NEONATAL DRUG FORMULARY

DRUG PRESENTAT DOSE PREPARATION ADMINISTRATIO ADVERSE NURSING

ION N EFFECT CONSIDERATIONS

AMIKACIN Vial: PMA ≤29 wks. DILUENT: Intravenous:  Hearing  Use diluted
500mg/2ml  Water for IV infusion via loss amikacin
250mg/ml 0 -7 days= injection syringe pump  Reduced within 24
18mg/kg Q48hrs  NSS 0.9% over 30 to 60 renal hours
Saline minutes. function  Store in
8-28 days=  D5W  Renal fridge
15/mg/kg Q36hrs Intramuscular Failure  Flush the
Draw up 0.4ml cannula
≥29= (100mg) from vial before and
15mg/kg Q24hrs after infusion
Add 19.6ml of with 0.5ml to
diluent to make a 1ml NSS
total of 20ml

Total amount =
100mg in 20ml

Final Concentration
= 5mg/ml
Aminophylline Vial: 250mg Loading dose: Diluent: Intravenous  Tachyca Use
in 10ml = 8 mg/kg IV infusion over • Water for rdia Aminophylline
25mg/ml 30 minutes. injection  Feeding within 24 hours
• 0.9% Sodium intolera of diluting
Maintenance dose: Chloride (NS) nce Flush the cannula
1.5 to 3 mg/kg/dose • 5% Dextrose (D5)  Jittery before and after
orally, or IV slow push  Seizures with 0.5ml -1ml of
every 8 to 12 hours (start Draw up 2ml NS
maintenance dose 8 to 12 Aminophylline
hours after the loading (50mg)
dose). Add 8ml to make a
total of 10ml

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 Total amount =
50mg in 10ml
Final concentration
= 5mg/ml
Amphotericin B Vial: 50mg 1 to 1.5 mg/kg every 24 Diluent: Intravenous  Hypokal  Monitor CBC,
hours IV infusion over 2 to emia electrolytes,
6 hours.  D5Water  Transien urine output,
 Sterile water for t BUN, and
Dosage modification for injection increase serum
renal dysfunction is only in creatinine at
necessary if serum Reconstitute with 10 Creatini least every
creatinine increases mL of D5W or ne other day.
greater than 0.4 mg/dL preservative free  Nephrot  Observe IV
from baseline during sterile water to a oxicity site for
therapy -hold dose for 2 concentration of 5 irritation--
to 5 days. mg/mL, then dilute phlebitis is
further using D5W to common.
Alternate-day dosing a concentration no  Reconstituted
recommended over greater than 0.1 solution
decreasing daily dose in mg/mL for infusion. stable for 24
patients experiencing hours at
renal toxicity . room
temperature
or 7 days in
refrigerator
 Do not flush
IV or mix
amphotericin
with saline
solution;
precipitation
will occur.
 May filter if
necessary;
mean pore
diameter
should not be

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 less than 1
micron.
 Protect from
light. Cover
soluset and IV
tubings.
Ampicillin Vial: 500mg 25 to 50mg/kg/dose Diluent: Intravenous (IV)  CNS  Incompatible
powder for • Water for Intramuscular Excitatio with D10%
injection injection (IM) n for water. Do not
Vial: • 0.9% sodium very flush in the IV
1000mg chloride (NS) large tubing with
(1g) powder • 10% or 5% dose D10W.
for injection Dextrose (D5 or  Prolong  Use within 2
D10) ed hours of
bleeding mixing
If using 500mg vial: time  Flush the
Add 5ml cannula
Final concentration before and
= 100mg/ml after with
If using 1000mg vial: 0.5ml -1ml of
Add 10ml NS, especially
Final concentration between
= 100mg/ml Ampicillin
and
Gentamicin
 Do not mix in
the same
syringe as
Gentamicin
as this can
cause
inactivation
of both drugs

Benzylpenicillin Vial: 600mg 25mg/kg/dose Diluent: Intravenous:  Rashes  Use within 1

(Pen G) powder for • Water for over 3 minutes  Angioede hour of
injection 50mg/kg/dose for injection ma mixing

