Neonatal Medications & Nutrition A Comprehensive Guide 3rd Edition

KARIN E. ZENK, PHARMD, FASHP Associate Clinical Professor of Pediatrics, University of California, Irvine, and in private consulting practice Formerly, Pharmacist-Specialist in Pediatrics and Neonatology, University of California, Irvine Medical Center

JACK H. SILLS, MD Medical Director, Neonatal Intensive Care Unit, University of California, Irvine Medical Center, Clinical Professor of Pediatrics, University of California, Irvine

ROBIN M. KOEPPEL, RNC, MS, CPNP, CS Neonatal Clinical Nurse Specialist/Pediatric Nurse Practitioner, University of California, Irvine Medical Center

NK BOOK PUBLISHERS

SAN T-A ROSA, CALIFORNIA

Neonatal Medications & Nutrition TABLE OF CONTENTS

Table of Contents by Therapeutic Categories and Indications xv Notice xxvi How to Use This Book xxvii Special Considerations in Neonatal Drug Therapy xxix

SECTION I-DRUC MONOGRAPHS Acetaminophen (Tylenol) 1 (Mucomyst) 8 Acyclovir (Zovirax) 11 Adenosine (Adenocard) 13 Albumin 15 Albuterol (Proventil, Ventolin) .17 Alprostadil (Prostin VR Pediatric) 22 Alteplase, Recombinant (Activase, Cathflo Activase, Actilyse) 25 Aluminum and Magnesium Hydroxides (Maalox) 33 Amikacin (Amikin) 35 Aminocaproic Acid (Amicar) 37 Aminophylline 40 Amiodarone (Cordarone) 45 Amoxicillin (Amoxil) 53 Amphotericin B, Conventional (Fungizone) and Amphotericin B Lipid Based (Abelcet, Amphotec, AmBisome) 55 Ampicillin 60 Aquaphor Ointment 63 Arginine Hydrochloride (R-Gene 10) 66 Atraeurium (Tracrium) 75 Atropine 78 Aztreonam (Azactam) 82 Beractant (Survanta) 85 Bretylium (Bretylol) 87 Bumetanide (Bumex) 89 Caffeine (Cafcit) 91 Calcitriol (Rocaltrol, Calcijex) 95 Calcium Caseinate (Casec) 98 Calcium Chloride . 100 Calcium Glubionate (Neo-Calglucon) 103 105 Calfactant (Infasurf) 107

Neonatal Medications & Nutrition vii Captopril (Capoten) Ill Carnitine (Carnitor) . . 115 Cefazolin (Ancef, Kefzol) 122 Cefoperazone (Cefobid) 124 Cefotaxime (Claforan) 126 Cefoxitin (Mefoxin) 128 Ceftazidime (Fortaz) 130 Ceftriaxone (Rocephin) 132 Cefuroxime (Zinacef, Kefurox) 135 Cephalothin (Keflin) 137 Cephapirin (Cefadyl) 139 Chloral Hydrate (Noctec) 140 Chloramphenicol (Chloromycetin) 142 Chlorothiazide (Diuril) 145 Cimetidine (Tagamet) 147 Cisapride (Propulsid) 149 Citrate and Citric Acid Solutions (Bicitra) 152 Clindamycin (Cleocin) 155 Clonidine (Catapres) 157 Codeine/Acetaminophen with Codeine 164 with Cetyl and Tyloxapol (Exosurf Neonatal) 167 Cosyntropin (Cortrosyn) 170 Cromolyn (Intal) 173 Cyclopentolate 0.2 Percent and Phenylephrine 1 Percent (Cyclomydril) 176 HC1 179 Dexamethasone (Decadron) 181 Dextrose 185 (Valium) 189 Diazoxide (Hyperstat I.V., Proglycem [Oral]) 197 Digoxin (Lanoxin) 202 (Digibind) 208 Dobutamine (Dobutrex) 211 Dopamine (Intropin) 213 Doxapram (Dopram) 216 Enalapril [PO] and Enalaprilat [IV] (Vasotec) 219 Epinephrine 222 Erythromycin (E-Mycin) 226 Erythropoietin/Epoetin Alfa (Epogen, Procrit) 230 viii Neonatal Medications & Nutrition Ethyl Alcohol (Ethanol) 235 Famotidine (Pepcid) 237 Fentanyl (Sublimaze) 240 Ferrous Sulfate (Fer-In-Sol Drops) 243 Flecainide (Tambocor) 246 Fluconazole (Diflucan) 252 Flucytosine (Ancobon) 254 Fludrocortisone (Florinef) 257 (Romazicon) 260 Folic Acid (Folvite) 262 Furosemide (Lasix) 265 Ganciclovir (Cytovene) 269 Gentamicin (Garamycin) 274 Glucagon 279 Glucose Polymers (Polycose, Moducal) 282 Glycerin 80 Percent [Glycerin Microenema] 284 Glycopyrrolate (Robinul) 286 Heparin Sodium (Liquaemin) 289 Hyaluronidase (Wydase) 294 Hydralazine (Apresoline) 297 Hydrochloric Acid [HC1] 0.1 N 300 Hydrochlorothiazide with Spironolactone (Aldactazide) 303 Hydrocortisone (Solu-Cortef) 305 Ibuprofen (Advil, Motrin) 309 Imipenem-Cilastatin (Primaxin) 315 Immune Globulin Intravenous (Sandoglobulin) 318 Inamrinone (Inocor) 321 Indomethacin (Indocin IV) 323 Insulin, Regular Human (Humulin R) 327

