bull bull

III

Threshold for Considering Photothera-ID shyfor Infan~_ ~5_yveeks Gestation

10 11 12 13 14

A9ltJcJayS)Z4

22 +------=~---------_1 - shy 950g--ltJ- 751IOOOg

- shy ----shy --1__ I001-19S$g

20 -0- 2OOOmiddot2499g __ 25002999g

sect 16

sect W-Jf-pound-~--------------~--- shy - shyIX 16 ~

+-w--middot----shy ---middotmiddot-middotmiddotmiddot--middotmiddotmiddotmiddotmiddot-------------middotshy

14

12 ______I~hold for ~~Iderlng Exchange Transfusion

for Infants lt 35 weeks Gestation

~ g II) I shy

16

16

14

12

10

6

10 11 12 13 14

Age (da)s)

Birth Weight Begin stopRestart I Phototherapy I ~ 7 days of age

I lt750 9 I 12 hrs of age I TSB5mgdl I 751middot1000g 12 hrs of age L TSB5 mgdl

feeding Schedule SUGGESTED FEEDlNG SCHEDULES Volume 5md In mllkolday

75HOOOg gt27 w1lts Q~u~~ 1-_-_--_--rPF2_O_E_BM__-_-_---+_--PF2_4_or--RlM-------t__+_---r-_ gt loo()j lt 32 wks 20 I 30 40 I 60 80 100 I 120 120 140 160

1801middot 2250g

Nipple and 33 v+s 9av~ q3h as

1

PF20 or EBM PF24 or FBM

40 I 60 120 I 160

EBM expressel breast mllk= full strenQth unfortified human mUk PF20 bull =prernature formula 20=20 kcaVol Enfamll Preterm Upil Fonnula with Iron Of Similac SpeiaJ Care Formula with Iron ~M fortiliel breast m~k_human milk with one packet Human MU~ Fortifier25c or human milk mtxed 1 1 with Similac NallJral Care PF 24 bull premabJre formula 2424 kcaloz EnlamU Prmrm Upa Formula with Iron or Similac Speial Care Formula with iron -For Infants gt34-36 WIeks gestation ad lib feedings with a minim um volume for each feeding may be ordered

Sodium Requirements 2-3 mEqkgday Potassium Requirements 1-3 mEqkgday Calcium Requirements 1-2 mEqkgday Glucose ReqUirements 4-8 mgkgmin

GIR Total cckgday x Dextrose (D10W = 01) x 1000 = mgkgmin of glucose 1440 minutesday

~ufdG In the first 24deg oflife Birth WelQht

Type gt2500~ D10W 1501middot2500g D10W 1001middot15000 D10W 10009 D5W

D75W D10W

StopRestart I Exchange 7middot14davsofaoe Transfusion I

TSB 5 mgdl TSB013 ~dl I TSB 7 mgdl TSB ~ 15 mgdl I

0-24 hours after birth Total Amountmiddot Glucose Infusion RateA

60-80 42middot56 80 56

80middot100 56-69 100middot120 35middot42 100-120 52middot63 100middot120 69middot83

Total Amt=cdkgl24hrs G I R - mglkqmin

bull Once phototherapy IS initiated It should be continued for at least 24 hrs regardless of bilirubin levels 301036 Ot014 12 gt14 eshy

37044 0107 12 gt7 866

gt45 All 6--UsUtll tV ccrcenration 30 mgm (max lOOrnglmt for IV push only) Doses of 300-400 lngkgday 1IhOamptd be re$8lved for pelients with mcnj~lis If non-mcningil ic infectiQlla UN 50 mgikgJdose UTI proph~ailis tten PO c611oo1 be )j-on 2S mglkgldoM IV given 024h

Gentamicin QV IML COIrecled Gestational

AM weks D~f~ife

(m=o) 4

Interval hours

36go All

30 to 34 oto 7gt 4

4 36 24

~35 0107gt 4

4 24 02

Usual IV concenllalion 2 Iflglmf (max 10 mglml) u)o not draw tobrmycin levels If Iha anticipated antibiotic course is lt3 deys panding culture results If 1h8lapy is to continue gt3 days draw a peek and it 1f000gtliavei around the 3d dose renal impairment is suspected as rn8nifeamplcd by an increeMd SCr or decreased UQP draw a trougt level prior to the 2d dose and hold the dose unlil the trough leV81 is known Therapfutic levels Peak 5-12~gml Trough lt2pglml

Vancomycin (IV) (ReseNe lor suapected or documerHed resistance 10 methicillinlnafampillin chnge 0 nafc~lin for MSSA infections

Corrected Gestelional A

9middot 301036

Gr71BA~ 10 12 37 to 44Postn Age (hours)

Nomogram Imiddot Risk zones for developing hyperbilirubinemia 45

bullbull middot00 nol dral vancomycin lelels if the enlieipeted anlibioCic course is lt3 days pending C4Jlwlamp results If

