, severe respiratory
depression, severe shock or hypovolaemia. Hypokalaemia, hypoxia and disorders of
acid/ base balance should be corrected before treatment with lignocaine.
Supplied as : Lignocaine Injection 2% Steriamps (clear, colourless, sterile,
isotonic solution), 100 mg/5mL (20 mg/mL - stored in box of
emergency drugs in fridge).
Dilution : Bolus solution: Can be administered undiluted or dilute to a
final concentration of 1mg/mL with NS. Give over 10 minutes.
Infusion syringes: prepared in pharmacy using undiluted 2%
(20mg/mL) solution. If prepared after hours in the unit use
undiluted 2% or can be diluted with NS to 1 mg/mL.
Stability : Steriamps for single use only. Discard unused portion. Infusion
syringes are stable for 48 hours once prepared, but may only be
used on patient for 24 hours.
Storage : Steriamps: store below 25 deg. C. Infusion syringes: store in
refrigerator until required for use, maximum of 24 hours at
room temperature.
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Canberra Hospital
Compatibility : NS, 5% Dextrose, Aminophylline, Caffeine, Calcium,
Ciprofloxacin, Dexamethasone, Digoxin, Dobutamine,
Dopamine, Flucloxacillin, Frusemide, Heparin, Hydrocortisone,
Insulin (regular), Lipid emulsion, Metoclopramide, Penicillin
G, Potassium, Ranitidine. Compatible at the Y site only:
Adrenaline, Cephazolin, Gentamicin, Midazolam, Morphine,
Noradrenaline, Propofol, Timentin, TPN, Vancomycin
Incompatibility : Ampicillin (variable compatibility/incompatibility depending
on concentration. Check with Pharmacy for more information)
Milrinone, Phenobarbitone, Phenytoin,
Serum Levels : Lignocaine levels are not performed at TCH. If required they
can be sent away to RNS, ring specimen referrals on 42845.
Levels above 9mg/L are associated with cardiac toxicity in
adults, but there is little information regarding levels in
neonates.
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Canberra Hospital
Lignocaine for local anaesthetic, cardiac arrhythmia

Indication : 1) Ventricular arrythmias

2) Local anaesthesia
3) Topical anaesthesia
Dose : 1) 1 mg/kg (0.1 ml/kg of 1%) loading dose. Follow within

15 minutes with an infusion of 10-50 microg/kg/min
otherwise repeat loading dose.
2) Nerve block: maximum dose without adrenaline 5
mg/kg
3) Surface anaesthesia of mouth, throat and upper GI tract:
mixture up to 3 mg (0.15 ml)/kg/dose
Interval : 1) Can be repeated after 5 minutes
3) Do not repeat within 2 hours
Route : 1) IV over 2 minutes
2) Local infiltration
3) Topical, can dab onto severe mouth ulcers before feeds
Total Daily Dose :
Comments : Can give 1% undiluted or dilute with NS. Excessive topical

use in mouth can paralyse gag reflex.
Supplied as : 1% ampoules (10mg/ml)

Mixture: 2% Xylocaine Viscous
Gel: 2%
Dilution : For IV infusion using 1% lignocaine solution (10mg/ml)
take 3 ml multiplied by weight of the patient in kg and
make up to 50 ml with NS. 1 ml/hr = 10 microg/kg/min.
DO NOT USE THIS DILUTION FOR SEIZURE
PROTOCOL
Stability : Discard any remaining solution from ampoules – intended
for single use only.
Incompatibility : Thiopentone, phenytoin, ampicillin.
Compatibility: 5%D, N/2 Saline, NS, aminophylline, calcium gluconate,

digoxin, dobutamine, dopamine, adrenaline, frusemide,
heparin, hydrocortisone, insulin, nitroglycerine, KCl,
ranitidine.
Serum Levels :
109
Canberra Hospital
Magnesium Sulphate
Revision Date : October 2016 Dtc Approved: October 2016
1] Hypomagnesaemia due to hypocalcaemia. Suspected in

Indication : infants with severe birth asphyxia. .
2] Severe acute hypomagnesaemia (ie Seizures)
3] As a vasodilator in Persistent Pulmonary Hypertension of
Newborn (PPHN)
Dose : Note: Doses are expressed as magnesium sulphate NOT
elemental magnesium
1] 100mg/kg/dose2
2] 50mg-100mg/kg/dose2
3] Loading dose: 200mg/kg2
Maintenance dose: 20-75mg/kg/hour given for up to 5 days.
(To commence immediately after loading dose and to
maintain plasma concentrations of 3.5-5.5mmol/L).2
Interval : 1] Stat, repeat if necessary 12 hourly for 2-3 doses2.
2] stat, repeat 6-12 hourly if required according to serum
levels1,3
3] Continuous infusion.
Route : 1] IM injection or diluted IV infusion over 30-60minutes
2] Diluted IV infusion over 20minutes
3] Diluted IV infusion
Continuous intravenous infusion.
Total Daily Dose : According to response/ serum magnesium levels.
Comments : May cause hypotension (vasodilatation), loss of reflexes,

respiratory depression. Contraindicated in the presence of a
heart block. Dangerous if used in the presence of renal
failure. May cause sedation and flaccid paralysis if used at
levels recommended for pulmonary vasodilatation.
Note, the concentration of magnesium sulphate (MgSO4)
ampoules varies from 49.3% (493mg/mL magnesium
sulphate) to 50% (500mg/mL magnesium sulphate)
depending on brands. These concentrations are considered
interchangeable and both are referred to as a concentration
of 50%.
Supplied as : Magnesium Sulphate 50% solution in 5mL ampoules,
containing Mg 2mmol/mL = 500mg/ml magnesium
sulphate
110
Canberra Hospital
Dilution : 1] For IM and IV use: Dilute 4mL (2000mg) of MgSO4 50%
solution with 6mL of water for injection.3
This dilution = 200mg/m
L.
2] Dilute to 200mg/mL (as above).3
3] Dilute 10mL (5000mg) of MgSO4 50% with 40mL of
water for injection. This dilution = 100mg/mL.
Loading dose: 200mg/kg = 2mL/kg over 20-30minutes.
Maintenance dose: 20-75mg/kg/hr = 0.2-0.75mL/kg/hr.
Stability : Discard ampoule and unused portion after initial use. Fresh
solution must be prepared every 24 hours
Compatibility: Glucose 5 %, Glucose 10 %, Sodium chloride 0.9%, Water

for Injection.
Incompatibility : Do not mix with any other drug.
Serum Levels : Normal newborn serum magnesium is 0.7 - 1.1 mmol/l.

Recommended serum Mg. Level in PPHN is 5-7 mmol/l.
Serum levels should be measured every 6-12 hours.
Compiled: October Review: October 2020
2016
Australian Medication Handbook Childrens Dosing Companion, July 2015

2
BNF for Children 2015
3
Paediatrics and Neofax ®. Application Version: 7.1.2.2015-Q3Application Version:
7.1.2.2015-Q3A
111
Canberra Hospital
Magnesium Aspartate
Revision Date : October 2016 DTC Approved: October 2016
Indication : Hypomagnesaemia
Dose : 0.1-0.2 mmol/kg TDS (>1 month of age), increase to 0.4-

0.5mmol/kg/dose up to 4 times per day as required.1
Interval : Divided into 1-3 doses/day with food.
Route : PO
Total Daily According to response/serum magnesium levels.

Dose :
Comments : Limited data available; dosing can vary greatly. Monitor blood
magnesium concentration and adjust dose according to response.
Diarrhoea is a common dose-limiting adverse effect.1
1 mmol Mg=2 mEq Mg.
Smallest dose that can be dispensed from pharmacy is 125mg =
0.4 mmol. Please prescribe in 125mg (0.4mmol) increments.
Supplied as : Magmin, Tab, magnesium 37.4 mg (1.55mmol) (magnesium
aspartate dehydrate 500 mg)
Compatibility: N/A
Incompatibility N/A
:
Serum Levels : Normal newborn serum magnesium is 0.7 - 1.1 mmol/l2
Compiled: Review: October 2020

October 2016
1
Australian Medication Handbook, July 2015
2
Rennie JM, Roberton NRC (Eds). Textbook of Neonatology, 3rd Ed. Churchill
Livingstone, Edinburgh, 1999
112
Canberra Hospital
Meropenem
Revision Date : 9 January 2014 Approve : AK, JD
Indication : A very broad-spectrum carbapenem antibiotic which

penetrates well into the CSF and most body tissues.
Used for treatment of Pseudomonas sp. and other serious
infection caused by susceptible organisms resistant to other
antibiotics.
from the TCH Infectious Disease team, but can be prescribed
in paediatric patients with Febrile Neutropenia under
direction from Sydney Oncolgists.
Dose : Sepsis: 20mg/kg per dose
Meningitis: 40mg/kg per dose
Interval : 1st week of life 12 hourly
> 1 week of life 8 hourly
Route : IV infusion over 30 minutes
Total Daily Dose : 40-120mg/kg
Comments : Clearance is directly related to renal function. Hepatic

function does not affect pharmacokinetics. Serum half-life is
3 hours in preterm and 2 hours in full term neonates.
Adverse effects: diarrhoea, nausea/ vomiting and rash have
been reported in paediatric patients.
Supplied as : 500mg and 1g vials (Merrem©)
Dilution : Usually prepared in Pharmacy.

Reconstitute 500 mg vial with WFI to make 10 ml total
(1000mg vial to 20 ml total). Remove 4 ml from vial and
further dilute with NS to total of 10 ml (20mg/ml).
Stability : Use immediately and discard any unused solution from the
vial. The diluted syringe is stable for 8 hours at room
temperature and for 24 hours in the fridge.
Storage : Keep vials at room temperature.
Keep syringes in the fridge
Compatibility : Aminophylline, dexamethasone, dopamine, dobutamine,
gentamicin, heparin, insulin, morphine, noradrenaline,
phenobarbitone, ranitidine, vancomycin.
Incompatibility : Aciclovir, calcium gluconate, diazepam, zidovudine,
amphotericin B, metronidazole.
Serum Levels :
113
Canberra Hospital
Metoclopramide
Revision Date : 9 January 2014 Approved: AK, JD
Indication : Vomiting and gastro-oesophageal reflux not responding to

more conservative measures. Feed intolerance or gastric
stasis in preterm infants. CAN ONLY BE USED WITH
CONSULTANT APPROVAL
Dose : 0.1-0.2 mg/kg.
Interval : 12 or 8 hourly.
Route : Oral
I.V.
Total Daily Dose : Do not exceed 0.3 mg/kg/day.
Comments : Toxicity causes extrapyramidal side effects - oculogyric

crises, torticollis, neck pain. Effects can be reversed with
diphenhydramine.
Supplied as : Syrup 1 mg/ml.

I.V. solution 5 mg/ml.
Dilution : Use syrup as supplied.
I.V. - dilute 1 ml IV solution with 4 ml NS = 1 mg/ml.
Stability : Discard ampoule once opened.
Compatibility: Aciclovir, Aminophylline, Dexamethasone, 5% Dextrose,

Fentanyl, Heparin, Hydrocortisone, Insulin, Midazolam,
Morphine, Normal saline, Potassium chloride, Ranitidine,
TPN.
Incompatibility : Calcium gluconate, cephalothin, chloramphenicol,
frusemide, penicillin, sodium bicarbonate.
Serum Levels :
114
Canberra Hospital
Metoprolol
Indication: Hypertension, palliation of tetralogy of fallot, SVT.
Dose: IV: 0.05-0.1mg/kg/dose. May be repeated twice if required,

then an infusion of 0.5-2.5microg/kg/min.
PO: 0.5-1 mg/kg/dose
Interval: IV: stat dose/s then IV infusion
PO: 6-12 hourly
Route: IV: slow IV bolus over minimum 5 minutes or infusion.
Total Daily Dose: 4mg/kg/day.
Comments: Metoprolol is a relatively cardioselective beta-1 adrenergic

blocking agent without intrinsic sympathomimetic activity.
Beta blockers can cause bronchoconstriction and bradycardia.
Use with caution in cardiac failure and conduction disorders.
Affects glucose metabolism. Caution in diabetes,
hyperthyroidism. Potentiates effect of calcium antagonists.
Withdraw gradually over 8-14 days. Overdose signs – excessive
bradycardia, hypotension, possible cardiac failure,
bronchoconstriction.
Supplied as: Ampoules 5mg/mL
Tablets 50mg
Dilution: Usually made up in pharmacy.
Add 1.5 mg per Kg of Metoprolol to a syringe and make up to
25mL with either D5W or NS.
1mL/hour = 1.0 microg/kg/min
Stability: Diluted ampoules: 24 hours at room temperature. Discard any
unused drug.
Storage: Ampoules and tablets at room temperature. Diluted IV
infusions in the refrigerator until ready for use.
Compatibility: NS 5DW Morphine
Incompatibility: Amphotericin
Serum Levels:
115
Canberra Hospital
Metronidazole
Indication : Anaerobic infections, peritonitis, NEC, and infections

involving bacteroides, clostridium, fusobacterium etc.
Dose : Loading dose: 15 mg/kg.

Maintenance dose: 7.5 mg/kg. Commence one dosage
interval after the loading dose:
Interval : Corrected gestational Postnatal Age Dosage Interval
age (weeks) (days old) (hours)
≤ 29 weeks 0-28 48
≥29 24
30 to 36 weeks 0-14 24
≥15 12
37 to 44 weeks 0 to 7 24
≥8 12
More than 44 weeks All 8
Route : I.V. over 20-30 minutes.
Total Daily Dose : 15 mg/kg/day.
Comments : Peripheral neuropathy, possible seizures, reversible

neutropenia. Drug metabolites may cause a brownish
discolouration of the urine.
Supplied as : 0.5% solution (100 mg in 20 ml = 5 mg/ml).
Dilution : Nil.
Stability : Discard after 24 hours from initial use.
Storage : Do not store in refrigerator (Crystals form, which redissolve

on warming to room temperature).
Compatibility: TPN, 5% Dextrose, Normal Saline, aminophylline,
cefotaxime, chloramphenicol, cimetidine, fluconazole,
dopamine, hydrocortisone, morphine, heparin, gentamicin
Incompatibility : Do not use with 10% dextrose. The primary iv solution
should be discontinued during metronidazole infusion.
Serum Levels :
116
Canberra Hospital
117
Canberra Hospital
Miconazole (Topical Gel)

Indication : Oral or G.I. Candida infections (gel).
Dose : 25 mg (1/4 of the 5 mL measuring spoon or 1.25 ml in

syringe).
Route : Oral
Total Daily Dose : Up to 100 mg/day.
Comments : Fungostatic activity without significant G.I. absorption.

Provided as a gel so that it remains in the mouth for a longer
period. For rectal clearance in infants with a NG tube
additional treatment with Nystatin via the NG tube may be
necessary.
Supplied as : Daktarin 2% Gel 20 g tube.
Dilution : Use dosage prescribed by measuring gel volume correctly.
Stability : Stable at room temperature.
Compatibility: Not Applicable.
Incompatibility : Nil.
Serum Levels :
118
Canberra Hospital
Midazolam
Indication : Midazolam is a short acting benzodiazepine with hypnotic,

sedative and anticonvulsant activity. Use in the neonatal
unit is for treatment of seizures and sedation
Dose : 0.1-0.2 mg/kg/dose
Neonatal Infusion: 10-100 microg/kg/hour
Paediatrics Infusion: 10-300 microg/kg/hour (change
infusion guardrails to paediatrics from NICU)
Interval : 1 - 4 hourly or by infusion.
Route : IV stat or infusion
Intranasal – stat only. Drop dose into alternate nostrils over
15 seconds. Absorption is rapid with maximum effect
within 10 minutes and duration up to 2 hours. May be
irritating.
Total Daily Dose : Individualise for patient. With infusion start at 10 microg/kg/hr. and
increase as required to a maximum of 100 microg/kg/hr in neonates and
300 microg/kg/hour in paediatric patients. For sedation most neonates
will only require 30 microg/kg/hour while paediatric patients may
require 200-300 microg/kg/hour. For neonatal seizure management in
HIE patients maximum dose is 100 microg/kg/hour
Comments : May cause apnoea, hypoventilation. Hypotension can occur when used
in combination with narcotics. Use under supervision. May increase
bronchial secretions. Pharmacokinetics are linear over a wide range
(0.05 to 0.4 mg/kg dose range.). Maybe reversed with Flumazenil
5microg/kg/dose undiluted by rapid IV bolus or infusion.
Supplied as : 15 mg/3ml ampoules and 1 mg/ml ampoules.
Dilution : Stable in water, NS, D5W, D10W.