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 meningitis or severe • 5% Dextrose (D5)  Anaphyla  Do not mix
infection • 0.9% sodium xis with other
chloride (NS) drugs
 Flush the
Frequency: Add 5.6ml cannula
Overall amount = before and
>7 days = Q12 600mg in 6ml after with
7 to 28 days = Q8 Final concentration 0.5ml -1ml of
= 100mg/ml NS
Beractant Vial: 4 mL/kg/dose Before Intratracheal  Transient  Inspect
(Survanta) 25mg/ml intratracheally, divided administration, decreased Survanta for
SURFACTANT single use into 4 aliquots (syringes). allow to stand at in oxygen discoloration
vial room temperature saturation ; normal
Prophylaxis: for 20 minutes, or  Transient color is off-
First dose is given as soon warm in the hand episodes white to
as possible after birth, for at least 8 of light-brown.
with up to three minutes. Artificial bradycard If settling
additional doses in the warming methods ia occurs during
first 48 hours of life, if should not be used storage, swirl
indicated. vial gently.
Do not filter
Rescue treatment of RDS: or shake the
Up to four doses in first 48 vial.
hours of life, no more  Refrigerate
frequently than every 6 at 2 to 8
hours degrees C
(36 to 46
degrees F)
and protect
from light.
 Vials should
be entered
only once.
Used vials
with residual
drug should
be discarded.

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  Unopened
vials that
have been
warmed to
room
temperature
one time
may be
refrigerated
within 24
hours and
stored for
future use.
Should not
be warmed
and returned
to the
refrigerator
more than
once
 After
administratio
n of each
quarter-
dose, the
dosing
catheter is
removed
from the ET
tube and the
infant is
ventilated for
at least 30
seconds until
stable


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 Caffeine Citrate Ampule: Loading dose: Solution Intravenous  Restlessn
20mg/ml 20 to 25 mg/kg of caffeine compatibility ess
10mg/ml citrate IV over 30 minutes  D5W  Vomiting
or orally. (Equivalent to 10  D50W
to 12.5 mg/kg caffeine  Sterile water for
base). injection

Maintenance dose:
5 to 10 mg/kg per dose of
caffeine citrate IV slow
push or orally every 24
hours. (Equivalent to 2.5
to 5 mg/kg caffeine base).

Maintenance dose should

be started 24 hours after
the loading dose.
Calcium Polyethylen For acute treatment of Solution Continuous  Rapid  Administer
Gluconate 10% e ampules neonatal hypocalcemia: Compatibility: Intravenous administr into a large
with twist 100 to 200 mg/kg/dose Infusion ation is vein through
off cap (1 to 2ml/kg/dose = 10 to  D5Water associate a small
20 mg/kg elemental  D10Water IV bolus: d with needle to
Calcium calcium)  NSS Administer vasodilati avoid
gluconate slowly as bolus, on, hypercalcemi
10% Maintenance treatment: about 1.5 mL hypotensi a,
injection 200 to 800 mg/kg/day over 1 minute, on, extravasation
yields 9.3 (2 to 8 ml/kg/day = 20 to do not exceed bradycard , and necrosis
mg/mL 80 mg/kg elemental 200 mg/min as ia,  Not to be
elemental calcium) an intermittent syncope, administered
calcium infusion or cardiac as IM or
(0.46 Exchange Transfusion: continuous arrhythmi SubQ.
mEq/mL). 100mg per 100 ml infusion as, and  Coadministra
Osmolarity citrated blood exchanged cardiac tion of
is 700 (1ml per 100 ml blood Administer by arrest ceftriaxone
mOsm/L. exchanged) slow IV push for sodium
cardiac arrest; injection with
infuse over 30 to calcium-

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 60 minutes for containing IV
other indications solutions
(including
continuous
calcium-
containing
infusions
such as
parenteral
nutrition) is
also
contraindicat
ed due to the
risk of
precipitation
of
ceftriaxone-
calcium
 Do not give
in arterial
line.
Calfactant Vial: 6ml Initial dose: 3 mL/kg Intratracheally  Transient  Same with
(Infasurf) intratracheally; may be episodes Beractant
Surfactant repeated if needed every of reflux  Refrigerate at
12 hours up to a total of 3 of 2 to 8
doses. surfactant degrees C (36
into the to 46 degrees
For prophylactic therapy endotrach F) and
in premature infants less eal tube, protect from
than 29 weeks of cyanosis, light.
gestational age at bradycard  Inspect
significant risk for ia, and Infasurf® for
respiratory distress airway discoloration;
syndrome, Infasurf should obstructio normal color
be given as soon as n have is off-white,
possible, preferably within been and visible
30 minutes after birth. reported flecks and