Ulelapy IS (0 continue gt3 day draw only II bough level priOf to the 3 dose If renal impairment is - uuspecled as manifeampted by all inaeased SO or ltMaeed UOP draw II trough level prior to the 2- dosemiddotrtmiddotj~middot~ 0~~~middotdmiddot~ ~nd hold the dMe until the trough le081 ill known Therapeutic trough leWis 10-20Jgfml

Ususl V oonentrelion 10 mgJml

Postnatal Age davs

All

AU

0-14

gt1 4

All

i 2raquo 242 r obam (IV 1M)+~ ~ bullbullbullbull-

Corrected Gastatio 1 09yo Life 1-~9~l_ _~lt 1lt + shy Alllt29251 -- ~ ( - Oto 7~ 301034 gt6~ ~ ---i_mLpgt+u

171 ~ 0107

35 gt1 ~ -- - - bull - - Uwa IV concentration 2 mgrnl (mu 10 mgfml)+

m=ose 15

15

15 20

m~) 4

4 4

4 4

neMlI hom

02

bullbullbullbull

-~=

24 24 12

+~ 00 not drOllw tobramycin lelels if the anticipated antibiotic couree is lt3 days pending culture middotmiddot~)Imiddot0middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot results IIthetapy is 10 continue gt3 days draw a peak and a bough level eround the 3 CO$e6S

~ bull ~)b-~tI~ 01 kgtK=r (0laquo (~ 18 vJk lIrd I~~ _ renal impaillnent is suspected as mnlfesl8d by an increased SCI or decreased UOP draw a bough level prior 10 the 2 dose and hold tho dose until the bough level ia known Therapeutic levels Peak 5-121o91ml Trough lt2~lglmt

r---+-- - - t)Inl III mectutrgt 1lt (c 38M1 + riosl f1tltgttS lf3) fll kJr~ wdl ~

o ~I- 1nJtflltll tiQ~~~ (JS~7 f y bull i$k~~ bullbull

Totr-ltlmycin for inhalation 80mg Inh qBh (not weight baaed)~1r111 AtI tlfJf) 7(h I SO~s 60ayamp 70-)s

Caffeine Citrate (Cafcitreg) (IV PO) A96 Loading dose 20 mglkg of caffeine cillate

Maintenance dose 5 mglkgfdoM Q24h hlgherdos up to 10 mglkglday may be uaed forNomogram 2middot Guidelines for photothe-pyfor InfantS ~ 35 wks gestation symptomatic patients

(Aftamp a division discussion of the availabla elidelC6 from ~Iinical triala it was decided thOlilroutine ~ drug levet monilorint ~fi not induat6d) lvels wfI1 be ordered aa needed for poor therapeutic r8spcnM or for aide effeclamp U8Ual serum concenlllloon Smiddot25mcglml

Usual concentration IV and PO 20 ffi9lml

Survenlareg (ET) 4mllkg May be Given Qeh ) 4 doaea

Order dS~~~~~ b8aed on the patienra reaponsa If required give initial dose ASAP fOl

Y3U~1 ~cenlrlion 25 mglml

--

elood Component Thert1pY PRBCs 20cckg over 4 hours (CMVmiddotnegative irradiated leukofiltered) Platelets 10-15 mLlkg for neonates lt 10kg 1 unitl10kg for infantsgt 10kg o Expected increase is - 50000L (ideal recovery)

Postmiddottransfusion count within 15-60 minutes may be beneficial o Recommendations for use include

Pits lt 20-50 x 100L in stable premature infants Pits lt 50-100 x 109L in ill premature infants Pits lt 20 x 109L in stable term infants Pits lt 50 x 1 09L in term infants wI active bleeding Pits lt 50 x 109L if invasive procedure is planned Pits lt 100 x 109L if on ECMO

FFP 10-15 mLlkg (for a 15-20 rise in coagulation factors) o May be repeated 3x124 hrs if needed o 15-30 mUkg for hemorrhages o Indications Replacement of clotting factors (OIC) Whole Blood Vol of blood to be exchanged = Babys Wt (in kg) x 85 x 2 o Indications Exchange transfusion

Nutrition NEONATALeNTERAk~~eN

EstImated hecd5 fDr growth goal is no-l50 kcaVrqday amp ] 5-1 9111015 proteinkgdillY (preterm) it0rai1s 100-130 kCiIIVkgdillV amp 1pound-22 gnltrs proteinllajdayterm)

When ant1 reds aret SO or 9Occkg dCUea5e lntnIpids to 2gkgday

UQcc kll dlscvnlinue both TPH and Imtaffpids fortify breast rmk In PfenatUle babks wIth e ~RHwnan tiCk FoftifleJ (t-M71 padcd 25 m1 EeN =21 kallo i~ ~~~ CI--SJrmac Natural Cate--t2 EBM 112 fornw=22 kealOl 3 ~Ho te Htmiddot1F Is HOT pproJlllatc hI( term Infants you can add wI iIInd nwlents to fe rifh standard e jjj ~g