Infusion: Weight in kg = "X". Add "X" mg to 50 ml of
D5W, D10W, or NS - 1 ml/hr. = 20 microg/kg/hr.
Stability : Discard after initial opening of ampoule.
Compatibility: 5%D, 10%D, NS, Calcium gluconate, Cefotaxime, Digoxin,

Dobutamine, Dopamine, Noradrenaline, Erythromycin,
Fentanyl, Fluconazole, Gentamicin, Heparin, Insulin,
Morphine, Potassium chloride, Vancomycin, Adrenaline,
Vecuronium, Ranitidine at Y-site only.
Incompatibility : Ampicillin, Ceftazidime, Dexamethasone, Hydrocortisone,
Sodium bicarbonate, TPN, Flucloxacillin, Frusemide.
Serum Levels :
119
Canberra Hospital
Milrinone
Indication : Poor cardiac output confirmed by echocardiogram despite

adequate support with dobutamine. Only to be ordered by
Consultant Neonatologist after echocardiogram.
Dose : Commence infusion at 0.5 mcg/kg/min
Continuous infusion 0.2-0.75 mcg/kg/min (must not exceed
0.75mcg/kg/min)
Interval : Continuous infusion
Route : IV
Total Daily Dose :
Comments : Milrinone may cause hypotension and this should be managed with a
Noradrenaline infusion and preload support. A Noradrenaline infusion
should be prepared and ready to commence when starting milrinone to
manage hypotension should it occur. Milrinone may cause hypotension
if run at high doses – hence must not exceed 0.75 mcg/kg/min.
Frusemide should never be administered in an IV line containing
Milrinone as this will cause precipitation. Milrinone is primarily renally
excreted and reductions in infusion rate may be required in renal failure.
Milrinone may also cause arrhythmias, hypokalaemia and
thrombocytopenia.
Supplied as : Primacor 10 mg/10 ml ampoule (1 mg/ml)
Dilution : Prepare 1.5 mg/kg of Milrinone into 50 mls of D5W or NS.

1 ml/h = 0.5 mcg/kg/min.
Stability : Discard ampoule and unused portion after initial use.
Storage : Room temperature, protect from light. Do not freeze.
Compatibility: D5W, NS, Adrenaline, aminophylline, atropine, calcium,

glyceryl trinitrate, digoxin, dobutamine, dopamine, fentanyl,
insulin, heparin, magnesium, morphine, noradrenaline,
potassium chloride, ranitidine, sodium bicarbonate,
vecuronium.
Incompatibility : Frusemide.
Serum Levels :
120
Canberra Hospital
Morphine IV
Revision Date : 15 April 2014 Approved: TC, LZ, JD
Indication : 1 & 2] Premedication for intubation, Analgesia or sedation
Dose : 1] Stat 0.1 - 0.2 mg/kg (100 - 200 microg/kg)

2] Infusion 10 - 30 microg/kg/hour
Interval : 1] 4 - 6 hourly
2] Infusion.
Route : 1] I.M. or I.V. over 5 minutes
2] IV
Total Daily Dose : Treat overdose with Naloxone - 0.01 mg/kg
Comments : May cause sweating, anorexia, dysuria, restlessness, bradycardia,

sedation, respiratory depression - decreased response to CO2 tension;
apnoea, urinary retention, hypotension, seizures, reduced gut mobility.
Use I.V. route only if patient receiving mechanical ventilation. Infusion
prevents risk of intermittent hypotension in sick infants.
Pharmacokinetics in the newborn varies and dosage should be reduced
in ELBW infants. Elimination half life is approximately 9 hours in
preterm infants. Addiction during short term use (< 1 week) not a
problem and weaning not necessary. May be reversed with Naloxone
[0.01 mg/kg/dose - IV bolus].
Supplied as : Morphine sulphate 5 mg/mL ampoules.
Dilution : Not required for I.M.

For stat I.V. : Add 1mL of solution (5mg/mL) to 4 mL of
NS (makes 1mg/1mL = 100 microg/0.1mL)
Dose = 0.1mL/kg (= 100 microg/kg)
Infusion: Add 1mL of solution (5mg/mL) to 4 mL of NS
(makes 1mg/1mL). Add 1mL/kg (=1mg/kg) of the diluted
Morphine solution to a syringe and further dilute to 50 mL
using D5W, D10W or NS
1 mL/ hr = 20 microg/kg/hr
Stability : Discard ampoule and unused portion after initial use
Storage : Unopened ampoules: room temperature, locked in drug safe
Compatibility: Compatible with aminophylline, atropine, fentanyl, heparin,

sodium bicarbonate, cimetidine, ranitidine, TPN, dopamine
Incompatibility : Iodides, sulphas, thiopentone sodium, phenytoin,
phenobarbitone, methicillin, pethidine
Serum Levels :
121
Canberra Hospital
Morphine Oral
Revision Date : 15 April 2014 Approved: TC, LZ, JD
Indication : 1] Neonatal narcotic abstinence syndrome.

2] Analgesic and Sedation
Dose : 1] Starting dose: 0.5 mg/kg/day (500 microg/kg/day) in 4
divided doses. See NAS protocol; change to 4 hourly if
symptoms poorly controlled.
2] Ventilated 100-200 microg/kg/dose
Non-ventilated 50 microg/kg/dose
Interval : 1] 6 hourly
2] 4-6 hourly
Route : Oral
Total Daily Dose : Upto 0.9mg/kg/day
Comments : May cause sedation, respiratory apnoea, urinary retention,

hypotension, reduced gut mobility. Pharmacokinetics in the
newborn varies and dosage should be reduced in ELBW
infants.
Intravenous route is the preferable route for morphine

administration for pain relief and sedation. Baby who is
ventilated for more than 1 week and on full enteral feeds
may be changed to oral morphine
To switch from intravenous to oral therapy: find dose baby

is receiving intravenously per hour, multiply by 6 (because
oral morphine is given six hourly) and then multiply by 2
because oral morphine is half as bioavailable as the
intravenous preparation. Prescribe this dose 6 hourly. (Eg:
A baby receiving 10microg/kg/hour by intravenous infusion
should receive 120 microg/kg 6 hourly orally)
Supplied as : Oral solution of morphine hydrochloride 1mg/mL
Dilution : Use undiluted
Stability : Stable for 6 months once the bottle is opened
Storage : Room temperature, locked in drug safe
122
Canberra Hospital
Serum Levels : NA
Mylanta
Indication : A compound antacid preparation useful in reducing gastric

erosions and bleeding during stressful intensive care
particularly in the presence of drugs with intense histamine
reactions. Also used in the amelioration of oesophagitis in
association with gastric reflux.
Dose : 1 - 3 ml (0.5 ml/kg/dose).
Interval : 4 - 6 hourly. Separate from other oral medication.
Route : Oral.
Total Daily Dose :
Comments : An aluminium hydroxide base. Will precipitate phosphate

and therefore should be used with caution where nutritional
phosphate is important. Note high level of magnesium in
compound.
Supplied as : Mylanta liquid.
Dilution : Not required.
Stability : Use as per expiry date.
123
Canberra Hospital
Naloxone
Indication : Narcotic antagonist. Opiate drug depression.

As an adjuvant therapy in resuscitation for narcotic- induced
respiratory depression.
Dose : 0.1-0.2 mg/kg (=100-200microg/kg), (0.25-0.5 ml/kg of 0.4

mg/ml solution).
Interval : Stat; repeat up to 3 times if necessary.
Route : I.V.
I.M.
Intra-tracheal, if necessary.
Total Daily Dose : Not more than 400 microg/kg
Comments : If successful in documented narcotic depression infants

must be monitored closely as the half-life of pethidine and
morphine exceeds the half-life of Naloxone. Exercise
caution when administering drug to infants of known or
suspected drug addicts due to risk of seizures and
withdrawal: Tachycardia, tachypnoea, hypertension,
tremors, vomiting.
Not effective against non-narcotic drugs.
Supplied as : 400 microg/ml; 1 ml ampoules.
Dilution : Use 400 microg/ml vial. No dilution necessary.
Compatibility: Data not available. Compatible with Heparin
Incompatibility : Alkaline solutions, sodium bicarbonate.
Serum Levels :
124
Canberra Hospital
125
Canberra Hospital
Neostigmine
Indication : 1] Myasthenia test.

2] Maintenance, in Neonatal transient myasthenia gravis
and Neonatal persistent myasthenia gravis.
3] Reversal of muscle relaxation.
Anticholinesterase
Dose : 1] 0.04 mg/kg (40 microg/kg)
2] 0.05-0.25 mg/kg (50-250 microg/kg)
3] 0.05 mg/kg (50 microg/kg) with atropine 0.02 mg/kg
Interval : 1] Stat
2] 2-4 hourly
3] Stat.
Route : IV, IM, SC
Total Daily Dose : For overdose give Atropine.
Comments : May cause vomiting, increased salivation, diarrhoea,

increased bronchial secretions, nystagmus, sweating,
hypotension. Contraindicated in mechanical intestinal or
urinary obstruction. May result in cardiac arrest, central
respiratory depression, pulmonary oedema, convulsions.
Supplied as : 0.5 mg/ml ampoules.
Dilution : 1] & 2] Not required.

3] Neostigmine 50 microg/kg with Atropine 20 microg/kg
IV.
Draw up 0.5 mg (1 ml) of Neostigmine into a 5 ml syringe.
Add 200 microg (0.5 ml) of Atropine. Add NS or
N/2Saline to make up 5 ml of solution. Give 0.5 ml/kg of
solution = 50 microg/kg Neostigmine and 20 microg/kg
Atropine.
Compatibility: NS, heparin, 5%D, hydrocortisone, KCl.
Incompatibility : Sodium bicarbonate, suxamethonium.
Serum Levels :
126
Canberra Hospital
127
Canberra Hospital
Noradrenaline
Indication : Severe refractory hypotension.
Dose : 0.1 – 1.0 microg/kg/min by continuous infusion.

Start infusion at 0.1 microg/kg/min. Rate may be increased
slowly to maximum 1.0 microg/kg/min provided limb
perfusion and urine output are watched carefully. Monitor
central vascular pressures where possible.
Route : Must only be given into a central vein.
Comments : Potent vasoconstrictor. Consider use where need to increase

vital organ perfusion outweighs the risk of lowering cardiac
output. Has been used in septic shock, with simultaneous
low dose dopamine to sustain renal blood flow. Main
effects are to increase cardiac contractility, heart rate and
myocardial oxygen consumption via beta-1 stimulation.
High dose infusions can cause a decrease in cardiac output
(from increased afterload on the heart) and compromise
ventricular function from increased myocardial oxygen
consumption.
Supplied as : Noradrenaline base 1 in 1000 (2mg in 2ml)

[Note that this is equivalent to 4mg of Noradrenaline acid
tartrate in 2ml]
Dilution : Take 1.5 mg/Kg of Noradrenaline base and dilute to 25 ml
with D10W or D5W.
0.1 ml/hr = 0.1 microg/kg/min
Stability : Stable in solutions with a low pH, such as dextrose, but is
best prepared afresh every 24 hours unless protected from
light
Storage : Ampoules should be protected from light during storage,
and discarded if discoloured.
Compatibility : May be co-infused with TPN, dopamine, dobutamine,
heparin, ranitidine, calcium, adrenaline, hydrocortisone.
Incompatibility : Sodium bicarbonate, Phenobarbitone, blood.
Refs: Northern Neonatal Network, Neonatal Formulary (9 th Ed.), 1996. BMJ Publishing Group.
L.A. Trissel, Handbook on Injectable Drugs (10 th Ed.)
128
Canberra Hospital
Nystatin (Oral)
Indication : Oral and gastrointestinal candidiasis.
Dose : 0.5 - 1.0 ml. (Use 0.25 ml < 1000 grams).
Route : Orally/NG tube.
Total Daily Dose :
Comments : Well tolerated. No known side effects. May be used in

conjunction with Miconazole gel in infants prescribed broad
spectrum antibiotics and who are given nystatin via NG
tube.
Not absorbed well from skin, GI tract or mucus membranes.
Supplied as : Nystatin suspension.
Dilution :
Stability :
129
Canberra Hospital
Nystatin (Topical)
Indication : Cutaneous Candidiasis. Prophylaxis against Candidiasis in

infants on broad spectrum antibiotics and steroids.
Dose : Liberal spread.
Interval : With each diaper change.
Route : Topical.
Total Daily Dose :
Comments : Well tolerated. No known side effects. Use with caution in

infants under phototherapy.
Supplied as : Nystatin cream.
Dilution :
Stability :
130
Canberra Hospital
Octreotide
Indication : Treatment of ongoing chylothorax
Dose : 0.5 microgram/kg/hour on day one, increasing by 1

microgram/kg/hour daily until maximum of 10
microgram/kg/hour
Interval : Continuous infusion
Route : IV
Total Daily Dose : 240 microg/kg/day
Comments : Long acting somatostatin analogue that causes vasoconstriction

of splanchnic vessels and reduces gastric, pancreatic and small
intestinal secretions. May result in mild abdominal distension,
loose stools, flatulence, liver function abnormalities and
hypoglycaemia.
Supplied as : 50microg/mL and 100microg/mL ampoules

Dilute to a suitable volume (eg 25mL or 50mL) in 0.9% NaCl.
The final concentration should be between 1 and 25microg/mL.
Stability : Ampoules: until expiry date on label
Infusions: 48 hours
Storage : Ampoules: Refrigerate. Protect from light.
Infusion: protect from light
Compatability: 5% Dextrose, 0.9% NaCl, Heparin, Potassium and TPN via a Y
site.
Incompatibility : Insulin, Pantoprazole
131
Canberra Hospital
Omegaven 10% Lipid Emulsion

Revision Date: Aug 2016 DTC Approved: 28/08/2016
Indication : Sterile fat emulsion for IV infusion for infants on long term
TPN with TPN induced liver disease. 1
Dose2 :
Lipid dose per Amount of
day Omegaven 10%
1g/kg/day 10mL/kg/day
2g/kg/day 20mL/kg/day
(MAX)
Interval : Daily
Route : IV infusion over 24 hours
Total Daily Dose : -
Comments : - Consider Omegaven lipids in babies with TPN associated cholestasis

with a conjugated SBR of > 35 micromol/L and predicted TPN use for
more than 21 days.3
- Omegaven can be used as a sole lipid source up to a max of 2g/kg/day.
SMOF lipid can used in conjunction with Omegaven to get to 3g/kg/day
if required. When used together vitamins will be added to the SMOF
component of the lipid.
- Omegaven has been shown to reverse TPN induced cholestasis.
However, there is no evidence that it prevents cholestasis in neonates;
hence prophylactic use should be avoided.4
- Omegaven should be ceased with 2 consecutive conjugated SBR
values < 17 micromol/L or when the baby tolerates enteral feeds
adequate to cease TPN
- Omegaven is not TGA approved in Australia. An SAS form needs to
be completed with each prescription before it can be issued from
pharmacy
Supplied as : Omegaven is an emulsion containing 10% highly refined

fish oil.
If ordered without vitamins pharmacy will dispense and

send Omegaven in its original packaging to the ward.
132
Canberra Hospital
Dilution : Vitamins can ONLY be added to the 2g/kg/day Omegaven solution, not
the 1g/kg/day solution (there is no compatibility data).
If vitamins are to be added pharmacy will prepare a syringe for doses up

to 50mLs (with at least 5mL coverage) and bags for doses over 50mLs
(with at least 25mL coverage). The Omegaven syringe/bag will also be
loaded with Vitalipid N (fat soluble vitamins) 4mL/kg/day (capped at
10mL/day) and Soluvit N (water soluble vitamins) 1ml/kg/day (capped
at 10mL/day). The addition of these vitamins dilutes the lipid
concentration from 10% to 9.5%. This is considered an acceptable
difference and bags with vitamins added will still be considered a 10%
solution. Run this solution through the Braun pump at Omegaven 10%
solution.
Example calculation:
3kg neonate 2g/kg/day Omegaven with vitamins
Total volume: 3 x 20 = 60mL
Total fat = 6g
Vitalipid 10% lipid solution 4mL/kg/day (10mL max) = 10mL (1g lipid)
Solutvit 0% lipid solution 1mL/kg/day (10mL max) = 3mL
(0g lipid)
Omegaven 10% lipid solution to make up to 60mL (60mL final volume
– 3mL Soluvit – 10mL Vitalipid) = 47mL (4.7g lipid)
Final lipid = 1g + 4.7g = 5.7g
Final lipid concentration = 5.7g/60mL = 9.5%
Stability : 24 hours once prepared
Storage : Syringes/minibags – keep in refrigerator until ready to use.