Ipratropium (Atrovent) ; 332 Iron Dextran (INFeD, DexFerrum) 334 Isoproterenol (Isuprel) 339 Ketamine (Ketalar) 343 Levothyroxin (Synthroid) 347 Lidocaine (Xylocaine) 7.356 Lidocaine/Prilocaine Cream [5 Percent] (EMLA) 359 Loperamide (Imodium) 363 Lorazepam (Ativan) 365 Magnesium Sulfate 369

Neonatal Medications & Nutrition ix Medium-Chain Triglycerides (MCT Oil) 372 Meperidine (Demerol) 374 Meropenem (Merrem) 377 Metaproterenol (Alupent) 380 Methadone (Dolophine) 382 (Urolene Blue) 387 Methylprednisolone (Solu-Medrol) 396 Metoclopramide (Reglan, Maxolon) 398 Metronidazole (Flagyl) 401 Metyrapone (Metopirone) 404 Midazolam (Versed) 407 Morphine 411 Multivitamins (Vi-Daylin Multivitamin Drops, Poly-Vi-Sol Infant Drops) 415 Mupirocin (Bactroban) 418 Nafcillin (Unipen) 421 (Narcan) 423 Neostigmine (Prostigmin) 426 (iNOmax for Inhalation) 429 Nitroglycerin (Nitro-Bid IV) 433 Nitroprusside Sodium (Nipride) 436 Norepinephrine (Levophed) 439 Nystatin (Mycostatin) 442 Octreotide (Sandostatin) 445 Palivizumab (Synagis) 449 Pancuronium (Pavulon) 452 Paregoric [Camphorated Opium Tincture] 454 Penicillin G Aqueous [Potassium or Sodium] 456 Penicillin G Benzathine (Bicillin L-A, Permapen) 459 Penicillin G Procaine (Wycillin) 463 Phenobarbital (Luminol) 467 Phentolamine (Regitine) 471 Phenytoin (Dilantin) 475 Phosphorus 479 Potassium [Chloride, Acetate] 482 Prednisone .-... 485 Propranolol (Inderal) 487 Protamine 494 Pyridoxine (Beesix) 496

Neonatal Medications & Nutrition Ranitidine (Zantac) 503 Respiratory Syncytial Virus Immune Globulin (RespiGam) 506 Ribavirin (Virazole) 510 Rifampin (Rifadin, Rimactane) 514 Simethicone (Mylicon) 519