2powdered forniUla -lt~] ~~ ~ ~j i~S AAP Recomm~atfons for Brust Fed Infants tii~tilIf baby b on breast milk alone (wtth out HMF) ~~i Ubull was p~mature add 2 mllronlkgday 8amp 200 lU mrrin DJdit( ~1I ~~~ 02Add 05 ni Poly-vtmiddotsol llh 1100 for (nrarls lt2500 q Add 1 mI PotymiddotvI-sol Ji1h Iron rOf Wants gt2500 9 S

amp was t~ now ltI rncnlhs of age ~ 200 IU vitamn DJday amp was term now gt4 montl~ of ltJ9C add 1 Inglronlt9lday f( 200 IU vitantn Oday ()J~0

1 ~ 02- ~ eU baby ls on breast milk amp rOJmlJla bullbullbull ~l~ e EI M woVitlmll1 0 add 200 IU vtlwn Ddltry if Infant lakes ltSOO nl 01 formuladay 9

Iron for temllnfallli add IIT1J Ironkg If Infant ukes lt90 rrlr~9dJY 0( fOMttub cii~ ~l prclelnllnfonU need II total 0(2 mg Ironk9day eT

Note VlmiddotSoI products ~ith Iron contain 400 IU oftamln D Dnd 10 rf9 fron per 1 mI Jf babies gt monihs of a9C lake 2 servingsday of lIon rortifled cereal or ~t no addlUanal k on Is necd~d A

r JlAt Discharge ]]If blrtflwelght Is send home on s sect ~ ~ lt1250 g folow up fonrrrld (Enfaure or NoollJre) E US118S01jl folol up formJla it dlschiHgc wd1ht Is 2500 grams

E ~jI 8

~ ~ 0gt1650 9 stilldard formula ~ o~

Note ltI Hay also amskJer llW1g toIrK up fomlU a In th hospital for JUemltvre Ihfanb -mo Me 9JCMInq 0 N

veil and gt3--1 kg 2

QAuus Growtfl Wdght length Foe JPrctefl11 laquo 2 kg) 10-20 glajJltJ 0Bmiddot11 clfWWtAJc 0 Smiddot10 cnVvIlc ~ Term (gt2 kg and lt3 mo corrtttcd) 2(HO gJday 069middot075 cmA-eek ~0 1middot06oniwt bullshy ~

u ~ Term (3~ mo eorreded) 15-10 gJdWf 05 (weIOc ~jl~1ETel (6middot 12 mo corTCcted) 1015 gday OJ Uf1e~ ii~ ~~jpound~NEONATALPARENTERALNUTRrnoN ~I~g ~g EstImated need for growth 900II15 90middot115 IocaIkgday amp 27middot 35 51ramokltJday(prelrrm)

9oa11s BOmiddot 1J() kcalIogday amp 1S] 51rftmSkg dily (term)

fllIll Use btrth WC5lht to Ilgwe fluid needs unti Ihfants wdqhlls abave blrttneJ~t A dry weight 1llo1) be used If )QUem is Avid overloaded Dry weights need to be I middot~ahlltcd weaky llldlde aD IV plg9Y~1 TV rl enteri4 fEeds fnedkatlons and lipid endsions In fbld acuIaUons ~cdOSS Fluid nHds 0 middot24 hours of rife

61rthweighl (9) T1gt Au~ (ltltkg) GlJt Sodium Bicarbonate (IV)

Gestation weeks Hemoglobin [gdL mean plusmn SD Hematocr it 1 mean plusmn SD)L

18-21 11 7plusmn 13 373plusmn 43

22-25 122plusmn16 386 plusmn 39

26-29 129plusmn 14 409 plusmn 44

gt36 165plusmn 15 51 0plusmn 45

~ E ~

i ~

~ E

N

Ii ~

~jpound

NMI

~

11 E~~ ~~ 110 ~Ipound shy~ 0o ~ r~) ~~~Hu(1)00

gti -~ Itgteltl

til ~ ~ sect 0 u S~ I

Clan

DISCMARQE CMECK LIST

TutlProceduralOrden Cast Manl ars nollnad or olaI11 dischalila

Hr7o~a~~lmd~~~~~ngl~~~h ~aa~a~l~a~n9a Fllmlfy cra coordlnalor tl olMad of poltllI1 dlschar a Ha alilis B v cdna Routln Immuntzallons (II lIgJbl (iI 60 day)

C1rcumcllion

S1ata scrlln

HU M t etlin ABRlfa IIcable Eya aum (If applic able lt32 wks or oograms)

Iala HUS rr applic able lt1500g 1500middot2000g It v nl llltd DOL a0 001 90)

D vt lopm t rlle l tum and ECI frrral Qr appllcabla lt34wttks nd 2000-9)-Pfascrlplions (wrItI an on outpallltlnl prescriptions and glVan 10 paraol 4amp-72 houlS bafora dlschrga 10 ba tlilad PRI OR to dllCharg) and Ins(rucllon for admlnlstralion lveo Spacial formula Wl C Form complaltd aod spacial rormula ducation 1In by dJIIUan or nuru RSV prophytaXls or app llcabla)