Protect from light.
Incompatibility : Incompatibilities may occur through the addition of

polyvalent cations, e.g. calcium, especially when combined
with heparin.5
Compatibility:
Serum Levels : NA
Compiled: August Review: August 2020

2016
References:
1. Royal Hospital for Women Omegaven Drug Page. Accessed online at-
https://www.seslhd.health.nsw.gov.au/rhw/Newborn_Care/Guidelines/Medication/pdf/LipidOmegApril
14.pdf
2. Park KT, Nespor, Kerner J J. The use of Omegaven in treating parenteral nutrition-associated liver
disease. Journal of Perinatology (2011) 31, S57–S60; doi:10.1038/jp.2010.182
3. Lam HS, Tam YH, Poon TC, Cheung HM, Yu X, Chan BP et al. Double-blind randomised
controlled trial of fish oil-based versus soy-based lipid preparations in the treatment of infants with
parenteral nutrition-associated cholestasis. Neonatology 2014;105:290–6.
4. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may
reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis. J
Nutr 2015;145:277–83
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Canberra Hospital
5. Omegaven product information. https://www.drugs.com/uk/omegaven-leaflet.html. Accessed online
on 25-08-16
Omeprazole
Revision Date : 28 January 2015 DTC Approved: March 2015
Indication : Hyperacidity, significant gastroesophageal reflux and

gastric ulcers. Proton pump inhibitor.
Dose : 0.5 mg/kg to 1.5mg/kg. 1
Interval : Daily dosing but may go to 12 hourly (max 0.75

mg/kg/dose) if required.
Route : Orally
Total Daily Dose : 1.5 mg/kg
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Comments : Babies with feeding tubes should be given omeprazole
2mg/mL mixture, prepared by the pharmacy department.
For babies without a feeding tube, dispersed tablets are
preferred. It is unreliable to measure doses other than 5mg
or 10mg from a 10mg tablet. Adjust dose to 5mg increments
(when possible) for ease of administration.
Half of a 10mg dispersible tablet (5mg) may be dispersed in
an oral dispenser with a small amount of water for injection
(WFI). DO NOT CRUSH the tablet as it is composed of
tiny enteric coated granules. Vigorously agitate the oral
dispenser to disperse the tablet. Administer the dose and
rinse the oral dispenser with more WFI to retrieve any
remaining granules from the dispenser. The granules settle
in the dispenser rather quickly. The dose should be agitated
and administered immediately. This dispersed fluid is
unsuitable for babies with small bore feeding tubes as the
granules may block the tube.
Babies going home on full suck feeds should be changed to

dispersed solution (see above) one week prior to discharge.
This will ensure appropriate training of the parents for
administering the correct dose. Freshly boiled (for 3
minutes) and cooled water can be used at home instead of
WFI.
Caution routine use of PPI in neonates with reflux due to

possible association of PPI use with NEC, sepsis and
gastrointestinal infections. 2
Supplied as : 10 mg dispersible tablets.
Oral mixture made by pharmacy 2 mg/mL for those babies
with feeding tubes
Dilution : Not Applicable.
Stability : Tablets – use immediately and discard unused half of tablet

Oral mixture – according to expiry date on the label. Shake
the bottle daily.
Storage : Tablets – room temperature
Oral Mixture – refrigerate and protect from light
References:
135
Canberra Hospital
1. Paediatrics and Neofax ®. Application Version: 7.1.2.2014-Q4

2. Chung EY1, Yardley J. Are there risks associated with empiric acid suppression
treatment of infants and children suspected of having gastroesophageal reflux disease?
Hosp Pediatr. 2013 Jan;3(1):16-23.
Pancreatic Enzymes/Creon
Revision Date : 21/3/17 Approved KO/TC
Indication : Pancreatic enzyme replacement or supplementation for

conditions of pancreatic enzyme insufficiency. E.g. cystic
fibrosis.
Dose : Different brands of enzyme products are available. All

contain lipase, amylase and protease. The dose is expressed
in units of lipase and is titrated to control steatorrhoea. If on
full feeds start with 5000 units/kg/day and increase if
necessary. Use a lower dose if on partial feeds.
Interval : Divide total daily dose between each feed, so that some is
given with every feed
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Route : Orally.
Total Daily Dose : Maximum 10,000 units/kg/day.
Comments : The capsules contain enteric coated beads. They can be

mixed with acidic food such as apple puree, but not alkaline
foods or antacids as these will dissolve the coating. Do not
crush the beads. Give with fluid. The small measuring
scoop that is provided with the bottle is designed to contain
a dose of 100 mg of granules. This amount provides 5,000
units of lipase. The dose will most likely be a portion of a
scoop, if so estimate the portion. There are reports of high
doses causing colonic strictures.
Supplied as : Creon 5000: Micro enteric coated bead with scoop- lipase
5000 U, amylase 3600 U, protease 200 U/100mg scoop
Dilution : Nil. Mix with apple sauce/apple puree for administration
on spoon.
Stability : Do not administer with alkaline foods or antacids
Pancuronium
Indication : Muscle relaxation for infants on full ventilation, especially ones

requiring high ventilator pressures.
Dose : 1] 0.1 mg/kg (100microg/kg)
2] 0.25-0.75 microg/kg/min
Interval : 1] Hourly and P.R.N.
2] infusion
Route : IV
Total Daily Dose :
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Canberra Hospital
Comments : Non-depolarising neuromuscular blocking agent that produces skeletal muscle
paralysis mainly by causing a decreased response to acetylcholine at the
myoneural junction. Ensure that pH, electrolytes and fluid balance are normal.
Generally not usually associated with a fall in BP, but both hypo- and
hypertension can occur. Ventilator support may need to be increased
particularly in larger infants, where spontaneous respiratory effort may be
underestimated. Cardiac output and heart rate usually increased. Sensation
remains intact in babies on paralysis and sedation should be used along with
paralysis. Peak effect in 4 - 5 minutes. Duration 40-60 minutes
Reversal :
Neostigmine 50 microg/kg with Atropine 20 microg/kg IV
Draw up 0.5 mg (1 ml) of Neostigmine into a 5 ml syringe. Add 200 microg
(0.5 ml) of Atropine. Add NS or N/2Saline to make up 5 ml of solution. Give
0.5 ml/kg of solution = 50 microg/kg Neostigmine and 20 microg/kg Atropine.
Supplied as : Pancuronium bromide 4 mg/2 ml (4000 microg/2 ml) ampoules.
Dilution : Add 2 ml (4 mg) Pancuronium to 2 ml NS to make total of 4 ml

solution. 1 ml = 1mg = 1000 microg. For infusion multiply
baby’s weight (kg) X 1.5 ml (of the 1 mg/ml) solution and further
dilute to 50 ml with NS or 5%D. 1 ml/hr = 0.5 microg/kg/min.
Storage : Refrigerator.
Compatibility: 5 % Dextrose, Normal Saline, Aminophylline, Dobutamine,

Dopamine, Fentanyl, Fluconazole, Gentamicin, Heparin,
Hydrocortisone, Midazolam, Morphine, Nitroprusside, Ranitidine,
Vancomycin.
Incompatibility : May precipitate with other drugs. Usual precautions apply.
Effect is increased in the presence of hypokalaemia,
hypocalcaemia, hypercapnia, acidosis, myasthenia etc. Decreased
effect is noted if infant is cold. With prolonged use dosage may
change.
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Canberra Hospital
Pantoprazole
Indication : Proton pump inhibitor which inhibits gastric acid secretion

in gastro-oesophageal reflux disease
Dose : 1.0 mg/kg/dose
Interval : Daily (may be administered as 0.5 mg/kg 12 hourly if daily

dosing does not control symptoms)
Route : Intravenous infusion over 15 minutes
Total Daily Dose : 1 mg/kg/day
Comments : Generally well tolerated but very occasionally may cause

nausea, vomiting or skin rash. Consider alternative options
with liver disease.
Change to oral omeprazole when practical.
Supplied as : Pantoprazole (Somac) 40 mg vial in powder form
Dilution : Add 10 ml of Normal saline to 40mg vial to make 4 mg/mL

solution. Take 1 mL (4 mg) of 4 mg/mL solution and dilute
with 9 mL of normal saline making 0.4 mg/mL solution
Stability : Vial is for single use only. Discard unused solution.
Storage : Vials: Store below 25 degrees. Protect from light.

Compatibility : 5% dextrose, 10% dextrose, normal saline
Incompatibility : Atazanavir this is because PPIs substantially reduce the

absorption of atazanavir
Multiple – consult with pharmacy
Serum Levels : Nil
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Canberra Hospital
Paracetamol (Draft)
Revision Date : 27/04/2017 DTC Approved: (TBA)
Indication1 : 1] Analgesic when narcotics are not required.

2] Antipyretic.
3]Prevention/treatment of side effects related to
immunisations.
4] Treatment of PDA
Dose1 : 1-3] IV/Oral:
< 2 kg – Load 15mg/kg then 7.5 mg/kg/dose;
>=2 kg and <3 kg – 15 mg/kg then 10mg/kg;
>=3 kg – Load 20mg/kg then 10mg/kg
4] IV/Oral:
15 mg/kg/dose 6 hourly
*CGA/PMA: Corrected gestational age/Post menstrual age

Interval : 1-3] 6 hourly
4] 6 hourly
Route : IV (only indicated if NBM, review after 48 hours).
Administered as an undiluted infusion over 15 minutes.
Oral
Total Daily Dose : 1-3] IV/Oral*:
< 2kg – 30 mg/kg/day;
>= 2 kg and <3 kg – 40 mg/kg/day;
>= 3kg – 40 mg/kg/day
4] IV/Oral*:
60mg/kg/day for 3-6 days
*Excluding loading dose
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Canberra Hospital
Comments : Non-narcotic analgesic and antipyretic. Paracetamol is rapidly absorbed by
mouth and widely distributed in the body. Extensively metabolized in the
liver, primarily by sulfation with a small amount by glucuronidation.
Metabolites and unchanged drug are excreted by the kidney. Elimination
half-life is approximately 3 hours in term neonates, and up to 11 hours in
preterm neonates. Elimination is prolonged in patients with liver
dysfunction or jaundice. Optimum pain relief occurs over an hour after the
blood level peaks. Caution should be used in the presence of hepatic
impairment. Overdose may result in liver cell necrosis and death. Caution in
dehydration and severe renal impairment.
Efficacy and safety (PDA)
One published, randomised, controlled trial has compared paracetamol with

placebo2. In 48 preterm infants intravenous paracetamol (20 mg/kg loading;
7.5 mg/kg every 6 hours) was compared with no paracetamol within the first
24 hours of life; with a higher closure rate and shorter time to closure in the
treatment arm and no reported adverse events. A systematic review of two
randomised, controlled trials reported comparisons of oral paracetamol
versus oral ibuprofen for the treatment of an echocardiographically
diagnosed PDA in 250 infants born preterm (≤ 34 weeks postmenstrual age
[PMA]). The success rate for paracetamol to close a PDA was similar to
that of ibuprofen. Adverse events were similar in both groups. However, in
general, the trends favoured infants who received paracetamol and
additionally the adverse events were lower in the paracetamol group3. A
second systematic review of studies involving the use of paracetamol in
preterm infants reported on sixteen studies: Two randomised controlled
trials and 14 uncontrolled studies. The quality of selected studies was rated
as poor. The majority of studies used 15 mg/kg every 6 hours for 3–7
days. Proportion meta-analysis of uncontrolled studies demonstrated a
pooled ductal closure rate of 49% (95% CI 29% to 69%) and 76% (95% CI
61% to 88%) after 3 and 6 days of treatment with paracetamol,
respectively4. A third, randomised, controlled trial involving 77 preterm
infants has since been published comparing oral paracetamol and NSAIDs
(intravenous indomethacin) with similar closure rates and no reported
adverse events5. More recently El Mashad compared paracetamol,
ibuprofen and indomethacin in an RCT involving 300 extremely premature
babies less than 28 weeks and showed 80% closure rate with paracetamol
similar to other groups but without any hepatic, renal or haematological side
effects6.
Repeat LFT’s pre-treatment and at 3 days.

Supplied as : 100mg/ml syrup SHAKE WELL BEFORE USE
1000mg/100mL (10mg/mL) vial

Stability : As per expiry date on the original container. IV paracetamol is a single use
vial.
Storage : Room temperature. Do not refrigerate or freeze vials of iv paracetamol.
Compatibility: IV paracetamol is compatible with 5% Glucose and 0.9% Sodium Chloride
Incompatibility : No information. IV paracetamol should not be mixed with other drugs.
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Canberra Hospital
Serum Levels : Routine levels not recommended. Levels to be taken if concerns of toxicity.
References:
1. Neomed consensus guideline. http://192.168.104.10/neomed/Drug.aspx?@drugid=87. Accessed 28-
04-2017
2. Härkin P, Härmä A, Aikio O, Valkama M, Leskinen M, Saarela T, Hallman M. Paracetamol
Accelerates Closure of the Ductus Arteriosus after Premature Birth: A Randomized Trial. J Pediatr.
2016 Oct;177:72-77.e2. doi: 10.1016/j.jpeds.2016.04.066. Epub 2016 May 20.
3. Ohlsson A, Shah PS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-
birth-weight infants. Cochrane Database of Systematic Reviews. 2015;3:CD010061
4. Terrin G, Conte F, Oncel MY, Scipione A, McNamara PJ, Simons S, et al. Paracetamol for the
treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta-analysis. Arch
Dis Child Fetal Neonatal Ed. 2016;101:F127-36
5. Dash SK, Kabra NS, Avasthi BS, Sharma SR, Padhi P, Ahmed J. Enteral paracetamol or Intravenous
Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A Randomized Controlled
Trial. Indian pediatrics. 2015;52:573-8
6. El-Mashad AE, El-Mahdy H, El Amrousy D, Elgendy M. Comparative study of the efficacy and
safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm
neonates. Eur J Pediatr. 2017 Feb;176(2):233-240. doi: 10.1007/s00431-016-2830-7. Epub 2016 Dec
21.
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Penicillin, Benzyl (Penicillin G)

Revision Date : 15 May 2015 DTC Approved : May 2015
Indication : 1. Empiric therapy for early onset sepsis in combination with

an aminoglycoside
2. Directed treatment of infection to a susceptible bacterium
3. Treatment of congenital syphilis
4. Treatment of meningitis to a susceptible bacterium,
including GBS (Group B Streptococcus)
Dose : 1, 2 and 3. 60mg/kg/dose1
4. 90 mg/kg/dose2
Interval: Dosing interval chart3
Post-menstrual age Postnatal age (days) Interval (hours)
(weeks)
≤29 0-28 12
>28 8
30-36 0-14 12
>14 8
37-44 0-7 12
>7 8
≥45 All 6
Route : IV
IM: Deep IM injection in anterolateral thigh
Total Daily Dose : 300mg/kg/day4
Note: Adjust meningitis doses to comply with maximum daily
Comments : 600mg of benzylpenicillin is equal to 1million units
Each 600mg vial contains 1.8mmol of sodium
Separate dose from aminoglycosides (eg. gentamicin) and flush

line between administration.
Dose adjustment required in renal impairment
Cardiac arrest and CNS toxicity has been reported with high
doses and rapid administration. Bone Marrow Depression,
granulocytopenia and hepatitis are rare side effects.
Hypersensitivity does not occur in neonates3

Supplied as : 600mg benzylpenicillin sodium powder for reconstitution
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Canberra Hospital
Dilution : IV: Dilute with 1.6 ml of WFI to make a 300mg/mL solution.
Further dilute with WFI to final volume 10mL (60mg/mL) and
then withdraw desired volume5.
IV infusion over 15-30 minutes. IV infusion over 30-60 minutes

recommended for larger doses e.g. meningitis1,5
IM: Use 300 mg/mL solution.