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 during foaming at
administr the surface
ation are normal.
 A higher  Suspension
rate of settles during
intraventr storage;
icular gently swirl
hemorrha vial in order
ge and to uniformly
periventri suspend. Do
cular not shake
leukomala  Used vials
cia was with residual
observed drug should
in be discarded
Infasurf®-  Unopened
treated vials that
infants have been
warmed to
room
temperature
one time may
be
refrigerated
within 24
hours and
stored for
future use
 Should not
be warmed
and returned
to the
refrigerator
more than
once
Cefazolin Vial: 500mg 25mg/kg/dose Diluent: Intravenous  Phlebitis  Reconstitute
and 1 gram  Sterile water for May be given IV  eosinophil d solution

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 injection direct bolus ia stable for 24
 D5Water injection slowly hours at
 D10Water over 3 to 5 room
 NSS minutes at a temperature
concentration of or 10 days in
Reconstitute 500- 100mg/ml or refrigerator
mg vial using 2 mL infusion.
of sterile water for
injection to a For IV infusion,
concentration of dilute
225 mg/mL. reconstituted
solution to a
Reconstitute 1000- concentration of
mg vial using 3 mL 5 to 20 mg/ml
of sterile water for and infuse over
injection to a 10 to 60 minutes
concentration of
330 mg/mL.

For bolus injection, Intramuscular

further dilute
reconstituted vial For IM injection,
with approximately use a
5 mL of sterile concentration of
water. 225 mg/ml

For intermittent or
continuous infusion,
further dilute
reconstituted drug
to a concentration
of 5 to 20 mg/mL in
compatible solution

Ceftazidime Vial: 30 mg/kg/dose Diluent: Intravenous  Rash  To reduce

500mg  Sterile water for  Diarrhea pain at IM
1 gram injection IV infusion by  Elevated injection site,

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 2 gram  D5Water syringe pump hepatic ceftazidime
6 gram  D10Water over 30 minutes transamin may be
 NSS ases mixed with
Intramuscular  Eosinophil 1% lidocaine
Intravenous ia without
solution:  (+) epinephrine.
Reconstitute 500- Coomb’s  Reconstitute
mg vial with 10 mL test d solution
of sterile water for stable for 12
injection to make a hours at
concentration of 50 room
mg/mL. temperature,
3 days
Intramuscular refrigerated.
solution: Prepared
by reconstituting
500-mg vial with 2.2
mL of 1% lidocaine
without epinephrine
or Sterile Water to a
concentration of
200 mg/mL.
Ceftriaxone Vial: Sepsis: 50 mg/kg IV every Diluent: Intravenous:  Eosinophil  Not
24 hours.  Sterile water for Infusion by ia, recommende
250 mg injection syringe pump  thromboc d for use in
500 mg Meningitis: 100 mg/kg IV  D5Water over 30 minutes. ytosis, neonates
1 gram loading dose, then 80  D10Water Avoid  leukopeni with
2 grams mg/kg IV every 24 hours.  NSS administration of a. hyperbilirubi
calcium-  Increase nemia.
Intravenous containing in Displaces
solution: solutions or bleeding bilirubin from
products within time. albumin
Prepared by 48 hours of the  Diarrhea. binding sites,
reconstituting last  Increase resulting in
powder with administration of in BUN higher free
compatible solution ceftriaxone and bilirubin
(sterile water for serum serum

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 injection, D5W, or Intramuscular: creatinin concentratio
D10W) to a To reduce pain at  Increase ns.
concentration of the injection site, in AST  Concurrent
100 mg/mL. To reconstitute with and ALT. administratio
make 40-mg/mL 1% lidocaine  Skin rash. n of
solution add 6.2 mL without  Transient ceftriaxone
to the 250-mg vial. epinephrine to a gallbladde and calcium-
final r containing
Intramuscular concentration of  precipitati solutions or
solution: Prepared 250 mg/mL or ons products in
by reconstituting 350 mg/mL.  occasiona neonates is
250-mg vial with 0.9 lly contraindicat
mL of 1% lidocaine associate ed.
without epinephrine d with  Reconstitute
to a concentration colicky d IV solution
of 250 mg/mL. abdomina is stable for 2
l pain, days at room
 nausea temperature,
 vomiting. 10 days
refrigerated.
A dark color
may appear
after
reconstitutio
n; however,
potency is
retained.
 Reconstitute
d IM Solution
is stable for
24 hours at
room
temperature,
3 days
refrigerated.
Cefepime Vial: Term and preterm infants Solution Intravenous  Rash  To reduce
500 mg greater than 28 days of Compatibility  Diarrhea pain at IM