Car seal avallabla

Car SlIIt Challangt (Itppllcblt lt37wlllc s lt2500 tam or oxyge~dapandanl

Cara By Pllanl room rauIVad if nlldd) Clschflla summary complalad Olschuga summary copls prinld 3 Ordtr 10 dlschar bull hom a written

ROP auideUnes MID 10 Ipound[bullbulln ann t u m) bymak of Ilfa WOO pnd dav 9 IrrCQQL )

Ebull-J

Corrwmnls

[S 1mmunlullons (Se c1ton 0 undr Infec1lous DlJusu)l

[S ~OP SUllnlo5l (StcUen C undar Mlstallanaous)1 (S nlra(anl1 Hemorrhagt and Pet1venlricllltr l eukom atacla (SelIon A undar NturolOIN)]

[S mmuntlallomshy(Stellon 0 un dar Infc1lous Dlsn)]

walght

lt 1500 lt 1500 lt 1500 0( 1600 0( 1500 s 1500 gt 1S00 g

aga al blrlh

22 wuks 23 waak 24 wk 25 wbullbullks 26 wks

27middotl0 weakl gt30 waak~

G utalonal WOl9 WOl8 WOl7

J~~~ famp~~ 4~~ X

EXm 131 wttlcs 0s1n8la1 a or1 a WOL6

~~~

a lt4 wttlcs WOl5 (OOL

35--4

tilth aVer Is WOllt4 (OOL 29-34

(al

It sedatiesRootine treatmenl of metabolic acldosia 1middot2 mEQIkgs 1000 05 100middot120 35middot42 PainInfuse over 1 hour075 100middot120 S2middot63 In cases of sewe reapirlltory ecidosis II continuoua infusion may utilized hort torm 010 1CXH20 69middotBJ Fentanyi (IV )

1001-1500 010 80middot100 5 amp-69 Continuous 0s1 mEqIltglhr infusion dose Thia will be a large volume of fluid end Mit alao1S01middot 25OO DID 8 S bull

ovide 012 mEkgdavof Na Stndard 2S mEq of sodium bicubonato in 50 cc of sterie

gt2S00 DID 60-80 42middotSo

concentration watr or D5W 05 mEQImlMilqoolJtrlenb Infusion rl mlhlr = I W1 ~kg) It delirct daM mE h It 2Inllatc Incleors~ by Goal Povldcs

2~o IntnJJpld 1 qIq 19lk51 3911aJ 2~Vn1 DutJose Smiddot7 GIR 1middot2 GIR 12 GUt J kraVg Protldn (Prunuol) ) middot2 gkg 191k9 3middot3591(9 kcaVg Respiratory

Albuterol (Inh) Electrolytes Nabulizlld SOlution 125-25 mg in 3 ml NS 0 2eh pmSodium ampPotu~lurn

r~~Ie~~~~~~DoTin-Q e-4-mlt1mm7c~ogdd= 0-_--

infusion dose Palienl W8(lht

Fot patlanls 0( 16kg For patl4lnts ~ 16 k g

250 mierogtams in 500 micrograms in

~~~~~ati()() 5 m~~~ml ) (10 fc~~=slmL mlfur - pt wt (kg) x mlh - pl 1 (kg) x

InfuSIOn rale deslIed dose desired doe (mool1ltamln + 5 mcgAonmin + 10

Usual IV ampule concenlJalion SO microgramsfml U~uill IV reqUirements 2) InCq Uakg 2middot3 mEq I(Jkg (4 puffs MOl =25mg nebulized ) bull

Evllualeuslng (utTenl tab data In extnlmo callOS of bronchospalm~ a continuous inhalation may be utilized hort arm for l orazepa m (Allvanreg) (IV PO) p1tienls 00 the ventilator or CPAP OOS()l mgNgdose 04-611 pro

Calcium ampPhosphorus UwaliV concentralion 2 mofml uwel po concentration 2 mglml 25 mgiampollhr 31 mg of lbu~roJ in 100 ml NS (swdng doae) 5 mgfBmlllr I 63 mg of Ibulerolln 100 mt NSUlual rv rCqu lJerroCnls J -1 S rrpoundq CJk9 )2 mmol P04ftlt91day 10 mr1BmVhr ~ 125 mg of IIlbutetol in 100 ml NSGtve standard Ca amp PO 100 a In rrost Instltmcs Midazolam (Ve rsedreg) (IV PO) 20 mglBmVhr =250 mo of albutflfol in 100 ml NSFor 1 m-b4 of PO must haY at least 131 mfq Ua andlor 1 7 mEq of K In Ue solutiln -rs line agent middotlolel3noo developamp repldly