Stability : Use as soon as possible and discard any unused solution5
Storage : Store below 25 degrees Celsius and protect from light6
Compatibility: Solution compatibility: 5% glucose, 10% glucose, 0.9% sodium

chloride,WFI
Y site compatibility: calcium gluconate, cefotaxime,
dextrose/amino acid solutions, dopamine, fluconazole,
frusemide, heparin, hydrocortisone sodium succinate, insulin
regular, morphine, potassium chloride, ranitidine, vancomycin
Stability is variable with lipid emulsion
Incompatibility : Aminoglycosides, aminophylline, amphotericin B, dobutamine,
phenobarbitone, phenytoin, Stability is variable with lipid
emulsion
Refer to Micromedex IV compatibility for more information
Serum Levels: NA
Compiled: March Review: March 2019

2015
References:
1. Paediatric Pharmacopoeia 13th Edition 2002. Pharmacy Department, Royal
Children’s Hospital
2. Neomed Consensus group.
http://192.168.104.10/neomed/Drug.aspx?@drugid=4. Accessed online
27/3/15
3. Neofax Penicillin G Drug Monograph, 2015. Accessed Online 25/03/2015
4. Paediatric Injectable Drugs Handbook, 10th Edition 2013. Penicillin G
Potassium/Sodium American Society of Health-System Pharmacists
5. SHPA Australian Injectable Drugs Handbook, 6th Edition 2014.
Benzylpenicillin Sodium
6. Product Information, BenPen, MIMS Amended 01/12/2006
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Pentavite (Multivitamin Prep)

Indication : Vitamin supplementation of preterm infants.

To be prescribed for all infants < 32 weeks gestation or <
1800 grams birthweight
Dose : 0.45 ml BD
Interval : Twice daily when 7 days of age and on full feeds.
Route : Oral.
Total Daily Dose : 0.9 ml.

Comments : Often given to low birth weight infants. Needs are usually
for vitamins A, D, C, & K. Vitamins E, B1, B2, B6 may
sometimes be necessary. Prescribed and recommended
(ESPGN) amounts are as follows:
Vit A 480 microg (300 microg)
Vit B1 540 microg ( 50 microg)
Vit B2 810 microg (200 microg)
Vit B3 710 microg (500 microg)
Vit B6 135 microg ( 20 microg)
Vit C 42 microg ( 20 microg)
Vit D 22 microg ( 20 microg)
Vitamin supplementation after 2 kg is considered not to be

essential.
Supplied as : Pentavite
Dilution : None required.
Stability : Stable for 9 weeks after opening
Storage : Room temperature prior to opening, followed by

refrigeration after opening.
Compatibility:
Incompatibility : None.
Serum Levels :
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Canberra Hospital
Phenobarbitone
Indication : An anticonvulsant, sedation, seizures.

Dose : Loading dose: 20 mg/kg (may be given as 2 x 10 mg/kg doses
3-4 hours apart).
Maintenance Dose: 4- 6 mg/kg/day.
Interval : Daily, may be divided into 2 doses but best given as once a day
at night to reduce drowsiness during the day.
Route : I.V. over 20 minutes.
I.M.
Oral.
Total Daily Dose :
Comments : Overdose may cause hypoventilation, hypotension, hypothermia, renal

failure, decreased anticoagulation. Withdrawal may occur with prolonged
use. Half-life in neonates is 96 hrs. IV dose must not be given faster than
1mg/kg /min.
Should not be used for routine sedation of babies on ventilator, as it has no
pain relief properties and sedative levels are much higher than therapeutic
anticonvulsant blood levels.
Elixir contains 10% ethanol and 30% sorbitol solution, so try to avoid using
Elixir. Tablets can be crushed and mixed with water - the tablets are
insoluble in water so the resultant mixture should be shaken and the dose
measured immediately, discarding any excess. Wherever possible, order
oral doses in 15mg increments so that on discharge, half tablets can be
crushed & administered.
PLEASE NOTE THAT IV PHENOBARBITONE IS NOT
TO BE ADMINISTERED THROUGH A FILTER
Supplied as : Phenobarbitone Sodium 200 mg/1 ml.
Phenobarbitone 30mg Tablets
Phenobarbitone Elixir 15mg/5mL
Dilution : Dilute 1ml solution with 4 mLs N saline giving 40 mg per mL
for IV use.
Compatibility: Compatible with 5% and 10 % Dextrose, Normal Saline,

aminophylline, calcium gluconate, heparin, sodium
bicarbonate.
Incompatibility : Phenytoin, cephalosporins, erythromycin, hydrocortisone,
streptomycin, morphine, vancomycin.
Serum Levels : 65 -130 mmol/L
10 - 20 mg/L.
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Canberra Hospital
Phenylephrine hydrochloride eye drops (2.5%)

Revision Date : 5 December, 2019 DTC Approved: August 2015
Indication : Used in conjunction with cyclopentolate to dilate the pupil

for:
1] ROP examination.
2] Intraocular surgery
Dose : 1drop of 2.5% w/v of Phenylephrine hydrochloride in each
eye both 30 mins and 15 mins prior to examination
Apply pressure to the lacrimal sac during and for 1-2

minutes after instillation to minimize systemic absorption1,2
Interval : Every 15 mins
Route : Topical (Eyes)
Total Daily Dose : NA
Comments : -Used in conjuction with cyclopentolate

-Eye specialist on call will telephone the Unit and give phone
instructions for eye drops to be given prior to his arrival in the unit
-Effect begins within 5 mins and lasts for 60 mins.
-Phenylephrine can be absorbed systemically. Systemic effects are those
of sympathomimetic drugs: tachycardia, hypertension, ventricular
dysrythmias2
-May decrease pulmonary compliance, tidal volume, and peak air flow
in babies with BPD1
Supplied as : Minims® Phenylephrine hydrochloride 2.5% w/v
Stability : For single use only. Discard any unused portion
Storage : Store at 2°C to 8°C. (Refrigerate. Do not freeze.). Do not

expose to strong light2
Serum Levels : NA
Compiled: Aug 2015 Revision: Aug 2019
References:
1. Neofax online. Accessed 21/10/15
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Canberra Hospital
2. Minims Phenylephrine Product Information.
https://gp2u.com.au/static/pdf/P/PHENYLEPHRINE_EYE_DROPS_MINIMS-
PI.pdf. Accessed online 21/10/15
Phenytoin
Indication : Seizures.
Dose : Loading Dose: 20 mg/kg

Maintenance dose (start 12 hours after loading dose)
Infants < 37/40: 4 mg/kg/day in 2 divided doses (12/24)
Infants > 37/40: 4-8 mg/kg/day in 2 or 3 divided doses
Route : Loading dose should be infused over 1 hour. Maintenance

doses may be infused over half an hour.
Maximum rate of infusion - 0.5 mg/kg/min. IM route is not
acceptable as the drug crystallises in muscle. Oral
absorption may be quite erratic.
Total Daily Dose : Maintenance dose 4-8 mg/kg/day depending on gestational
age.
Comments : Use with caution. Very irritant to veins. Phenytoin has a pH of 12 and if
extravasated can cause tissue necrosis. Causes hypotension and
bradycardia if given rapidly. Erratic metabolism. Not an ideal
anticonvulsant in neonatal period. Phenytoin has a narrow therapeutic
index and metabolism is non-linear. Small increases in dose may
produce a large increase in plasma concentration. Phenytoin is highly
bound to plasma proteins. Therapeutic plasma concentrations are
reduced in the first 3 months of life because of reduced protein binding.
Phenytoin metabolism changes dramatically in newborns as metabolic
pathways mature. Multiple serum concentration measurements are
required in newborns.
Supplied as : Phenytoin 50 mg/mL in 2mL ampoules (100mg in 2 mLs)
6 mg/mL mixture
Dilution : Phenytoin may be given undiluted or diluted with Normal Saline to a
final concentration of 3-10mg/mL. Diluted solution must be used within
ONE hour. Take 100mg phenytoin (2mL) and add to 8mL Normal
Saline or 200mg phenytoin (4mL) and add to 18mL Normal Saline
(makes 10mg/mL). Discard any solution after one hour. The flush given
after the dose must run at the same rate as the dose, to avoid the drug
being bolused.
Stability : Discard unused portion after one hour.
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Compatibility: Compatible with fluconazole, sodium bicarbonate, N Saline
Incompatibility : Aminophylline, erythromycin, vitamins, Dextrose.

Phenytoin is highly unstable in any iv solution.
Serum Levels : 0-3 months: 24-55 micromol/L; > 3/12 40-80 micromol/L. Sample dose
should be taken immediately prior to a dose (trough level). Levels can
be checked 24 hours after a loading dose or 5-10 days after a change to
the maintenance dose.
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Canberra Hospital
Phosphate Supplement
Indication : Hypophosphataemia related to phosphate depletion and

osteopenia of prematurity.
Dose : Phosphorous: 15-30 mg/kg/dose
Interval : 6 hourly
Route : Oral
Total Daily Dose : Phosphorus: 60-125 mg/kg/day
Comments : Dibasic or monobasic solution of sodium or potassium

phosphate is used for enteral supplementation. This can be
prepared in pharmacy.
(In Nutritional needs of the preterm infant. Ed Tsang 1993)
ATTENTION: Phosphate (Sandoz) tablets contain 500 mg
phosphorous/16.1 mmol Phosphate per 500mg tablet.
Orders are to be written in mg/kg phosphorous. (0.5-1.0
mmol phosphate = 50-100 mg phosphate = 15-30 mg
phosphorous.)
Supplied as : 500 mg phosphorous tablets (containing 16.1 mmol
phosphate)
Dilution : Dissolve 1 tablet in 18 ml sterile water – 500 mg
Phosphorous (16.1 mmol phosphate) per 20ml = 25 mg/ml
phosphorous. Work out dose as per order (ensure mg or
mmol dose).
Stability : Refrigerate after making up and discard at the end of the
shift
Storage : As per pharmacy
Compatibility:
Incompatibility : Give at separate times to oral calcium to prevent

precipitation and malabsorption.
Serum Levels : Monitor serum calcium and phosphate regularly until
maximum dosage administered and levels stabilise.
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Canberra Hospital
Piperacillin/Tazobacatam
Indication : Broad spectrum semi synthetic penicillin combined with a beta

lactamase inhibitor. For treatment of non-CNS infections including
Pseudomonas aeruginosa, E. coli, Enterobacter, Klebsiella,
Haemophilus influenzae, Proteus mirabilis, Staph. aureus and group B
streptococcus.This is a restricted ORANGE ANTIMICROBIAL
and can only be used for the indications outlined in the AMS
SOP unless otherwise specified by the Infectious Disease team.
Dose : 50-100mg/kg/dose
(Dose expressed as the Piperacillin component)
Interval : Corrected gestational Postnatal Age Dosage Interval
age (weeks) (days old) (hours)
≤ 29 weeks 0 to 28 12
>28 8
30 to 36 weeks 0 to 14 12
>14 8
37 to 44 weeks 0 to 7 12
>7 8
>45 weeks ALL 8
Route : IV infusion by syringe pump over 30 minutes
Total Daily Dose :

Comments : Restricted ‘orange’ antibiotic. Requires ID approval if
prescribed outside the restricted indications.
Each gram contains approx 2.79 mmol Na. May cause prolonged
bleeding time, hypokalaemia, raised creatinine, raised LFTs,
hyperbilirubinaemia. Prolonged use (greater than or equal to 21 days):
monitor renal, hepatic, haemopoietic function.
Supplied as : Tazosin 4g/500mg Vials
(Piperacillin 4g + Tazobactam 500mg)
Dilution : Reconstitute vial with 16.8mL WFI. Makes 200mg/mL. Further dilute
each 1mL (200mg) to 10mL with NS.
If fluid restricted can use a smaller dilution volume eg 5mL. Administer
over 30 minutes.
Usually made up by pharmacy. Advise pharmacy if reduced volume
(other than 200mg/10mL) is preferred.
Stability : Discard after use. Syringes made by Pharmacy will have expiry date
printed on syringe label
Storage : Vials at room temperature
Prepared syringes in the refrigerator
Compatibility : 0.9% NaCl, 5% Dextrose, Clindamycin, Dopamine, Fluconazole,
Frusemide, Heparin, Metronidazole, Morphine, KCl, Ranitidine
Incompatability : Aminoglycosides – separate infusion by 1 hr. Aciclovir, Amphotericin
Lipid Complex, Azithromycin, Caspofungan, Dobutamine,
Pantoprazole, Vancomycin
152
Canberra Hospital
Serum Levels Not applicable
153
Canberra Hospital
Potassium Chloride
Indication : Hypokalaemia – secondary to prolonged diuretic therapy or

steroid administration, or as maintenance therapy for infants
on parenteral feeds.
Dose : Maintenance requirement is 2mmol/kg/day. Calculate

Potassium deficit and daily requirement. Give in divided
dosage. Intravenous correction should never be with a
solution containing more than 100mmol/l, and not given at
a rate more than 0.2 mmol/kg/hr.
Interval : 2 - 12 hourly.
Route : Oral.
IV infusion.
Total Daily Dose : As needed.
Comments : Use with care in renal failure. In infants on chronic diuretic

therapy, KCl replacement therapy should be used
cautiously.
Supplied as : I.V.: Strong Potassium Chloride 7.5 % IV solution 10

mmol/10 ml.
Oral: 10% KCl Oral mixture containing 20 mmol KCl in 15
mL, i.e. 1.33 mmol/mL.
Dilution : Oral: Mix with feeds.
I.V.: Add to IV fluids or if used as a side-arm infusion, the
ratio should be 1 ml of 7.5% KCl to 9 mLs of D10W or
normal saline.
Stability : As per pharmacy.
Compatibility: Most drugs and infusions.
Incompatibility : Amphotericin B, Diazepam and Phenytoin.
Serum Levels :
154
Canberra Hospital
Povidone-Iodine (Betadine)
Indication : A topical antiseptic, to prevent infection in minor cuts,

wounds and abrasions
Route : Topical
Comments : Povidone-Iodine 10% (Betadine®) is equivalent to 1%

available iodine. Povidone-Iodine is an iodophore in which
iodine is bound to a carrier molecule, povidone. This
complex slowly liberates inorganic iodine when in contact
with skin and mucous membranes. Only a small amount of
iodine is released at any one time, giving Povidone-Iodine a
lower irritant potential and longer duration of action than
conventional iodine solutions.
Povidone-iodine is a topical microbiocidal antiseptic and is
microbiocidal to viruses, bacteria, fungi and spores.
Premature infants. Not recommended for use as an
antiseptic on premature newborn infants.
Full term infants. The use of povidone-iodine containing
preparations on full term infants is associated with a small
risk of transient hypothyroidism particularly if applied to
large areas of the body and/or for extended periods of time
(greater than five days). Repeated or large applications of
Betadine in full term infants should be coupled with
appropriate monitoring of thyroid function
Supplied as : Ointment 10%
Cream 5%
Liquid 10%w/v
Liquid spray 5%w/v
Dilution :
Stability :
Storage : Store below 25°C
Serum Levels :
References
eMIMs; 2012
http://www.orion.net.au/products/pdf/rio01598_ug.pdf
155
Canberra Hospital
Prednisolone
Indication : Asthma, croup, chronic lung disease.
Dose : 1 mg/kg/dose
Interval : Every 12-24 hours
Route : Orally
Total Daily Dose : 1-2 mg/kg/day. Use lowest dose possible.
Comments : 1mg prednisolone is equivalent to 4mg hydrocortisone in

glucocorticoid activity. Single daily doses are best given in
the morning and with feeds. May suppress linear growth.
Consider bone mineral density assessment for patients
receiving large and long term doses of oral steroids.
Immunosuppressant. Steroids may mask signs of infection.
Prolonged treatment may cause adrenal suppression and
atrophy may occur and secretion of corticotropin may be
suppressed. In this situation withdrawal of steroids should
be gradual. The lowest possible effective dose should be
used to treat the condition. Side effects include electrolyte
disturbances, gluconeogenesis, adrenal axis suppression,
osteoporosis, increased liability to infection, growth
retardation, GI irritation (with ulceration).
Supplied as : Oral mixture 5 mg/ml
Dilution :
Stability :
Compatibility:
Incompatibility :
Serum Levels :
156
Canberra Hospital
Prevenar 13
Indication: Active immunisation against invasive disease, pneumonia,

acute otitis media caused by Streptococcus pneumoniae
serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F in
infants, children 6 wks-5 yrs
Dose: 0.5 mL
Interval: Immunisation schedule: 2, 4 and 6 months of age. A single

booster injection should be given in the second year, at least 2
months after the primary series.
Route: IM to anterolateral aspect of the mid thigh for infants under 12
months. For infants over 12 months, the deltoid region of the
arm is used. Do not inject into the gluteal area.
Total Daily Dose:
Comments: For further or more detailed information on vaccine schedules,

consult The Australian Immunisation Handbook (most recent
edition, or the website:
http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips
Supplied as: 0.5 mL suspension in single use glass vials or pre-filled

syringes.
Dilution: Before use shake well to obtain a homogeneous white
suspension.
Stability: Prevenar is for single use in one patient only. When using vials,
Prevenar is to be administered immediately after being drawn
up into a syringe.
Storage: Store in refrigerator 2 to 80 Celsius
Incompatibility: Do not mix with other vaccines or products in the same syringe.
Serum Levels:
157
Canberra Hospital
Propofol
Revision Date : 30 June 2009 Approved: AK, JD
Indication : Propofol is a short acting intravenous anaesthetic agent

dispersed in a soya oil emulsion base.
Bolus intravenous induction agent for endotracheal
intubation ONLY. Do not use as an infusion. Propofol is
contraindicated for sedation in all paediatric patients.
Dose : 2.5mg/kg/dose IV
Dose may be repeated three times in total
Interval : Stat dose for intubation only, administer over 20 seconds.
Route : IV. Do not administer via an in-line filter.
Total Daily Dose : 7.5 mg/kg
Comments : Onset of action is approximately 30 seconds. Duration of action: 3-