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 1 gram age:  Sterile Water for Intramuscular  Elevated injection site,
2 grams 50 mg/kg/dose IV every injection hepatic cefepime
12 hours.  D5Water transamin may be
 D10Water ases mixed with
Term and preterm infants  D5LR  Eosinophil 1% lidocaine
28 days of age and  D5NSS ia without
younger:  NSS  (+) epinephrine.
30 mg/kg/dose IV every Coomb’s  Reconstitute
12 hours. Reconstitute 500- Test d solution
mg vial with 5 mL of stable for 24
Meningitis and severe sterile water for hours at
infections due to injection to a room
Pseudomonas aeruginosa concentration of temperature,
or Enterobacter spp: 100 mg/mL. 7 days
50 mg/kg/dose IV every Maximum refrigerated.
12 hours. concentration for IV 
administration is
160 mg/mL and for
IM administration
280 mg/mL.

Cefotaxime Vial: 50 mg/kg/dose Solution Intravenous  Rash  Reconstitute

Compatibility  Phlebitis d solution
500 mg 3 – 5 minutes  Diarrhea stable for 24
1 gram  Sterile water for For IV push, a  Leukopeni hours at
2 grams injection concentration of a room
 D5Water 50 to 100 mg/mL  Granulocy temperature,
 D10Water may be used. topenia 7 days
 NSS  Eosinophil refrigerated.
For intermittent ia  DO NOT mix
The 500-mg vial is IV infusion, dilute with other
reconstituted with to a drugs.
10 mL sterile water concentration of  Flush the
for injection to yield 10 to 40 mg/mL cannula
a concentration of and infuse over before and
50 mg/mL. 10 to 30 minutes. after with

Reference: Micormedex NeoFax Essentials 2014

 0.5ml -1ml of
Intramuscular NS
Chlorampenicol Vial: 1 gram Loading dose: Solution Intravenous  Reversible  It is essential
Compatibility: bone that
20 mg/kg IV infusion by For IV marrow adequate
syringe pump over 30  Sterile water for intermittent suppressi blood studies
minutes. injection infusion, further on be made
 D5Water dilute to a  Irreversibl during
Maintenance dose: (Begin  D10Water concentration of e aplastic treatment.
12 hours after loading  NSS 20 to 25 mg/mL anemia.  If blood
dose.) in compatible  Serum dyscrasias
Reconstitute with solution. concentra occur,
Premature infants under 10 mL sterile water tion therapy
1 month of age: for injection or D5W greater should be
2.5 mg/kg/dose every 6 to a concentration than 50 discontinued.
hours. of 100 mg/mL. mcg/mL
has been
Full-term infants under 1 associate
week of age and d with the
premature infants over 1 "gray
month of age: baby"
5 mg/kg/dose every 6 syndrome
hours. (ie,
abdomina
Full-term infants over 1 l
week of age: distention
12.5 mg/kg/dose every 6 , pallid
hours cyanosis,
vasomoto
r collapse;
may lead
to death
within
hours of
onset).
 Fungal
overgrowt

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 h.
Clindamycin Bottle 5 to 7.5 mg/kg Solution  Hypersen  Should not
(oral): Compatibility: sitivity be used in
75 mg reactions, combination
 Sterile water for  jaundice with topical
injection and liver or oral
 D5Water function erythromycin
 D10Water test -containing
 NSS abnormali products due
ties have to possible
Oral preparation been antagonism.
(clindamycin reported  Assess liver
palmitate) is in function.
reconstituted with associatio  Monitor GI
sterile water for n with status closely
injection, yielding a clindamyc  Oral
75 mg per 5 mL in reconstituted
solution. therapy. : Do not
refrigerate.
Stable at
room
temperature
for 2 weeks.

Reference: Micormedex NeoFax Essentials 2014