Racamic Epinephrine (Inh) Inlermit1ent Dosin 005-015 mQkgldoampe 0 2-4h Pn Ma9neslum 05 ml of II 225 solution Continuous Uwel rv IlqUlefnenh 05-1 mEq glkg Oexamelhaaone (IV PO) intuaion dose GlYo SoIlInfard t1g lCOlaquo uness mom retcNed 9 durtnSl dei-ery If rrom r ete~ed 1-9 walt ltl8middotn hourr Usual concantralion IV 0 1 mglml (mx 1mgfml) PO 01 mglml (mllx 1 mglml) Patient IhCll nlrt standard 9100 (C The tol~gtMng regimena have been ebJdied in randomized trials lot prevention of BPD waiaht

StandardTrace Ellmenb 1O-daylower dose Leper r-vimtn (Do~e LW et ~I Pediatrics 11775-83 2(08 ) (nlJSt ~ marked on TflN fom1) O I~ mglkg 02411 x 3 days iI~otae-I For nlDst bbles 010 mglkg 02lt4n x 3 days Ctol~Jls6 (witllJut 14cctracemiddot4) For babCes 1111 elevlltld direct bllrubln 005 mglkg 024h x 2 days Infusion late PlbJO d~ (with or ltfthott Neotnce-4) For babies vilo ruve reltelved ~ltIe enlefal nutlitlon gt30 days 002 mg1lo 02 x 2 dave

1()60 microgtlm Sikglh

16 -3 kg gt 3 kglt 16 kg

3 5 mg in SCmI 75 mg in 5Om115 mg in 5Om1 D5W DSWD5W

003 mahnl) (007 m9iD-lll--I--lt-0-15~mrr7m-rl mllhr =plt (kg ) mlitlr 11 wt (kg) Itmill - pt wt (kg)

It desired do dasired dONIt desired dose mCCWkQhf 70 m Q(~ll50mgJi) 33

Renal OyrlunctJon (without NeotnrM) For bablCo vith suspected rEllal dysfunction bo nol on dlal~k U$UalIV I1el concenltalion 1 mgrml Vlth (hoksbld~ amp l entil dysfunction Hatlc tb Neotr~ce ~ lind 51lve line only Because of concerns ebout the long lerm lde cffecb of po3tnllbl dexamethasone in prelarm

infanta currant practice is shifting to smaUer dosas and short courses Consul Vllth tho Morphine (lV lM PO) atLending regllrding the pf8lerred dexamethasone regiman for Individual patient

Patient wei ht lt 16 k

Slandard 15 mg in SOml

concentIlioo oo~~ml)l mllhr pi wt (kg) mllhr - 11 wt (kg) x dulred dose

mcafKalhr + 150

Intermillenl Coal 005-02 mCl1cQdoae Q4-eh Dm

(must be miJrk~ on TPN form) ContinlJOUS 10-20 microoramsfkQh fusion dose

peripheral Ilne$ 01 mglkgldoaIV or PQ012t1 x 5 do (Qiv 2 doses prior 10 eehllduilld exlubation) For airway edem n infants vto hevo previously f ilad exlubatJon (nol V411 studied) All cenl13l KOOS and lool) I~es 02S unlLcJn~ - gt3k16-3

75 mg in 5Om135 mg in saml Methylpreniolole (IV)

~Jl9n For acute eXllGorbalions of reacbVe airway diMliM 0 1~1m1)(OO~Sml ca 20 9=1rrEq=O5 111middot101 1 motkg1dosc 012h x 2 doses then 05 mgikgldO 0 I 2h x 4 days mlfhr plwt(kgraquo)Cmiddot1g 12 rrg=1 rrEqO51Tigt1O A oncmiddottime doO of 10 mgkg may be uaed pre-operativey for palienlpound undergoing ~rdiac ampurgary Ifusionre It desired dose Ia 2J rrg~ 1 mEq= 1 m )oj w iln b~ass ~=~~~OmCQIkaIhr) + l3I 39119=1 rrpoundq= 1mf-o1 Usual concontration 4 mglmf

UauIIV VlSI concentrlltx)J 2 mglmIa 31 n9 - 1 nilOl

--

elood Component Thert1pY PRBCs 20cckg over 4 hours (CMVmiddotnegative irradiated leukofiltered) Platelets 10-15 mLlkg for neonates lt 10kg 1 unitl10kg for infantsgt 10kg o Expected increase is - 50000L (ideal recovery)

Postmiddottransfusion count within 15-60 minutes may be beneficial o Recommendations for use include

Pits lt 20-50 x 100L in stable premature infants Pits lt 50-100 x 109L in ill premature infants Pits lt 20 x 109L in stable term infants Pits lt 50 x 1 09L in term infants wI active bleeding Pits lt 50 x 109L if invasive procedure is planned Pits lt 100 x 109L if on ECMO

FFP 10-15 mLlkg (for a 15-20 rise in coagulation factors) o May be repeated 3x124 hrs if needed o 15-30 mUkg for hemorrhages o Indications Replacement of clotting factors (OIC) Whole Blood Vol of blood to be exchanged = Babys Wt (in kg) x 85 x 2 o Indications Exchange transfusion