10minutes. Metabolised mainly in the liver to form inactive sulphate and
glucuronide conjugates that are excreted in the urine. 95% bound to plasma
proteins. Sleep is expected in <1 minute. Treatment has failed if sleep
(defined as loss of eyelash reflex) is not achieved in three minutes and the
infant must be intubated with morphine, atropine and suxamethonium.
Contraindications: Impaired cerebral circulation; Raised intracranial
pressure; Known allergy to egg, lecithin, glycerol, soya oil, sodium
hydroxide and disodium edetate. Potential Adverse Effects;
CARDIOVASCULAR: Hypotension, myocardial depression, bradycardia;
RESPIRATORY: Respiratory depression and acidosis. Apnoea, pulmonary
oedema, anaphylaxis; SKIN: Rash, pruritis, pain on injection
Supplied as : 10mg/mL 20mL vial

Stability : Do NOT use if the emulsion is separated or discoloured.
Discard unused contents immediately.
Storage : Store below 25C. Do NOT freeze. Protect from light
Compatability: 5% Glucose
Incompatibility : Adrenaline, aminophylline, amphotericin, ampicillin, atropine,

benzylpenicillin, calcium chloride, cefepime, ceftazidime, ciprofloxacin,
clindamycin, dexamethasone, digoxin, dobutamine, dopamine, fentanyl,
fluconazole, frusemide, gentamicin, heparin, hydralazine, hydrocortisone,
imipenem-cilastatin, lignocaine, metoclopramide, midazolam, morphine,
naloxone, noradrenaline, pancuronium, phenobarbitone, phenytoin,
potassium chloride, ranitidine, sodium bicarbonate, sodium nitroprusside,
suxamethonium, ticarcillin-clavulanate, vancomycin
158
Canberra Hospital
Propanolol
Indication : 1. Hypertension particularly associated with thyroid crises.

Consider use of other antihypertensives according to
aetiology of hypertension.
2. Infantile haemangioma
Dose : 1. Oral: 0.25 - 0.5 mg/kg. Maximum of 3.5 mg/kg/dose
2. Initial dose: 2 mg/kg/day in 3 divided doses, but may
commence at 0.3-1 mg/kg/day to assess tolerability,
increasing to 2 mg/kg/day over several days.
Maintenance dose: 2-3 mg/kg/day in 3 divided doses. Taper
over 2-4 weeks
Interval : 1. 6 - 8 hourly.
2. 8 hourly
Route : Orally
Total Daily Dose : 1. Oral: 12 mg/kg/day

2. Oral: 3 mg/kg/day
Comments : Bradycardia may be considerable. Atropine will reverse
associated severe bradycardia. Start at smaller dose and
increase over 3-4 days to maximum. May take 7-30 days to
reach maximum effect.
Measure systemic blood pressure frequently. Assess for
increased airways resistance. Give consistently in relation to
feeds to avoid fluctuations in absorption. Regular feeds (3-4
hourly) may be required to avoid hypoglycaemia,
particularly during initiation and after dose changes.
Supplied as : Oral Solution 2mg/mL. If oral dose is needed after hours,
disperse tablet in Water for Injection to give 2mg/mL
solution, eg 10mg tablet in 5mL. Discard unused portion
Dilution :
Stability : Expiry date printed on product label.
Compatibility:
Incompatibility :
159
Canberra Hospital
Serum Levels :
160
Canberra Hospital
Prostaglandin E1(Alprostadil)
Indication : Ductal dependent congenital heart disease.
Dose : Graded infusion. Start at 10 nanog/kg/min increasing to 100

ng/kg/min. Usual maintenance dose is 10-20 nanog/kg/min.
Route : I.V.
Total Daily Dose :
Comments : Causes apnoea and bradycardia. Where the infant is not

ventilated there must be a ventilator available and ready to
use. Also cuases pyrexia, hypotonia, skin flushing, seizures,
oedema, sepsis and DIC.
If undiluted Alprostadil solution comes in direct contact
with a plastic container (eg a syringe barrel) the solution
may turn hazy. If this occurs the solution should be
discarded. Consequently, the infusion solution should be
added to the chamber first.
Supplied as : Prostin 500 microg/ml.
Dilution : Put 20mL of fluid (NS or 5DW) into a syringe. To this

syringe, add 0.06mL x weight per kg of Alprostadil
solution and then make up to a total volume of 25mL using
the NS or 5DW. Using this resulting concentration:
0.5mL/hour = 10nanogram/kg/min.
Stability : Discard unused portion. Prepare solution every 24 hours.
Storage : Refrigerated
Compatibility: Caffeine, pantoprazole, and sodium nitroprusside.
Incompatibility : No data available.

Incompatible with levofloxacin – never heard of it, must be
a quinolones they use in the US
Serum Levels :
161
Canberra Hospital
Prostacyclin PGI2(Epoprostenol)
Indication : Vasodilator used for persistent pulmonary hypertension.

Anticoagulant.
Dose : 0.002 microg (2nanog) – 0.012 microg (12nanog)/kg/min
titrated to response.
Interval : Infusion.
Route : I.V.
Total Daily Dose :

Comments : The high pH of the solution will cause tissue damage if extravasation
occurs – the use of a central line is preferred. Concurrent use of
inotropes is recommended. Facial flushing and or sweating may occur.
Continuous monitoring of BP and HR – report hypotension, tachycardia
or bradycardia immediately. Elevated blood sugar levels have been
reported. Observe for bleeding. Test gastric pH and report if < 3 – a
histamine antagonist may be required. Measure urine output and
perform urinalysis 4-6 hourly. 1000 nanograms = 1 microg
Supplied as : Flolan. Pack contains one 500 microg freeze-dried Epoprostenol vial,
two 50 ml sterile glycine buffer solution vials and a filter unit.
Dilution : Only the sterile diluent provided may be used to reconstitute and
dilute the Epoprostenol.
Reconstitution: Withdraw 10mL of the sterile buffer solution and inject
it into the Flolan vial. Shake gently until dissolved, then withdraw the
entire contents of this 10mL vial and re-inject it back into the remaining
40mL solution of the first vial. This vial now contains 500microg/50mL
(=10microg/mL).
Dilution: The concentrated solution above can be further diluted, using
the other vial of sterile buffer solution. The most dilute solution able to
be used is 2microg/mL (=2000nanogram/mL). This solution can be
prepared by diluting 10mL of the concentrated Flolan solution and
making it up to a total volume of 50mL with the other sterile buffer
solution. Use the filter provided to draw these two solutions into the
50mL syringe.
Stability : Vial for single use only. Discard remainder after reconstitution.
Reconstituted and diluted solution only stable for 12 hours at room
temperature in refrigerator. Note that potency may be reduced with time,
so may need to titrate dose towards end of 12 hours, and freshly made
solutions may have higher potency. Approximately 90% of potency
retained after 12 hours at room temperature in manufacturers diluent.
Storage : Store vials at room temperature, protect from light.
Compatibility: No fluids are considered compatible, including normal saline
Incompatibility : This drug should not be mixed with other drugs and is administered
through a dedicated line. The line should not be flushed or stopped and
the solution must be changed every 12 hours.
162
Canberra Hospital
Serum Levels :
Pyridoxine
Indication : Seizures, suspected pyridoxine deficiency or dependency.

Vitamin B6. This is an SAS drug. The Consultant
Neonatologist must complete an SAS form and return this
to pharmacy.
Dose : Diagnostic : 100mg
Maintenance 10-15mg/kg/dose
Interval : Daily
Route : I.V. or I.M.

Oral
Total Daily Dose : 10-100 mg
Comments : Differentiate between dependency and deficiency. Infuse

slowly over 1-2 minutes. Perform this therapeutic test under
continuous EEG monitoring.
Supplied as : Ampoules 50mg/ml

Tablets 25 mg and 100 mg.
Dilution : Nil
Stability :
Compatibility: 5%D, NS
Incompatibility : Alkaline solutions.
Serum Levels :
163
Canberra Hospital
Ranitidine
Indication : Treatment of oesophagitis, gastric or duodenal ulceration in

babies during intensive care in which stress ulceration may
occur. Use when tolazoline therapy is established.
Dose : I.V. dose: 0.5 - 0.7 mg/kg/dose.

Infusion: 0.05-0.25 mg/Kg/hr
Oral dose: 2-4mg/kg/dose
Interval : I.V.: < 1500 gm 8 hourly, > 1500 gm 6 hourly.
Oral : 8 –12 hourly
Route : I.V. or Oral
Total Daily Dose : I.V. 3mg/kg

Oral 12 mg/kg
Comments : H2 receptor antagonist with 5 - 12 times the potency of
cimetidine. Renal excretion predominates and levels should
be monitored in renal impairment. No side effects have
been reported apart from one case report of
thrombocytopenia.
Supplied as : Ranitidine hydrochloride 50 mg in 5 ml ampoules.
Dilution : Take 1 ml of 50 mg/5 ml ampoule and dilute in 9 mls of NS

(= 1mg/ml solution) and administer over 20 minutes
Compatibility: Compatible with Aciclovir, aminophylline, dexamethasone,

dobutamine, dopamine, gentamicin, Dextrose solutions,
Normal Saline, TPN, morphine, vancomycin.
Incompatibility : Diazepam, phenytoin, phenobarbital.
Serum Levels :
164
Canberra Hospital
Recombinant Factor VIIa

Indication : Ongoing microvascular bleeding and coagulopathy from any

cause refractory to other corrective measures. To be ordered by
a Consultant Neonatologist only and requires permission from
the On-Call Haematologist. Supplies should come from
transfusion service.
Dose : 90 micrograms/kg.
Interval : Usually a single dose, but may be repeated 2 hourly if bleeding

persists.
Route : I.V. bolus injection over 2-5 minutes.
Total Daily Dose :
Comments : Complications to rFVIIa are rare. Thrombosis is uncommon.

Hypersensitvity may occur, rash, fever, nausea and increased
LFT’s have been reported.
Supplied as : Novoseven or Eptacog alfa 1.2 mg vial
Dilution : Reconstitute 1.2 mg vial with 2.2 ml of WFI to a final

concentration of 0.6 mg/ml. Swirl gently. The remainder of the
solution may be used within 3 hours if repeat doses are
required.
Stability : 3 hours after reconstitution
Storage : Store in refrigerator. Protect from light. Do not use after expiry
date.
Incompatibility : Do not mix with infusion solutions.
Serum Levels :
165
Canberra Hospital
Resonium A
Indication : Treatment of hyperkalaemia.
Dose : 0.25 - 1 gram/kg per dose, adjusted according to serum

electrolyte results.
Interval : Oral: 6 hourly.
Rectal : 6 hourly
Route : Oral
Rectal
Total Daily Dose :
Comments : Fine powder of sodium polystyrene sulphonate a cation

exchange resin. Used to treat hyperkalaemia in renal
failure. Ensure evacuation by colonic irrigation after 8 –12
hours, if possible. May take hours to days to have an effect.
Can cause constipation. In children, 1 gram will exchange 1
mEq K+. May cause magnesium and calcium loss.
Supplied as : Fine powder.
Sodium Polystyrene sulphonate
Dilution : Pre-weighed aliquots supplied by pharmacy. Mix with
water, D5W or D10W.
If necessary, the resin can also be prepared on the ward
immediately prior to use by mixing with enough liquid to
make it liquid enough to pass down the nasogastric tube, or
of a suitable paste consistency for rectal administration
using a feeding tube. This may be anything from 2-5 ml/kg.
Storage : Room temperature. Do not refrigerate.
Serum Levels : Check electrolytes regularly.
166
Canberra Hospital
Rifampicin
Indication : Oral treatment of MRSA in conjunction with fusidic acid,

vancomycin. Also used in treatment of tuberculosis and for
prophylaxis against N. meningitidis and Haemophilus
infections, amongst contacts.
Dose : 1) Treatment: 10 mg/kg.
2) Prophylaxis N. meningiditis: 5 mg/kg/dose
3) Prophylaxis HIB: 10 mg/kg/dose
Interval : 1) Once daily
2) 12 hourly for 2 days
3) Once daily for 4 days
Route : Oral on an empty stomach
IV infusion.
Total Daily Dose : 10 mg/kg.
Comments : Drug is 35% protein bound. 35% appears in urine after 4 hours.
Penetrates CSF well. Can cause gastrointestinal upset and intolerance,
jaundice, and a transient rise in liver AST and ALP. Commonly colours
urine and other body fluids a reddish tinge. Increases the metabolism of
various drugs like chloramphenicol, diazepam, digoxin, fluconazole and
phenytoin. Monitor tramsaminases and bilirubin.
Supplied as : Syrup 100 mg/5 ml.
Vials 600 mg powder for reconstitution.
Dilution : Reconstitute with 10 ml of sterile water to make a strength
of 60 mg/ml. A 3 mg/ml solution is prepared by adding 0.5
ml of reconstituted solution to 9.5 ml of 5% Dextrose or
saline. The required amount is infused over 60 minutes.
Stability : Vials for single use only. Discard any unused portion.
Storage : Both IV vial and syrup keep at room temperature.
Compatibility: 5% D, NS.
Incompatibility : No data available.
Serum Levels : Toxicity is uncommon but serious hepatotoxicity may

occur. Measurement of levels advised. Required levels 0.3
- 0.6 microg/ml.
167
Canberra Hospital
Rotavirus Vaccine
Indication : For the prevention of rotavirus gastroenteritis
Dose : 1.5 mL
Interval : Two doses at least 4 weeks apart. The first dose is given
between 6 and 14 weeks of age, and the second dose must
be given by 24 weeks of age.
Route : Oral. Under no circumstances should the vaccine be given
by injection. The child should be in a reclining position.
Administer orally (i.e. into the child's mouth towards the
inner cheek) the entire contents of the oral applicator.
Total Daily Dose : Not applicable
Comments : Rotarix is live attenuated human rotavirus RIX4414 strain.

