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Chapter 132

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This section provides a description of commonly used drugs used in the contemporary care of sick newborn infants. It is not intended to be an exhaustive list of all drugs available for infants, nor is it intended to be an in-depth source of information about neonatal pharmacology. Readers are encouraged to consult with their institutional pharmacists regarding issues of pharmacokinetics, drug interactions, drug elimination and metabolism, and monitoring drug serum levels. Information on medications and breast-feeding and pregnancy can be found in Chapter 133.

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  • INDICATIONS AND USE: Analgesic, antipyretic.
  • ACTIONS: Analgesic effect is caused by inhibition of prostaglandin synthesis in the CNS and peripherally, which blocks pain impulse generation. Reduction of fever is produced by direct action on the hypothalamic heat-regulating center.
  • SUPPLIED: Suppositories, elixir, liquid, drops (preferred).
  • ROUTE: PO, PR.
  • DOSAGE:
    • Neonates: 10–15 mg/kg/dose PO/PR every 6–8 hours as needed.
    • Preterm infants 28–32 weeks: 10–12 mg/kg/dose PO every 6–8 hours or 20 mg/kg/dose PR every 12 hours. Maximum daily dose: 40 mg/kg/day.
    • Preterm infants 32–36 weeks < 10 days: 10–15 mg/kg/dose PO every 6 hours or 30 mg/kg PR loading dose; then 15 mg/kg/dose every 8 hours. Maximum daily dose: 60 mg/kg.
    • Term infants ≥10 days: 10–15 mg/kg/dose PO every 4–6 hours or 30 mg/kg PR loading dose; then 20 mg/kg/dose every 6–8 hours. Maximum daily dose: 90 mg/kg.
  • ADVERSE EFFECTS: Hepatic necrosis with overdosage, rash, and blood dyscrasias (neutropenia, pancytopenia, leukopenia, and thrombocytopenia). Renal injury may occur with chronic use.

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  • INDICATIONS AND USE: Mild diuretic or an anticonvulsant in refractory neonatal seizures. To decrease cerebrospinal fluid (CSF) production in posthemorrhagic hydrocephalus; also used in the treatment of renal tubular acidosis.
  • ACTIONS: Competitive, reversible, carbonic anhydrase inhibitor. Retards abnormal discharge from CNS neurons. Beneficial effects may be related to direct inhibition of carbonic anhydrase or may be due to the acidosis produced. Produces urinary alkalosis, useful in the treatment of renal tubular acidosis.
  • SUPPLIED: Injection, tablets (suspension can be compounded by the pharmacist).
  • ROUTE: IV, PO.
  • DOSAGE:
    • Diuretic: 5 mg/kg/dose IV/PO daily.
    • Anticonvulsant: 4–16 mg/kg/day PO divided every 6–8 hours not to exceed 30 mg/kg/day or 1 g/day.
    • Alkalinize urine: 5 mg/kg/dose PO 2–3 times over 24 hours.
    • Decrease CSF production: 5 mg/kg/dose IV/PO every 6 hours; increased by 25 mg/kg/day to a maximum of 100 mg/kg/day. Furosemide has been used in combination.
  • PHARMOCOKINETICS: Unchanged in urine. Half-life is 4–10 hours.
  • ADVERSE EFFECTS: Gastrointestinal (GI) irritation, anorexia, transient hypokalemia, hyperchloremic metabolic acidosis, growth retardation, bone marrow suppression, thrombocytopenias, hemolytic anemia, pancytopenia, agranulocytosis, leucopenia, drowsiness, and paresthesias.
  • COMMENTS: Limited clinical experience in neonates. Questionable efficacy to slow progression of hydrocephalus in neonates and infants. Used as an adjunct to other medications in refractory seizures. Tolerance to diuretic effect may occur with long-term use.

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  • INDICATIONS AND USE: Treatment and prophylaxis of herpes simplex virus (HSV-1 and HSV-2) infections, herpes simplex encephalitis, herpes zoster infections, and varicella zoster infections.
  • ACTION:Antiviral agent that inhibits viral DNA synthesis and viral replication. It ...

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