Nutrition NEONATALeNTERAk~~eN

EstImated hecd5 fDr growth goal is no-l50 kcaVrqday amp ] 5-1 9111015 proteinkgdillY (preterm) it0rai1s 100-130 kCiIIVkgdillV amp 1pound-22 gnltrs proteinllajdayterm)

When ant1 reds aret SO or 9Occkg dCUea5e lntnIpids to 2gkgday

UQcc kll dlscvnlinue both TPH and Imtaffpids fortify breast rmk In PfenatUle babks wIth e ~RHwnan tiCk FoftifleJ (t-M71 padcd 25 m1 EeN =21 kallo i~ ~~~ CI--SJrmac Natural Cate--t2 EBM 112 fornw=22 kealOl 3 ~Ho te Htmiddot1F Is HOT pproJlllatc hI( term Infants you can add wI iIInd nwlents to fe rifh standard e jjj ~g

2powdered forniUla -lt~] ~~ ~ ~j i~S AAP Recomm~atfons for Brust Fed Infants tii~tilIf baby b on breast milk alone (wtth out HMF) ~~i Ubull was p~mature add 2 mllronlkgday 8amp 200 lU mrrin DJdit( ~1I ~~~ 02Add 05 ni Poly-vtmiddotsol llh 1100 for (nrarls lt2500 q Add 1 mI PotymiddotvI-sol Ji1h Iron rOf Wants gt2500 9 S

amp was t~ now ltI rncnlhs of age ~ 200 IU vitamn DJday amp was term now gt4 montl~ of ltJ9C add 1 Inglronlt9lday f( 200 IU vitantn Oday ()J~0

1 ~ 02- ~ eU baby ls on breast milk amp rOJmlJla bullbullbull ~l~ e EI M woVitlmll1 0 add 200 IU vtlwn Ddltry if Infant lakes ltSOO nl 01 formuladay 9

Iron for temllnfallli add IIT1J Ironkg If Infant ukes lt90 rrlr~9dJY 0( fOMttub cii~ ~l prclelnllnfonU need II total 0(2 mg Ironk9day eT

Note VlmiddotSoI products ~ith Iron contain 400 IU oftamln D Dnd 10 rf9 fron per 1 mI Jf babies gt monihs of a9C lake 2 servingsday of lIon rortifled cereal or ~t no addlUanal k on Is necd~d A

r JlAt Discharge ]]If blrtflwelght Is send home on s sect ~ ~ lt1250 g folow up fonrrrld (Enfaure or NoollJre) E US118S01jl folol up formJla it dlschiHgc wd1ht Is 2500 grams

E ~jI 8

~ ~ 0gt1650 9 stilldard formula ~ o~

Note ltI Hay also amskJer llW1g toIrK up fomlU a In th hospital for JUemltvre Ihfanb -mo Me 9JCMInq 0 N

veil and gt3--1 kg 2

QAuus Growtfl Wdght length Foe JPrctefl11 laquo 2 kg) 10-20 glajJltJ 0Bmiddot11 clfWWtAJc 0 Smiddot10 cnVvIlc ~ Term (gt2 kg and lt3 mo corrtttcd) 2(HO gJday 069middot075 cmA-eek ~0 1middot06oniwt bullshy ~

u ~ Term (3~ mo eorreded) 15-10 gJdWf 05 (weIOc ~jl~1ETel (6middot 12 mo corTCcted) 1015 gday OJ Uf1e~ ii~ ~~jpound~NEONATALPARENTERALNUTRrnoN ~I~g ~g EstImated need for growth 900II15 90middot115 IocaIkgday amp 27middot 35 51ramokltJday(prelrrm)

9oa11s BOmiddot 1J() kcalIogday amp 1S] 51rftmSkg dily (term)

fllIll Use btrth WC5lht to Ilgwe fluid needs unti Ihfants wdqhlls abave blrttneJ~t A dry weight 1llo1) be used If )QUem is Avid overloaded Dry weights need to be I middot~ahlltcd weaky llldlde aD IV plg9Y~1 TV rl enteri4 fEeds fnedkatlons and lipid endsions In fbld acuIaUons ~cdOSS Fluid nHds 0 middot24 hours of rife

61rthweighl (9) T1gt Au~ (ltltkg) GlJt Sodium Bicarbonate (IV)

Gestation weeks Hemoglobin [gdL mean plusmn SD Hematocr it 1 mean plusmn SD)L

18-21 11 7plusmn 13 373plusmn 43

22-25 122plusmn16 386 plusmn 39

26-29 129plusmn 14 409 plusmn 44

gt36 165plusmn 15 51 0plusmn 45

~ E ~

i ~

~ E

N

Ii ~

~jpound

NMI

~

11 E~~ ~~ 110 ~Ipound shy~ 0o ~ r~) ~~~Hu(1)00

gti -~ Itgteltl

til ~ ~ sect 0 u S~ I

Clan

DISCMARQE CMECK LIST

TutlProceduralOrden Cast Manl ars nollnad or olaI11 dischalila

Hr7o~a~~lmd~~~~~ngl~~~h ~aa~a~l~a~n9a Fllmlfy cra coordlnalor tl olMad of poltllI1 dlschar a Ha alilis B v cdna Routln Immuntzallons (II lIgJbl (iI 60 day)