Excretion of the vaccine virus in the stools occurs after
vaccination with a peak excretion at 7 days. There is a
theoretical risk of transmission to non-vaccinated contacts,
therefore. Rotarix is only administered to NICU patients (of
the appropriate age) at the time of discharge.
Rotarix should not be administered to any patient with a
history of chronic GI disease, a febrile illness, or in the
presence of vomiting or diarrhoea.
The first dose of Rotarix must not be administered to
patients older than 14 weeks and the second dose must not
be administered to patients older than 24 weeks, as there is
no safety data in this age group, particularly in relation to
intussusception.
Supplied as : Rotarix brand of rotavirus vaccine is supplied as a clear
liquid in an oral applicator.
Dilution : The vaccine is ready to use (no reconstitution or dilution is
required).
Stability : See manufacturer’s expiry date.
Storage : Rotarix should be stored between 2 and 8 degrees C.

Protect from light.
Incompatibility : There are no restrictions on consumption of food or breast
milk either before or after the vaccine is given.
Serum Levels : Not applicable
168
Canberra Hospital
Salbutamol - for I.V. Administration

Indication : Respiratory failure and bronchospasm in bronchopulmonary

dysplasia.
Hyperkalaemia.
Dose : Loading dose 2-4 microg/kg over 10 minutes followed by an
infusion at 0.1-1 microg/kg/minute (6-60 microg/kg/hour).
Infusion rate may be increased until a tachycardia is noted and
then reduced slightly to below this threshold rate. Utmost care is
required in administration of this drug under these
circumstances.
An infusion of 4 microg/kg over 5 minutes can cause a drop in
serum potassium by as much as 1.5 mmol/l.
Interval : 1] iv
2] Continuous infusion.
Route : Intravenous only.
Comments : When used in chronic BPD sudden improvement in PaCO2 by

improved ventilation may shift potassium intracellularly and
create a sudden hypokalaemia. This is particularly notable in
cases where prolonged diuretic use has also caused chronic low
plasma chloride levels. Check chloride levels before
administration of IV salbutamol and be prepared to add KCl
supplements to maintain normal potassium levels.
Supplied as : Ventolin injection 500 microg/ml.
Dilution : Dilute with NS or D5W for infusion. Take ‘X’ x 0.6 ml of

ventolin injection and make upto 25 ml with Normal Saline or
5% Dextrose, where ‘X’ is the baby’s weight in kg. Therefore,
0.5 ml/hour = 0.1 microg/kg/min.
Stability : Reload infusion after 24 hours.
Compatibility : No data.
Incompatibility : Usual conditions apply.
Serum Levels :
169
Canberra Hospital
Salbutamol (Nebulised)
Indication : Chronic lung disease with reversible airways component.
Dose : 0.15 mg/kg to 0.25 mg/kg.
Route : Nebuliser.
Total Daily Dose :
Comments : Nebulisation into ventilator circuit is inefficient. Usually

requires hand ventilation during administration. Excess
dosage will cause tachycardia and tremor - half dose if this
occurs.
Supplied as : Nebules 2.5 mg in 0.5 ml.
Dilution : Dilute to 2 ml with NS.
Stability : Discard unused diluted solution.
170
Canberra Hospital
Sandoglobulin (Normal Human Immunoglobulin)

Indication : 1] Immunoglobulin deficient states.

2] Severe neutropenia.
3] Septic shock.
Dose : 300 - 400 mg/kg.
Interval : Daily for three days.
Route : I.V.
Total Daily Dose : 300 - 400 mg/kg.
Comments : Prophylactic treatment with immunoglobulin to ELBW

infants was thought to (but to date not proven) reduce the
incidence of sepsis and NEC. When used, well tolerated by
newborn. Specific reactions between antibodies and
antigens not noticed.
Supplied as : Sandoglobulin 1 G, 3 G, or 6 G vials. Should only use 1 G
vials as this is a very expensive product.
Dilution : Dilute 1 g vial with 20 ml of Normal Saline to give a
solution containing 50 mg/ml. Infuse at a rate of 0.5
ml/kg/hour and double the rate twice at hourly intervals, if
no systemic reactions are observed. Maximum rate of
infusion being 2 ml/kg/hour. Do not shake the bottle or
create any froth. Gentle rotation may be necessary. Re-
constitution may take up to 20 minutes. Warm to body
temperature before administration.
Stability : The solution will be stable and reusable within 24 hours.
Storage : Powder at room temperature. Re-constituted solution

refrigerated.
Compatibility : No data.
Incompatibility : Do not use if turbid. Administer though an in-line filter.
Serum Levels :
171
Canberra Hospital
Sildenafil
Revision Date : 16/11/2015 DTC Approved: 2/12/15
Indication : Persistent pulmonary hypertension of the newborn1, or

pulmonary hypertension secondary to BPD or other cause2.
Dose : Commence at 0.5-1 mg/kg per dose, increasing to a maximum

of 2 mg/kg dose every 36 to 48 hours as long as blood pressure
stable2, 3
Interval : 6 hourly
Route : Oral
Total Daily Dose : Maximum dose 2 mg/kg/dose every 6 hours2, 3, 4
Comments : Inhibitor of cGMP-specific phosphodiesterase-5.

Contraindicated in hypotension, if patients is receiving nitrates
and in hereditary degenerative retinal impairment. Administer
only in situations where left ventricular performance can be
monitored (i.e. via ECG). Reduce dose in renal and hepatic
impairment. Withdraw treatment gradually. Monitor blood
pressure. Do regular eye testing whilst on treatment. Use with
caution in presence of other cardiovascular disease, bleeding
disorders, active peptic ulceration, ocular disorders. Initiate
cautiously if baby is on nitric oxide. Side effects: dyspepsia,
flushing, headache, dizziness, penile erection, visual
disturbances, raised IOP, nasal congestion. Rarely causes
vomiting, priapism, painful red eyes, rash.5
Supplied as : 25 mg and 50 mg film coated tablets. Pharmacy during business
hours will make a 2 mg/mL sildenafil suspension.
Dilution : Tablets are film coated. Peel film off the tablet then crush and
dissolve in water. Discard any unused dose.
Stability : Store at room temperature until the expiry date indicated on

packaging.
Storage : Tablets and suspension to be kept at room temperature.
Incompatibility :
Serum Levels :
172
Canberra Hospital
Compiled: November 2015 Review: November 2019
References:
1. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates.
Cochrane Database Syst Rev. 2011 Aug 10;(8):CD005494. doi:
10.1002/14651858.CD005494.pub3. Review
2. Yaseen H, Darwich M, Hamdy H. Is Sildenafil an Effective Therapy in the
Management of Persistent Pulmonary Hypertension? J Clin Neonatol. 2012
Oct-Dec; 1(4): 171–175.
3. Wardle AJ, Wardle R, Luyt K, Tulloh R. The utility of sildenafil in pulmonary
hypertension: a focus on bronchopulmonary dysplasia. Arch Dis Child. 2013
Aug;98(8):613-7. doi: 10.1136/archdischild-2012-303333. Epub 2013 Apr 26.
Review.
4. Joint Formulary Committee. 2010-2011 ed. London: British Medical
Association and Royal Pharmaceutical Society of Great Britain; 2010. British
National Formulary
5. Neofax online, accessed 21/10/15
173
Canberra Hospital
Sodium - Increasing Sodium Content of IV Bags

Revision Date : 29 October, 2010 Approved : AK, ZK
Starting Finished Volume to be Volume of 20% NaCl

Concentration Concentration Removed From to be added to 500
500 mL Bag mL bag
0% N/4 = 0.225% 5.6 mL 5.6 mL
0% N/2 = 0.45% 11.25 mL 11.25 mL
For example:
Add 5.6 mL of 20% NaCl to a 500 mL bag of 10% Dextrose to make N/4 10% Dextrose
174
Canberra Hospital
Sodium Bicarbonate
Indication : 1] Resuscitation.
2] Metabolic acidosis.
Dose : 1] 1 - 3 mmol/kg
2] Body Deficit: 0.3x weight in kg. x base deficit.
Generally, half correction is given, followed by another
quarter correction, if indicated on the basis of blood gas
analysis.
Interval : Stat
Route : Slow I.V.
Total Daily Dose :
Comments : Dilute before administration using WFI or D10W. Give

over 30 minutes if correcting metabolic acidosis. May be
sometimes given with FFP where additional volume loading
is required. Monitor local infusion site for complications
[hyperosmotic solution] - always dilute 1:1 with water for
injection
Monitor arterial blood gases as ordered by medical officer
Infuse carefully - as rapid administration has been linked
with IVH and local tissue necrosis;
Supplied as : Ampoules 10 ml 8.4 % NaHCO3. 1 ml = 1 mmol NaHCO3
Dilution : Dilute to 4.2 % by adding 5ml 8.4% Bicarbonate to 5ml

WFI or D10W (1ml of dilute solution =0.5mmol NaHCO3).
Stability : Discard unused portion after opening.
Compatibility : Compatible with aminophylline, amphotericin B, atropine,

heparin, morphine, fentanyl, cimetidine.
Incompatibility : Do not infuse with any calcium containing solution,
adrenaline, dopamine, dobutamine.
Serum Levels : On Blood gas analysis.
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Sodium Chloride 20% (NaCl)
Revision Date : 3 July 2014 Approved: TC, LZ, JD
Indication : Correction of hyponatraemia
Dose : 1] Oral/Nasogastric:
Starting dose depends on degree of hyponatraemia. Usual
dose 2-4mmol/kg/day. Higher doses (up to 6mmol/kg/day)
may be required for severe depletion. Adjust the dose
according to clinical requirements. Higher doses may be
required in premature infants due to significant renal losses
of electrolytes.
Prescribe medication name as 20% NaCl
Prescribe dose in terms of mL
Prescribe dose calculation in terms of mmol/kg/day
2] IV:
Required dose of sodium in mmol
= weight (kg) x 0.6 x {x – serum sodium (mmol/L)}
Where x is the desired serum sodium concentration
Maximum recommended correction in 24 hours is
12mmol/L
Interval : 1] 2 - 12 hourly
2] continuous infusion
Route : 1] Oral/nasogastric
2] Intravenous infusion
Total Daily Dose : As directed by level of hyponatraemia
IV: Correct sodium level slowly, not raising serum level by
more than 0.5mmol/L per hour. Maximum recommended
correction in 24 hours is 12mmol/L
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Comments : Never administer undiluted hypertonic 20% sodium chloride
intravenously. 20% NaCl must be diluted prior to use. Give via
central line if available.
Regularly review and adjust dose. Chronic administration without dose

adjustment to account for changing renal handling of sodium is likely to
lead to adrenal imbalance and hypertension.
Review any concurrent diuretic therapy as sodium replacement while on

sodium losing diuretics is counter-productive.
Osmolality information:
Isotonic solution = 300mOsmol/L
Max via peripheral line = 900mOsmol/L
Peripheral lines aim for 14.4 – 43.2mOsmol in 48mL i.e. 300-
900mOsmol/L, but this may be adjusted at consultant discretion
1mmol of NaCl provides 2mOsmol
1mL of 5% Dextrose (5%D) provides 0.278mOsmol
1mL of 10% Dextrose provides 0.556mOsmol
e.g. 2.5kg baby, peripheral line, desired serum Na 135, actual serum Na
120: Dose of Na (mmol) = 2.5 x 0.6 x 12 = 18mmol (÷3.4mL) = 5.3mL
of 20% NaCl
48mL syringe will contain 36mOsmol (NaCl) plus 42.7mL diluent
Using WFI: 36+0 = 36mOsmol/48mL (WFI preferred)
Using 5%D: 36+(42.7 x 0.278) = 48mOsmol/48mL
e.g. 1kg baby, desired serum Na 135, actual serum Na 128, peripheral
line: Dose of Na (mmol) = 1 x 0.6 x 7 = 4.2mmol (÷3.4mL) = 1.24mL
of 20% NaCl
48mL syringe contain 8.4mOsmol (NaCl) plus 46.76mL diluent
Using WFI: 8.4+0 = 8.4mOsmol/48mL (5%D preferred)
Using 5%D: 8.4+(46.76 x 0.278) = 21.4mOsmol/48mL
Supplied as : 1] Pharmacy prepare a 20% NaCl solution
(1mL = 3.4mmol) every Friday
2] Ampoule: 20% Sodium Chloride (2g in 10 mL)
1 mL = 3.4 mmol NaCl
Dilution : 1] Oral: Into feed
2] Intravenous: Consider total osmolality of solution
Central line: Draw up (the required mmol dose of sodium divided by
3.4)mL of 20% sodium chloride and transfer to a 25mL syringe. Further
dilute to 24 mL with or WFI, 5% or 10% dextrose. Run the solution at 1
mL/hr. Solution may be more concentrated in fluid restricted ELBW
infants with central access
Peripheral IV: Calculate the osmolality of solution before making
syringe. Aim for 14.4 -43.2Osmol in 48mL i.e. 300-900mOsmol/L
Draw up (the required mmol dose of sodium divided by 3.4)mL of 20%
sodium chloride and transfer to a 50mL syringe. Further dilute to 48 mL
with WFI or 5% Dextrose. Run the solution at 2 ml/hr
Stability : 1. Discard according to expiration date on label
2.Discard according to expiration date on ampoule
Storage : 1. Refrigerate
2. Store at room at room temperature
Discard any unused portion of ampoule
Compatibility : Water for injection, 5% dextrose, 10% dextrose
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Serum Levels : Dictated by serum sodium levels
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Sotalol
Revision Date : 28 May 2012 Approved: AK, JD
Indication : Sotalol is a beta blocker used for prevention and treatment of

supraventricular and ventricular arrhythmias
Dose : IV: 0.5-1.5 mg/kg/dose
Oral: 2-5mg/kg/day in 2 divided doses – increasing to
maximum of 12 mg/kg/day. Doses above 5mg/kg/day are best
given in three divided doses.
Interval : IV: 6/24
Oral: 12/24 for doses up to 5mg/kg/day, and 8/24 for doses
between 5-12mg/kg/day.
Route : IV.
Total Daily Dose : IV maximum daily dose: 6mg/kg/day

Oral maximum daily dose: 12mg/kg/day
Comments : Continuous ECG monitoring during acute phase of treatment of
SVT. Can have proarrhythmic effects (in 10% of patients),
sinoatrial block, A-V block, torsades de pointes, ventricular
ectopic activity, prolonged QT interval. Dose may need
adjustment with reduced renal function. May mask
hypoglycaemia, hyperthyroidism. Do not give with other
medications that may prolong QT interval, e.g. erythromycin,
fluconazole, chloral hydrate.
Oral doses: administer 30 minutes prior to feed to improve
absorption.
Supplied as : 40 mg/4 ml vial
Pharmacy will prepare a 5mg/mL suspension during normal
hours. For oral doses after hours, crush an 80mg tablet and
make up to 16mL with Water for Injection to make 5mg/mL.
Discard unused portion.
Dilution : IV: Dilute 1mL from vial with 9 mL of Normal Saline (to make
a 1mg/mL solution). Administer prescribed dose over 10
minutes.
Stability : Vials – room temperature
Suspension – room temperature
Storage :
Compatibility: 0.9% NaCl, 5% Dextrose
Incompatibility :
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Canberra Hospital
Spironolactone
Indication : Diuretic therapy. Used in treatment of cardiac failure and

chronic lung disease.
Dose : 1 mg/kg.
Route : Oral.
Total Daily Dose : 2 mg/kg/day.
Comments : Potassium sparing diuretic, usually used in combination

with frusemide or chlorthiazide. In infants with CLD on
diuretic therapy, potassium loss best treated with KCl
replacement rather than spironolactone, which causes
significant hypochloraemia.
Shake suspension well before use.
Supplied as : During pharmacy working hours a suspension can be
prepared. After hours, spironolactone 25mg tablets are kept
as ward stock.
Dilution : Not required for suspension.
Disperse one 25mg tablet in 10mL water for injection to
make a 2.5mg/mL solution. Discard any unused solution
immediately after use.
Stability : Suspension: 30 days
Tablets: see manufacturers expiry date on label.
Storage : Suspension: keep in refrigerator.
Tablets: room temperature.
Incompatibility : Nil.
Serum Levels : Monitor serum K+, Cl-
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Canberra Hospital
Streptokinase
Indication : Arterial thrombosis after arterial catheterisation or

complications of polycythemia.
Dose : Loading dose: 1000 u/kg.