Sodium Bicarbonate [NaHCO3] 521 Sodium Chloride [NaCl] 524 Sodium Polystyrene Sulfonate (Kayexalate) 527 Spironolactone (Aldactone) 530 Succinylcholine (Anectine) 533 Sucralfate (Carafate) 535 Sucrose 24 Percent Oral Solution (Sweet-Ease) 540 Terbutaline (Brethine, Brethaire) 545 Theophylline 548 Ticarcillin (Ticar) 551 Tobramycin (Nebcin) 553 Tolazoline (Priscoline) 556 Tromethamine (THAM) 559 Urokinase (Abbokinase) 563 Ursodiol (Actigall) 567 Vancomycin (Vancocin) 571 Vecuronium (Norcuron) 575 Vidarabine (Vira-A) 578 Vitamin E (Aquasol E) 580 Vitamin K, (AquaMEPHYTON) 582 Zidovudine (Retrovir) 587 Zinc Qxide, [A Component of Desitin Ointment] 593

SECTION II-NUTRITION Enteral Nutrition 597 Caloric Requirements and Weight Gain 597 Protein and Fat 598 Introducing Feedings 598 Feeding Choices 599 Human Milk 600 Commercial Milk-based Formulas 600 Commercial Therapeutic Formulas 601 Premature-infant formulas 601 Soy-protein formulas 601 Casein (protein) hydrolysate formulas 603

Neonatal Medications & Nutrition xi Breast Milk Fortifiers 604 Nutritional Supplements for Preterm Infants 612 Feeding Problems 612 Monitoring Infants on Enteral Feedings 613 Parenteral Nutrition 613 Fluid Requirements 613 Protein Requirements 616 Caloric Requirements 616 Carbohydrate 616 Fat 617 Concentration and caloric value 617 Dose and administration 618 Monitoring and adverse effects 619 IV fat and carnitine 619 Electrolyte and Mineral Requirements 620 Vitamin Requirements 621 Trace-Element Requirements 622 Other Additives 623 Heparin Requirements 623 Administration of Parenteral Nutrition 623 Monitoring Infants on Parenteral Nutrition 623 Transition from Parenteral to Enteral Nutrition 623 Supplementation for Special Conditions 624 Cholestasis 624 Nutritional Osteopenia (Rickets of Prematurity) 625 Bronchopulmonary Dysplasia 626 Asphyxia and Necrotizing Enterocolitis 626

SECTION HI-IMMUNIZATIONS Diphtheria and Tetanus Toxoids and Pertussis Vaccine [DTP] 638 Haemophilus Influenzae Type B Conjugate Vaccine [Hib] 641 Hepatitis B Immune Globulin (H-BIG) 644 Hepatitis B Vaccine (Engerix-B, Recombivax HB) 646 Pneumococcal 7-Valent Conjugate Vaccine

(Diphtheria CRM197 Protein) (Prevnar) 650 Poliovirus Vaccine, Inactivated [IPV] 653 Poliovirus Vaccine, Live, Oral [OPV] 655 Varicella-Zoster Immune Globulin [Human] (VZIG) 658

xii Neonatal Medications & Nutrition SECTION IV-APPENDICES A Simplified Neonatal Calculations 661 B Every-18-Hour Medication Worksheet 669 C IV Drug Administration Methods 671 D Umbilical Arterial Catheter (UAC) Administration of Drugs 675 E Y-Site Compatibility of Common NICU Drugs 681 F Restoring Patency to Occluded Central Venous Catheters 697 G Guidelines for Management of Intravenous Extravasations 701 H Classification and Spectrum of Activity of Anti-Infectives 705 I Adverse Effects of Diuretics 713 J Antidotes for Drugs That Cause Loss of Respiratory Effort 715 K Neonatal Withdrawal Score Sheet 717 L Composition of Feedings for Infants and Young Children in the Hospital 721 M Normal Neonatal Laboratory and Other Values 731 N Conversions and Equivalents 739 O Neonatal Cardiopulmonary Resuscitation and Postresuscitation Drug Doses 743 P Endotracheal (ET) Tube and Suction Catheter Sizes by Infant Weight 747 Q Standardized NICU Oral Unit Dosing 749

SECTION V-INDICES

ABBREVIATIONS 753

INDEX OF TABLES AND FICURES 759

INDEX 765 CEU

Neonatal Medications & Nutrition xiii