C1rcumcllion

S1ata scrlln

HU M t etlin ABRlfa IIcable Eya aum (If applic able lt32 wks or oograms)

Iala HUS rr applic able lt1500g 1500middot2000g It v nl llltd DOL a0 001 90)

D vt lopm t rlle l tum and ECI frrral Qr appllcabla lt34wttks nd 2000-9)-Pfascrlplions (wrItI an on outpallltlnl prescriptions and glVan 10 paraol 4amp-72 houlS bafora dlschrga 10 ba tlilad PRI OR to dllCharg) and Ins(rucllon for admlnlstralion lveo Spacial formula Wl C Form complaltd aod spacial rormula ducation 1In by dJIIUan or nuru RSV prophytaXls or app llcabla)

Car seal avallabla

Car SlIIt Challangt (Itppllcblt lt37wlllc s lt2500 tam or oxyge~dapandanl

Cara By Pllanl room rauIVad if nlldd) Clschflla summary complalad Olschuga summary copls prinld 3 Ordtr 10 dlschar bull hom a written

ROP auideUnes MID 10 Ipound[bullbulln ann t u m) bymak of Ilfa WOO pnd dav 9 IrrCQQL )

Ebull-J

Corrwmnls

[S 1mmunlullons (Se c1ton 0 undr Infec1lous DlJusu)l

[S ~OP SUllnlo5l (StcUen C undar Mlstallanaous)1 (S nlra(anl1 Hemorrhagt and Pet1venlricllltr l eukom atacla (SelIon A undar NturolOIN)]

[S mmuntlallomshy(Stellon 0 un dar Infc1lous Dlsn)]

walght

lt 1500 lt 1500 lt 1500 0( 1600 0( 1500 s 1500 gt 1S00 g

aga al blrlh

22 wuks 23 waak 24 wk 25 wbullbullks 26 wks

27middotl0 weakl gt30 waak~

G utalonal WOl9 WOl8 WOl7

J~~~ famp~~ 4~~ X

EXm 131 wttlcs 0s1n8la1 a or1 a WOL6

~~~

a lt4 wttlcs WOl5 (OOL

35--4

tilth aVer Is WOllt4 (OOL 29-34

(al

It sedatiesRootine treatmenl of metabolic acldosia 1middot2 mEQIkgs 1000 05 100middot120 35middot42 PainInfuse over 1 hour075 100middot120 S2middot63 In cases of sewe reapirlltory ecidosis II continuoua infusion may utilized hort torm 010 1CXH20 69middotBJ Fentanyi (IV )

1001-1500 010 80middot100 5 amp-69 Continuous 0s1 mEqIltglhr infusion dose Thia will be a large volume of fluid end Mit alao1S01middot 25OO DID 8 S bull

ovide 012 mEkgdavof Na Stndard 2S mEq of sodium bicubonato in 50 cc of sterie

gt2S00 DID 60-80 42middotSo

concentration watr or D5W 05 mEQImlMilqoolJtrlenb Infusion rl mlhlr = I W1 ~kg) It delirct daM mE h It 2Inllatc Incleors~ by Goal Povldcs

2~o IntnJJpld 1 qIq 19lk51 3911aJ 2~Vn1 DutJose Smiddot7 GIR 1middot2 GIR 12 GUt J kraVg Protldn (Prunuol) ) middot2 gkg 191k9 3middot3591(9 kcaVg Respiratory

Albuterol (Inh) Electrolytes Nabulizlld SOlution 125-25 mg in 3 ml NS 0 2eh pmSodium ampPotu~lurn

r~~Ie~~~~~~DoTin-Q e-4-mlt1mm7c~ogdd= 0-_--

infusion dose Palienl W8(lht

Fot patlanls 0( 16kg For patl4lnts ~ 16 k g

250 mierogtams in 500 micrograms in

~~~~~ati()() 5 m~~~ml ) (10 fc~~=slmL mlfur - pt wt (kg) x mlh - pl 1 (kg) x

InfuSIOn rale deslIed dose desired doe (mool1ltamln + 5 mcgAonmin + 10

Usual IV ampule concenlJalion SO microgramsfml U~uill IV reqUirements 2) InCq Uakg 2middot3 mEq I(Jkg (4 puffs MOl =25mg nebulized ) bull

Evllualeuslng (utTenl tab data In extnlmo callOS of bronchospalm~ a continuous inhalation may be utilized hort arm for l orazepa m (Allvanreg) (IV PO) p1tienls 00 the ventilator or CPAP OOS()l mgNgdose 04-611 pro