Maintenance: 1000 u/kg/hr.
Route : I.V.
Total Daily Dose : Not exceeding 25,000 u/kg.
Comments : Recognised therapy as an alternative to thrombectomy.

Main complication is haemorrhage from administration site.
Use only when fibrinogen concentration is > 1.5 g/l. Check
level every 2 hours and discontinue if fibrinogen
concentration falls below 1.0 g/l. Restart as level rises
again. Increase infusion rate by 500 u/kg/hour at four
hourly intervals. Discontinue as level of fibrinogen remains
low and follow with heparin infusion 25 u/kg/hour for 48
hours.
Supplied as : Streptase 250,000 units/ampoule.
Dilution : Dilute in 20 ml NS and then further dilute with haemaccel

to a solution suitable for 6 hours infusion.
Stability : 6 hours after reconstitution.
Incompatibility : Usual precautions apply.
Serum Levels : Measure fibrinogen levels for effective management. For

severe overdose use EACA.
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Sucrose
Indication: Oral sucrose can be administered to infants under 3 months of

age who are undergoing painful procedures, who are exhibiting
signs of discomfort that does not respond to breastfeeding or
other nursing interventions and for whom parental verbal
consent is obtained.
Dose: 0.25 mL
Interval: First dose is given 2 minutes prior to the procedure, then the
same dose can be administered, if required, every 2 minutes up
to a total of 1 mL. This 1 mL dose can be given no more than 3
times in a 24-hour period.
Route: Orally, either onto the anterior portion of the tongue, or
administered on a dummy.
Total Daily Dose: 3 mL
Comments: Sucrose should not be administered to infants with known

fructose or sucrose intolerance. It is ineffective if given via a
nasogastric tube. Sucrose is ineffective when given to infants of
mothers who were methadone dependent whilst pregnant.
Painful procedures include: venipuncture, heel lancing, eye
checks, IM injections, nasogastric or orogastric tube insertion,
arterial puncture, percutaneous catheter insertion, lumbar
puncture (in addition to local anaesthetic), catheter
insertion/bladder tap, dressing changes, post-op (in addition to
prescribed paracetamol). This is a nurse-initiated medication
and requires a prescription to be signed by a medical officer
within 24 hours of administration.
Supplied as : 25% sucrose
Dilution : Nil
Stability : According to expiry date on the bottle
Incompatibility : Nil
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Survanta: Beractant
Indication : Respiratory distress due to definite surfactant deficiency and

hyaline membrane disease. Surfactant deficiency also occurs in
pulmonary hypoplasia and congenital diaphragmatic hernia.
Dose : Survanta: 100 mg/kg/dose (4 ml/kg) maximum cumulative dose
of 400 mg/kg
Interval : Survanta: 6 hourly.
Route : Endotracheal tube.
Comments : Infants less than 28 weeks gestation are usually given prophylactic
surfactant at the time of birth, preferably before the institution of
the first mechanical breath. Infants > 28 weeks gestation are
administered surfactant if they require IMV or are on CPAP and 
40-50% oxygen with the diagnosis of HMD on CXR.
Given with a size 5 infant feeding tube directly down the ETT or
via the suction port of the Trach-care device.
Supplied as : Survanta (Beractant): 200 mg/8 ml.
Dilution : Survanta: Nil required.

Should be given by experienced person (Neonatologist) or under
supervision of Neonatologist. Ventilator settings may need
adjustment during administration. Beware of blockage of ETT. If
possible avoid suctioning for 2 hours post dose administration.
Stability : Single vial may be used for the same patient within 24 hours. Do
not warm whole vial. Draw up dose in syringe and warm,
refrigerate remaining preparation for next dose.
Storage : Survanta: Refrigerated.
Incompatibility : Do not mix with anything.
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Suxamethonium Chloride (Scoline)

Revision Date : 27 March 2014 Approved: TC, LZ, JD
Indication : Rapid onset, short acting muscle relaxation for intubation
Dose : 2 mg/kg. Give Atropine first
Interval : Stat, May repeat if necessary
Route : I.V.
Can be given I.M. if necessary (use 2.5 mg/kg)
Total Daily Dose :
Comments : Short acting competitive inhibitor of cholinergic receptors.

Complete muscle relaxation within 30 - 60 seconds,
persisting for 2 - 3 minutes, gradual spontaneous recovery
within 10 minutes. Approximately 10% of drug is excreted
unchanged in the urine
May cause profound bradycardia or asystole. Pretreat with
Atropine 10 microg/kg first. Duration of action is
prolonged in patients with low plasma pseudocholinesterase
concentration. Contraindicated if family history of
malignant hyperthermia, pseudocholinesterase deficiency,
or myopathies.
Supplied as : Ampules 100 mg/2 mL
Dilution : Add 2mL of solution (100mg/2mL ampoule) to 3mL of

D5W or N Saline
Makes 100mg/5mL = 2 mg/0.1mL
Dose = 2mg/kg = 0.1 mL/kg
Stability : Discard unused portion
Storage : Refrigerate 2 - 8oC. Do not freeze
Incompatibility : Do not mix with any other drugs
Serum Levels : Not Applicable
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Canberra Hospital
Teicoplanin
Indication : A glycopeptide antibiotic effective against MRSA.

Restricted to patients in whom vancomycin is
contraindicated.
Dose : Loading dose: 16 mg/kg
Maintenance dose: 8 mg/kg
Interval : Once daily
Begin maintenance dose 24 hours after loading dose
Route : IV infusion over 60 minutes
Total Daily Dose : Maintenance 8 mg/kg
Comments : Use with caution when patient is receiving concurrent

nephrotoxic drugs, due to potential for increased
nephrotoxicity and ototoxicity. Perform haematological,
renal and liver studies in patients on prolonged courses.
Dose may need adjustment in renal failure.
Supplied as : Vial containing 400 mg (400,000 IU) Teicoplanin for
reconstitution.
Dilution : Add 10 ml WFI slowly down the side wall of the vial of
Teicoplanin. Gently roll the vial between the palms until
dissolved. DO NOT SHAKE. If the solution foams, allow
to stand for 15 minutes for the foam to subside. Withdraw
gently 0.5 ml of solution and make up to 10 ml total volume
with NS (2mg/ml).
Stability : Vial for single use only. Discard any remaining portion.
Storage : Store powder vial at room temperature.
Compatibility: NS, 5%D, 4%Dextrose and N/5 saline.
Incompatibility : No information available.
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Theophylline
Indication : Recurrent apnoea and poor respiratory drive; weaning from

ventilation.
Dose : Loading dose: 4 mg/kg.

Maintenance: < 2 weeks: 2.0 mg/kg/dose.
>2 weeks: 4.0 mg/kg/dose.
Interval : Loading dose followed by maintenance dose 12 hours

afterwards. Dosage interval may be altered according to
maturity. Generally interval is 12 hourly.
Route : Oral.
Total Daily Dose : According to plasma levels and maturity.
Comments : Not usually given more frequently than 8 hourly. May

cause gastro-intestinal bleeding, hypotension, vomiting,
tachycardia, diuresis, tachypnoea, and convulsions. Omit
dose if HR > 180 bpm. Levels will increase with
concurrent administration of erythromycin. 80 mg
theophylline = 100mg aminophylline!
Supplied as : 100 ml bottle, 133.3 mg/25 ml = 5.3mg/ml.
Stability : Until expiry date.
Incompatibility : Not applicable.
Serum Levels : Greatest effect at levels > 70 micromol/ml (12.7

microg/ml). Need level > 40 micromol/ml (7 microg/ml)
for any effect and the risk of toxicity occurs at levels > 90
micromol/ml (51 microg/ml).
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Thyroxine
Indication : Hypothyroidism
Dose : 10-15 microg/kg/dose
Interval : daily
Route : orally
Total Daily Dose : Adjust according to TFT levels
Comments : Round doses off to nearest 12.5 microg (1/4 x 50 microg tablet). Some
babies may need to give alternating daily dose. For example of a baby
requires 20 microg/kg/day = 140 microg/week, give Mon/Wed/Fri 12.5
microg and the other 4 days give 25 microg = 137.5 microg/week. If a
baby needs 30 microg/day = 210 microg/week give 37.5 microg (3/4
tablet) Mon/Wed/Fri and 25 microg (1/2 tablet) the other 4 days = 212.5
microg/week.
Long plasma half-life 6-7 days in euthyroid, 9-10 days in hypothyroid,
and 3-4 days in hyperthyroid states. Slow onset of action, peak effect
occurs 3-4 weeks after initiating therapy. Effect of dosage adjustment is
thus very slow.
Supplied as : 50 microg tablet
Dilution : Crush required portion of tablet and administer.
Stability :
Compatibility:
Incompatibility :
Serum Levels : Aim to maintain serum thyroxine in the upper half of the
normal range and serum TSH in the normal range.
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Ticarcillin/clavulanic acid
Indication : Sepsis by pseudomonas, proteus, some strains of E. coli.

Dose : 50 mg/kg/dose of ticarcillin
Interval : Weight:
< 2000 gm & < 7 days 12 hourly
< 2000 gm & > 7 days 8 hourly
> 2000 gm & < 7 days 8 hourly
> 2000 gm & > 7 days 6 hourly
Route : IV
Total Daily Dose :
Comments : Similar to Carbenicillin. More active against Pseudomonas

than Carbenicillin. Usually administered with an
aminoglycoside for full therapeutic effect. Reduce dosage
in renal failure.
Supplied as : Timentin 3.1 g. Vials
(Ticarcillin 3g + Clavulanic acid 100mg)
Dilution : Dilute in 13 ml WFI. = 200mg/ml
Further dilution may be required. Administer over 30
minutes.
Usually made up by pharmacy.
Compatibility : No data available.
Incompatibility : Do not mix with aminoglycosides.
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Tobramycin
Indication : Aminoglycoside with activity against Pseudomonas.

Similar spectrum to gentamicin. Restricted to infections
caused by micro-organisms with documented resistance to
gentamicin.
Dose : < 30 weeks 2.5 mg/kg
30-35 weeks 3.5 mg/kg
> 35 weeks 5 mg/kg
Term > 1 week of age 7.5 mg/kg
Interval : < 26 weeks 36 hourly
> 26 weeks 24 hourly
Route : IV infusion.
I.M. acceptable if large infant.
Total Daily Dose : 2.5-7.5 mg/kg.
Comments : Nephrotoxicity more likely if used with other nephrotoxic

drugs. Toxicity more likely if therapy extends beyond 7
days, even if drug levels within normal range.
Supplied as : Tobramycin Sulphate 40 mg/ml 2 ml vials.
Dilution : Dilute to 1 mg/ml with NS by diluting 0.5 ml of solution

(20 mg) up to 20 ml of NS.
Storage : Some brands require room temperature others refrigerator.

Protect from light.
Compatibility : Compatible with 5%D, 10%D, NS, aciclovir, calcium
gluconate, insulin, metronidazole, morphine, TPN,
ranitidine, tolazoline, frusemide, midazolam.
Incompatibility : Ampicillin, Clindamycin, Heparin, Imipenem,
Indomethacin, Penicillin G, Ticarcillin.
Serum Levels : Trough 0.5 –1 microg/ml, taken just before the dose.
Peak 5- 12 microg/ml, taken 30 minutes after the end of
infusion.
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Ursodeoxycholic Acid (URSO)

Revision Date : 12 July 2012 Approved: AK, JD
Indication : A bile acid used to minimise cholestatic jaundice
Dose : 10-15 mg/kg/dose
Route : Oral
Total Daily Dose : 20-30 mg/kg/day
Comments : May cause diarrhoea, pruritus, hypersensitivity including

urticaria, increased cholestasis, nausea, vomiting, or sleep
disturbance. Continue to monitor bilirubin and liver function
tests to determine response to treatment
Supplied as : Ursofalk suspension 50 mg/ml
Dilution : Nil required

Stability : Discard 4 months after opening bottle.
Storage : Room temperature. Protect from light.
Compatibility:
Incompatibility :
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Canberra Hospital
Valproate
Indication : Anticonvulsant
Dose : 2.5 - 5mg/kg/dose increasing at weekly intervals up to

20mg/kg/dose
Interval : Every 12 hours
Route : Orally
Total Daily Dose :
Comments : The mechanism of action is attributed to dose dependent

enzyme inhibition of gamma-aminobutyric acid
transaminase (GABA-T) and consequent increased levels of
the inhibitory neurotransmitter, gamma-aminobutyric acid
(GABA). Best given after feeds. Levels may be lowered by
concurrent administration of phenytoin and carbamazepine.
Elimination is low in neonates, and comparatively high at
the end of the first post-natal month, correlating with bound
and unbound drug.
Supplied as : Mixture 40 mg/ml
Dilution :
Stability :
Compatibility:
Incompatibility :
Serum Levels : Trough level 300-700 micromol/L (x0.14=mg/L), take

immediately prior to a dose.
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Canberra Hospital
Vancomycin
Indication : MRSA and MRSE colonisation or sepsis, nosocomial or late neonatal infection.
This is a restricted ORANGE ANTIMICROBIAL and may be prescribed
without prior ID approval when used for the indications outlined in the AMS
SOP.
Dose : 15 mg/kg/dose.
Interval : CGA PostNatal Interval
(weeks) (days) (Hours)
≤29 0 - 14 18
>14 12
30-36 0 - 14 12
>14 8
37-44 0–7 12
>7 8
≥45 ALL 6
Adjust dosages according to levels. If therapeutic levels are
attained there is no need to increase the dosage when the weight
increases.
Route : I.V.
Total Daily Dose : 15 - 60 mg/kg/day according to age and bodyweight.
30 mg/kg/day for 24 hour infusion (reduce to 20 mg/kg/day if
Creat > 90 micromol/L)
Comments : Causes thrombophlebitis and tissue necrosis if extravasation occurs.
Febrile convulsions, anaphylaxis and eosinophilia have been reported.
Give infusion over 60 minutes to avoid Red Man syndrome.
Nephrotoxicity is enhanced when combined with aminoglycosides (eg.
gentamicin)
Supplied as : Vials 500 mg powder. Pharmacy will prepare 50mg/10mL syringes during
normal working hours.
Dilution : Reconstitute 500mg vial with 10mL WFI (500mg/10mL). Dilute
1mL (50 mg) of this solution to a total volume of 10mL with NS
(5 mg/mL)
Stability : Discard vials after single use
Prepared syringes – expiry date on label
Storage : Vials: Room temperature, refrigerate after reconstitution.
Prepared syringes: Refrigerator
Compatibility : TPN, Amikacin, Calcium gluconate, Fluconazole, Hydrocortisone, Insulin,
Meropenem, Midazolam, Morphine, Tolazoline, Vecuronium 10% D,
Aciclovir, Ampicillin, Ranitidine.
Incompatibility : Cefotaxime, Dexamethasone, Heparin, Phenobarbitone, Benzylpenicillin
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Serum Levels : Trough levels should be taken immediately prior to the dose at the
48 hour point. Do not withhold doses whilst waiting for levels to be
reported. Levels to be maintained between 10-20 mg/L for non-CNS
infections and 15-25 mg/L for CNS infections. Trough levels for 24
hour infusions should be maintained between 15-30 mg/L. Adjust
dosages to achieve adequate levels, above the total daily doses
recommended above, if required.
Once therapeutic levels are attained there is no need to increase the
dosage when body weight increases.
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Canberra Hospital
Vecuronium
Indication : A curariform non-depolarising neuromuscular blocking

agent for complete paralysis during artificial ventilation.
Dose : Initial dose 0.1 mg/kg (100 microg/kg),

Subsequent doses 0.03- 0.15 mg/kg
0.05 – 0.1 mg/kg/hr as infusion
Route : I.V.
infusion
Comments : A shorter acting agent than pancuronium but with similar
properties. Vagal and ganglion blocking activity minimal
and less histamine release. Cardiovascular side effects are
thus less marked. Hypotension may be a problem and
counteraction by volume loading may be necessary.
Reports of excessively prolonged action in neonates
reported (i.e. > 1-2 days). Some form of eye lubrication is
necessary in infants paralysed with vecuronium.
Action reversed by neostigmine.
Effect increased by aminoglycosides and other antibiotics,
diuretics, -blocking agents, verapamil. Effect decreased
by steroids, theophylline, anticholinesterases.
Supplied as : Powder for reconstitution 4 mg and 10 mg vial.
Dilution : The 4 mg ampoule is reconstituted with 1 ml WFI, the 10

mg vial with 5 ml WFI. Each solution should be further
diluted with NS to make a 1 mg/ml solution.
Multiply weight of baby (kg) x 2.5 ml (of the 1 mg/ml
solution) and further dilute to a total volume of 25 ml with
either NS or 5%D 1 ml/hr = 0.1 mg/kg/hr. Start at 0.5 ml/hr
= 0.05 mg/kg/hr.
Stability : For single use only. Discard any unused portion.
Compatibility : NS, 5%D, Adrenaline, Aminophylline, Dobutamine,

Dopamine, Fentanyl, Fluconazole, Gentamicin, Heparin,
Hydrocortisone, Midazolam, Morphine, Noradrenaline,
Ranitidine, Vancomycin.
Incompatibility : Do not mix with other drugs. Frusemide.
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Serum Levels :
Vigabatrin
Indication : Neonatal convulsions that are not satisfactorily controlled

by other anticonvulsants.
Dose : 20 mg/kg/dose
Increase to 40-80/mg/kg/dose if necessary
Route : Oral
Total Daily Dose : Max 80mg/kg/day
Comments : Mechanism of action is attributed to dose dependent

enzyme inhibition of GABA transaminase and consequent
increased levels of the inhibitory neurotransmitter GABA.
May cause drowsiness. Observe for unwanted, adverse
neurological effects.
Supplied as : Vigabatrin 500mg sachets (Sabril)
Dilution : Dissolve contents of sachet in 10 ml WFI to give a clear

solution 50mg/ml
Stability : Discard after 24 hours
Incompatibility : Decreases phenytoin levels by 20%. The clinical

significance of this is not known. Plasma concentrations of
carbamazepine, sodium valproate, phenobarbitone do not
appear to be affected.
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Canberra Hospital
Vitamin A (Retinol)
Indication : Prevention or amelioration of BPD or Chronic Lung

Disease.
Dose : < 1000 gm: 2000 units.