Calcium ampPhosphorus UwaliV concentralion 2 mofml uwel po concentration 2 mglml 25 mgiampollhr 31 mg of lbu~roJ in 100 ml NS (swdng doae) 5 mgfBmlllr I 63 mg of Ibulerolln 100 mt NSUlual rv rCqu lJerroCnls J -1 S rrpoundq CJk9 )2 mmol P04ftlt91day 10 mr1BmVhr ~ 125 mg of IIlbutetol in 100 ml NSGtve standard Ca amp PO 100 a In rrost Instltmcs Midazolam (Ve rsedreg) (IV PO) 20 mglBmVhr =250 mo of albutflfol in 100 ml NSFor 1 m-b4 of PO must haY at least 131 mfq Ua andlor 1 7 mEq of K In Ue solutiln -rs line agent middotlolel3noo developamp repldly

Racamic Epinephrine (Inh) Inlermit1ent Dosin 005-015 mQkgldoampe 0 2-4h Pn Ma9neslum 05 ml of II 225 solution Continuous Uwel rv IlqUlefnenh 05-1 mEq glkg Oexamelhaaone (IV PO) intuaion dose GlYo SoIlInfard t1g lCOlaquo uness mom retcNed 9 durtnSl dei-ery If rrom r ete~ed 1-9 walt ltl8middotn hourr Usual concantralion IV 0 1 mglml (mx 1mgfml) PO 01 mglml (mllx 1 mglml) Patient IhCll nlrt standard 9100 (C The tol~gtMng regimena have been ebJdied in randomized trials lot prevention of BPD waiaht

StandardTrace Ellmenb 1O-daylower dose Leper r-vimtn (Do~e LW et ~I Pediatrics 11775-83 2(08 ) (nlJSt ~ marked on TflN fom1) O I~ mglkg 02411 x 3 days iI~otae-I For nlDst bbles 010 mglkg 02lt4n x 3 days Ctol~Jls6 (witllJut 14cctracemiddot4) For babCes 1111 elevlltld direct bllrubln 005 mglkg 024h x 2 days Infusion late PlbJO d~ (with or ltfthott Neotnce-4) For babies vilo ruve reltelved ~ltIe enlefal nutlitlon gt30 days 002 mg1lo 02 x 2 dave

1()60 microgtlm Sikglh

16 -3 kg gt 3 kglt 16 kg

3 5 mg in SCmI 75 mg in 5Om115 mg in 5Om1 D5W DSWD5W

003 mahnl) (007 m9iD-lll--I--lt-0-15~mrr7m-rl mllhr =plt (kg ) mlitlr 11 wt (kg) Itmill - pt wt (kg)

It desired do dasired dONIt desired dose mCCWkQhf 70 m Q(~ll50mgJi) 33

Renal OyrlunctJon (without NeotnrM) For bablCo vith suspected rEllal dysfunction bo nol on dlal~k U$UalIV I1el concenltalion 1 mgrml Vlth (hoksbld~ amp l entil dysfunction Hatlc tb Neotr~ce ~ lind 51lve line only Because of concerns ebout the long lerm lde cffecb of po3tnllbl dexamethasone in prelarm

infanta currant practice is shifting to smaUer dosas and short courses Consul Vllth tho Morphine (lV lM PO) atLending regllrding the pf8lerred dexamethasone regiman for Individual patient

Patient wei ht lt 16 k

Slandard 15 mg in SOml

concentIlioo oo~~ml)l mllhr pi wt (kg) mllhr - 11 wt (kg) x dulred dose

mcafKalhr + 150

Intermillenl Coal 005-02 mCl1cQdoae Q4-eh Dm

(must be miJrk~ on TPN form) ContinlJOUS 10-20 microoramsfkQh fusion dose

peripheral Ilne$ 01 mglkgldoaIV or PQ012t1 x 5 do (Qiv 2 doses prior 10 eehllduilld exlubation) For airway edem n infants vto hevo previously f ilad exlubatJon (nol V411 studied) All cenl13l KOOS and lool) I~es 02S unlLcJn~ - gt3k16-3

75 mg in 5Om135 mg in saml Methylpreniolole (IV)

~Jl9n For acute eXllGorbalions of reacbVe airway diMliM 0 1~1m1)(OO~Sml ca 20 9=1rrEq=O5 111middot101 1 motkg1dosc 012h x 2 doses then 05 mgikgldO 0 I 2h x 4 days mlfhr plwt(kgraquo)Cmiddot1g 12 rrg=1 rrEqO51Tigt1O A oncmiddottime doO of 10 mgkg may be uaed pre-operativey for palienlpound undergoing ~rdiac ampurgary Ifusionre It desired dose Ia 2J rrg~ 1 mEq= 1 m )oj w iln b~ass ~=~~~OmCQIkaIhr) + l3I 39119=1 rrpoundq= 1mf-o1 Usual concontration 4 mglmf

UauIIV VlSI concentrlltx)J 2 mglmIa 31 n9 - 1 nilOl