1000 - 1500 gm: 3000 units
Interval : Alternate days.
Route : Oral.
Total Daily Dose :
Comments : Vitamin A is associated with BPD through its role as a

mediator of epithelial cell differentiation. Deficiency states
are characterised by squamous metaplasia of the tracheo-
bronchial epithelium similar to those found in BPD. High
doses of Vitamin A are toxic.
Supplied as : Vitamin A - Bioglan Micelle A.
Dilution : Nil.
Stability : As advised by pharmacy and as per bottle labelling.
Incompatibility :
Serum Levels : 30 - 60 microg/dL, Levels > 80 microg/dL are toxic.
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Canberra Hospital
Vitamin E (Alpha-Tocopherol)
Indication : An antioxidant used in the prevention or amelioration of

oxygen toxicity or oxygen free radical damage. May be
administered in treatment of Vitamin E deficient anaemia.
Dose : 5 mg.
Interval : Daily.
Route : Oral.
Total Daily Dose : 5 mg.
Comments : Efficacy has been debated. Suggested value has been in the
prevention of BPD, reduction in the severity of IVH and of
ROP, and the prevention of anaemia of prematurity.
Toxicity results in inhibition of prostaglandin synthesis in
platelets, decreased platelet aggregation, increased
haemorrhagic tendency in Vitamin K deficiency,
creatinuria. High dose intravenous use has resulted in liver
necrosis and death. Trials have shown an increased rate of
sepsis and death.
Supplied as : Solution 100 mg/ml.
Dilution : Nil.
Stability : One month.
Incompatibility : Do not give with Iron.
Serum Levels : < 4 mg/dL.
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Canberra Hospital
Vitamin K
Indication : Prevention of Haemorrhagic Disease of the Newborn

(prophylaxis) or as treatment for established vitamin K
deficiency.
Dose : 1 mg IM or IV (0.1ml)
< 1500 grams: 0.5 mg IM (0.05ml)
Prophylaxis for maternal anticonvulsant therapy: parenteral 1 mg.
Therapeutic: 1 mg parenterally.
Interval : Parenteral prophylaxis at birth.
.
Route : I.M. (preferred), I.V. Generally given IM on the right thigh soon
after birth.
Total Daily Dose:
Comments : Routine administration is essential.
Supplied as : Konakion, Vitamin K1, 2.0 mg in 0.2 ml.
Dilution : Nil
Stability : Use immediately.
Storage : Room temperature, shield from light.
Compatibility : Adrenaline, Amikacin, Ampicillin, Dobutamine, Heparin,

Hydrocortisone, Ranitidine, Sodium bicarbonate, Tolazoline.
Incompatibility : Phenytoin.
199
Canberra Hospital
Zidovudine
Revision Date : 28 January 2015 DTC approved: March 2015
Indication : Reduce risk of transmission of HIV in the Perinatal period.

Use in conjunction with other antiretroviral therapy if maternal
viral load is >50 copies/mL at time of delivery – consult the HIV
in Pregnancy SOP
Dose : Antiretroviral therapy should be commenced immediately after
delivery and be continued for 4 weeks.
> 35 weeks: PO: 4mg/kg/dose every 12 hours for 4 weeks

IV: 1.5mg/kg/dose every 6 hours. 1
30 – 34 weeks: PO: 2mg/kg/dose every 12 hours for 2 weeks, then

increase
2mg/kg/dose every 8 hours for 2 weeks
IV:1.5mg/kg/dose every 12 hours for 2 weeks,
then increase
1.5mg/kg/dose every 8 hours for 2 weeks. 1,2
< 30 weeks: PO: 2mg/kg/dose every 12 hours for 4 weeks

IV: 1.5mg/kg/dose every 12 hours. 1,2
Change over to oral regimen when infant is able to tolerate oral

medication, to complete 4 week course.
Interval : As above
Route : PO:
IV: one hour infusion (for infants unable to tolerate oral dosing)
Comments : Generally well tolerated. Haematological side effects include

anaemia and leucopenia. Avoid in patients with low neutrophils
(<0.75x109/L) or low haemoglobin (<75g/L).2
If infant vomits within 20 minutes of an oral dose, repeat the dose.
Prepacks of Syrup and Ampoules are kept in Delivery Suite for
emergency use and should accompany baby after birth. Pharmacy
must be notified to replace stock when used. Intravenous
zidovudine is available under the SAS scheme – an SAS Category
A form must be completed and returned to pharmacy for every
patient requiring IV vials
Supplied as : Oral syrup: 10mg/mL.3
IV vials: 200mg/20mL.4
200
Canberra Hospital
Dilution : IV: MUST be diluted with sodium chloride 0.9% or glucose 5%
to a maximum concentration of 4mg/mL prior to infusion. 4
Withdraw 40mg (4mL) of zidovudine and add to 16mL of diluent
fluid (makes 2mg/mL). For fluid restricted pts, add 40mg (4mL)
of zidovudine to 6mL of diluent fluid (makes 4mg/mL)
Infuse required dose over one hour
Stability : IV ampoules - use once only and discard any residue.
Where practical, the Pharmacy IV room will prepare IV doses in
syringes.
Storage : Oral solution – Room temperature, protect from light
IV vials - Room temperature, protect from light
Compatibility : glucose 5%, sodium chloride 0.9%, aciclovir, amifostine,
amikacin, anidulafungin, aztreonam, ceftazidime, ceftriaxone,
cisatracurium, clindamycin, dexamethasone, dobutamine,
dopamine, doripenem, erythromycin, filgrastim, fluconazole,
gentamicin, granisetron, heparin sodium, imipenem-cilastatin,
linezolid, lorazepam, metoclopramide, morphine sulfate,
oxytocin, pentamidine, phenylephrine, piperacillin-tazobactam
(EDTA-free), potassium chloride, ranitidine, remifentanil,
tobramycin, trimethoprim-sulfamethoxazole, vancomycin 4,5
Incompatibility : Blood products, albumin, meropenem. 4,5
References
1. British HIV Association. Guidelines for the management of HIV in pregnant

women 2012 (2014 interim review)
http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/BHIVA-
Pregnancy-guidelines-update-2014.pdf
2. Capparelli EV, Mirochnick M, Dankner WM et al: Pharmacokinetics and
tolerance of zidovudine in preterm infants. J Pediatr Jan, 2003; 142(1): 47-52.
3. MIMS Australia, 2014. MIMS Online Retrovir® (zidovudine) Syrup Product
Information. [Online]. Available at:
https://www.mimsonline.com.au/Search/Search.aspx (Accessed: 5 December
2014)
4. Nicolette Burridge, Natalie Collard, Keli Symons. Australian Injectable drugs
handbook, 6th Edition (electronic version). SHPA publications reference
group, Collingwood, VIC. Available at:
http://aidh.hcn.com.au/browse/z/zidovudine (Accessed: 5 December 2014)
5. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland:
American Society of Health System Pharmacists; 2013.
201
Canberra Hospital
Zoster Immunoglobulin
Indication : Prevention of Varicella infection in babies or young infants

with family contacts recently developing chicken pox or
shingles. For babies of mothers who have developed
chicken pox from 7 days prior to 7 days after delivery.
Dose : 125 IU
Interval : Once only, but the dose may be repeated if a second

exposure occurs more than 3 weeks after the first dose.
Route : I.M.
Total Daily Dose :
Comments : Not useful in the management of established infection. ZIG

must be given as early as possible in the incubation period –
within 96 hours of exposure if possible.
Supplied as : ZIG - CSL. Available from blood bank.
Dilution : Nil.
Stability :
Storage : Refrigerate at 2 - 8oC. Do not freeze. Protect from light.
Incompatibility :
Serum Levels :
202
Canberra Hospital
References:
1. Kemp CA, McDowell JM editors Paediatric Pharmacopoeia. 13th Edition.

Melbourne: Pharmacy Department, Royal Children’s Hospital, 2002.
2. Pagliaro LA, Pagliaro AM editors. 2nd Edition. Illinois: Problems in Paediatric
Drug Therapy. 1987.
3. Johnson KB. The Harnet Lane Handbook. 13th Edition. St Louis, Mosby Year
Book, Inc. 1993.
4. Young TE, Mangum B. Neofax 13th Edition. Raleigh, Nth Carolina, Acorn
Publishing USA. 2000.
5. Trissel LA. Handbook on injectable drugs. 11th Edition. Bethesda, American
Society of Health-System Pharmacists. 2001.
6. Aminophylline product information, Mulgrave, Victoria. FH Faulding and CO Ltd
(Trading as David Bull Laboratories). TGA Approval 19 May 1998. Date of most
recent amendment 21 August 2000.
7. Therapeutic Guidelines: Antibiotics. 11th Edition. Melbourne. Therapeutic
Guidelines Ltd. 2000.
8. Morris N. Australian injectable drugs handbook. 2nd Edition. South Melbourne,
Society of Hospital Pharmacists of Australia. 1999.
9. Australian Technical Advisory Group on Immunisation. The Australian
Immunisation Handbook. 7th Edition. Canberra, Australian Government
Publishing Service. 2000.
10. Carlton JB. The handbook of parenteral drug administration. 4th Edition.
Shepparton, Victoria. 1997.
11. http://www.health.gov.au/internet/immunise/publishing.nsf/content/F11B0C092A
C5A5D3CA25719D00183398/$File/nip-schedule-card-july07.pdf
12. http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips
13. Royal Hospital for Women Neonatal Drug Protocol Manual, 2012.
14. http://www.kemh.health.wa.gov.au/services/nccu/guidelines/drug_protocols.htm
15. Flippin Blood, Second edition June 2012 Quick reference guide
16. Blood and Blood Product Administration SOP Issued September 2012
17. Massive Transfusion SOP Issued September 2012
18. Weiss, A.L. Et al (2013). Septic Shock: Ongoing management after resuscitation
in Children. Up To Date.
19. Silvergleid, A. Et al (2013). Clinical use of plasma components. UpToDate
203

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Neonatal Intensive Care Drug Manual

DRUG NAME ......................................................................................................................................... 8

ACETYLCYSTEINE (INHALATION THERAPY) ........................................................................... 9

ACETYLCYSTEINE (MUCOMYST) ............................................................................................... 10

ADRENALINE (RESUSCITATION) ................................................................................................. 13

ADRENALINE (INFUSION, INHALATION) .................................................................................. 14

AMPHOTERICIN B (LIPID COMPLEX) ........................................................................................ 19

BUCCAL GLUCOSE GEL 40%......................................................................................................... 25

CAFFEINE BASE ................................................................................................................................ 27

CALCIUM GLUCONATE .................................................................................................................. 29

CALCIUM CARBONATE SUSPENSION ........................................................................................ 30

CEFTAZIDIME PENTHYDRATE .................................................................................................... 34

CHLORAL HYDRATE ....................................................................................................................... 37

CLINOLEIC LIPID EMULSION ....................................................................................................... 40

CUROSURF: PORACTANT ALFA ................................................................................................... 45

CYCLOPENTOLATE HYDROCHLORIDE EYE DROPS (0.25%) .............................................. 47

FERROUS SULFATE (FERRO-LIQUID) ........................................................................................ 61

FLUTICASONE (FLIXOTIDE) ......................................................................................................... 67

FOLIC ACID ........................................................................................................................................ 68

GAVISCON (ALGINIC ACID) .......................................................................................................... 72

G-CSF (GRANULOCYTE-COLONY STIMULATING FACTOR................................................. 73

HEPARIN CVC LOCK ....................................................................................................................... 78

HEPATITIS B IMMUNOGLOBULIN .............................................................................................. 79

HEPATITIS B VACCINE ................................................................................................................... 80

IMMUNOGLOBULIN IV (INTRAGRAM®P): DRAFT .................................................................. 90

INSULIN (ACTRAPID – FOR HYPERGLYCAEMIA)................................................................... 97

INSULIN (FOR HYPERKALAEMIA) .............................................................................................. 98

IPRATROPIUM BROMIDE............................................................................................................. 100

ISOPRENALINE ................................................................................................................................ 101

ISOVUE ............................................................................................................................................... 102

LABETALOL ..................................................................................................................................... 104

LACTULOSE ..................................................................................................................................... 105

LEVETIRACETAM (KEPPRA)....................................................................................................... 106

LIGNOCAINE FOR LOCAL ANAESTHETIC, CARDIAC ARRHYTHMIA ............................ 109

MAGNESIUM SULPHATE .............................................................................................................. 110

MAGNESIUM ASPARTATE ........................................................................................................... 112

MEROPENEM ................................................................................................................................... 113

METOCLOPRAMIDE ...................................................................................................................... 114

METOPROLOL ................................................................................................................................. 115

METRONIDAZOLE .......................................................................................................................... 116

MICONAZOLE (TOPICAL GEL) ................................................................................................... 118

MIDAZOLAM .................................................................................................................................... 119

MILRINONE ...................................................................................................................................... 120

MORPHINE IV .................................................................................................................................. 121

MORPHINE ORAL ........................................................................................................................... 122

MYLANTA ......................................................................................................................................... 123

NALOXONE ....................................................................................................................................... 124

NEOSTIGMINE ................................................................................................................................. 126

NORADRENALINE .......................................................................................................................... 128

NYSTATIN (ORAL) .......................................................................................................................... 129

NYSTATIN (TOPICAL) .................................................................................................................... 130

OCTREOTIDE ................................................................................................................................... 131

OMEGAVEN 10% LIPID EMULSION........................................................................................... 132

OMEPRAZOLE ................................................................................................................................. 134

PANCREATIC ENZYMES/CREON................................................................................................ 136

PANCURONIUM ............................................................................................................................... 137

PANTOPRAZOLE ............................................................................................................................. 139

PARACETAMOL (DRAFT) ............................................................................................................. 140

PENICILLIN, BENZYL (PENICILLIN G) ..................................................................................... 143

PENTAVITE (MULTIVITAMIN PREP) ........................................................................................ 145

PHENYLEPHRINE HYDROCHLORIDE EYE DROPS (2.5%) .................................................. 148

PHENYTOIN ...................................................................................................................................... 149

PHOSPHATE SUPPLEMENT ......................................................................................................... 151