MultiVitamins:

Ascorbic acid
Drops 100mg/mL:
Syrup: 100mg/ml
<3mos: 0.3ml/day
2-6y/o: 5ml/day
3-12mos: 0.6ml/day
7-12y/o: 10ml/day
1-2y/0: 1.2ml/day

Vit. B complex + hysine + beclizine (Appebon

syrup)
2-6y/o: 1-2tsp OD
7-14y/o: 2-4tsp OD

Iron
wtx5/elem Fe
1mkday OD- prophylactic
Hemarate 30/5
3-6mkday BID-therapeutic
Iberet 26.25/5
Zinc RD 10-20mg/day
Incremin 30/5
10mgdrops- infant
Sangobion 12/10
20mg- >2yo
Ferlin 30/15

Folic acid
2.5g/ml
0.2 mkday

Vitamin A

6-11mos: 100,000IU 1 dose

12-71mos: 200,000IU

<2yrs: drops
10mg/ml=1ml

>2yrs: syrup
20mg/5ml= 5ml

Analgesics/Antipyretic
Paracetamol (Q4h)
RD: 10-15mkdose PO
10mkdose IV
15mkdose-BFC
Drops: 100mg/ml
60mg/0.6mk
Syrup: 120mg/5ml
125mg/5ml
350mg/5ml
Tab: 325mg/tab
250mg/tab
500mg/tab
Amp: 150mg/ml
300mg/ml

Mefenamic Acid (q6-8hr)

RD: 5-8 mkdose
Susp: 50mg/5ml
125mg/5ml
Cap: 250mg/500
Aspirin (Q4-6H)
RD: 10-15mg/kg/dose upto
60-80mg/kg/24h
Anti-inflam:60-100mg/kg/24hPO
Kawasaki: 80-100mkday
Nimesulide (BID)
RD: 2.5-5mkdose
100mg/tab

Ibuprofen
RD: 5-10 mg/kg/dose
PO Q6-8H
Susp: 100mg/5ml
Forte: 200ng/5ml
Cap: 200mg

Antacids
Ranitidine (Q8h-12h)
RD: 0.75mkose PO
0.8-1mkdose IV
Amp: 25mg/ml, 50mg/5ml
Tab: 150mg/300mg
Cimetidine (Q4-6h)
RD: 10-15mkday
<1y.o: 20mkday
1-12y.o: 20-25mkday
Liquid: 100mg/5ml
Amp: 150mg/ml, 100mg/ml
Tab: 200mg, 400mg

Famotidine (Q12h/IVQ8h)
RD: 0.2mkdose
Amp: 25mg/2ml
Tab: 20mg/40
Omeprazole
1mgkday

AlMg (Maalox) (Q6h)

2-4 tabs max: 16tabs
*take 30 minutes 1 hr after
meal at bedtime
Susp: 180ml; 355ml
Tab: chewable
Fw/flatulenceAlmg+dimeticone (Maalox
plus)

Ursofalk
10-15mkday
200/5ml

Anti-emetic/ Anti-spasmodic
Metoclopramine
Nifuroxide (Ercefuryl)
RD: 0.5mkdose PO
<6mos- 10ml
0.2mkdose IV
>6mos- 5ml
Amp: 10mg/2ml,
Adult: 1cap Q6H
Susp: 220mg/5ml
5mg/2ml
Cap: 200mg
Syr: 5mg/5ml
Tab: 10mg
Dicycloverine HCL
Hyosciene N-Butyl (Bromide)
(Q8h)
Q6-8h
RD: 2.5-5mg/kg/day
RD: 0.15mkdose
6mos-2y.o: 0.5-1ml
Amp: 20mg/ml
2y.o-5y.o: 2.5-5ml
Tab: 10mg
Drops: 5mg/ml, 15mg/ml
Syr: 2mg/ml, 10mg/ml
Tab: 10mg
Domperidone (Motilium)Q8h*15
RD: 0.3mkdose
Dyspepsia: Adult: 1tab/2tsp Q8h
Children: 2.5ml Q8h Suspension: 1mg/ml Tab: 10mg
N/V: Adult: 2tab/4tsp Q6-8h
Children: 5ml Q6-8h
Dyspepsia
N/V
10kg
2.5ml
5ml
20kg
5ml
10ml
30kg 7.5ml
15ml

Anti-Diarrheals
Paroromycin (Humagel)
RD: 20-30mkday 3-4 dived
dose
150mg/cap, 150 mg/5ml
Racecadotril (Hidrasec)
1 mos onwards
RD: 1.5mg/kg/day Q8h

Erceflora Bacillus
clausii
>1mos: 1-2 vials/day
2-11y.o: 1-2 vials/day
Adult: 2-3 vials/day
Nifuroxamide
(Ercefuryl)
<6mos: 1tsp BID
>mos: 1tsp TID

BW
Hidrasec Sachet
<9kg
10mg 1 sachet
9-13kg 10mg 1 sachet
13-27kg 30mg 1 sachet
>27kg 30mg 2 sachet
Adult dose: 100mg/cap Q8h
Antihelminthics
Mebendazole
500mg/tab single dose
100mg/tab or 5ml BIDx3 consecutive days
20mg/ml susp: 5ml BIDx3 consecutive days
50mg/ml susp: 10ml SD
Enterobiasis (100mg or 5mg SDrpt 2 or 4 weeks)
Susp: 20mg/ml, 50mg/ml
Tab: 100mg; 500mg
*deworm @2-4 yrs old
Pyrantel Pamoate
RD: 10-20 mkdose
Susp: 125mg/5ml
Tab: 125mg; 850mg
Albendazole
RD: 75mkday
Susp: 200mg/5ml
Tab: 400mg

Quinolones
Ciprofloxacin - BID
Vial: 100mg/50ml, 200mg/100ml, 400mg/200ml
Amebicide
Metronidazole q6h
RD: 30-50 mkday PO
7.5 mkdose IV
15mkdose loading dose
Vial: 5mg/ml
IV: 500mg/100
Susp: 125mg/5ml
200mg/5ml
Paramomycin
RD: 20-30 mkday
Susp: 150mg/15ml

Antihistamine
Hydroxyzine Hcl (Iterax)
Q12h x 5 days
RD: 1mg/kg/day or wt/4
Syrup: 2mg/ml
Tab: 10mg; 25mg
Amp: 5mg/ml
Chlorphenamine Maleate
Q8h
RD: 0.2mkdose
Amp: 10mg/ml
Vial: 10mg/ml
Syrup: 2mg/5ml
Tab: 4mg
*20kg-1/2 amp IM
>20kg-1amp IM
Cetirizine diHCL-OD-BID
RD: 0.25-0.27 mkdose
Drops: 10mg/ml
2.5mg/ml
Soln: 1mg/ml
Sry: 5mg/5ml
Tab: 10mg

Furazolidone
RD: 4-7 mkday
Liquid: 16.7 mg/5ml
Susp: 50mg/ml

Etofamide (Kitnos)
RD: 15-20mkayX3 days Q12H
Susp: 100mg/5ml
Tab: 200mg; 500mg

Desloratadine (Aerius)
6-11 mos: 2ml
1-5 y.o: 2.5 ml
6-11y.o: 5ml
>/=12y.o: 10ml
Syr: 2.5ml/5ml
Tab: 5mg
Diphenhydramine Hcl
RD: 3-5 mkdose PO
1mkdose IV
Syr: 12.5mg/5ml
Cap: 25mg, 50 mg
IV/IM: 50mg/ml

Levocetirizine
0.125mkdose

Mucolytic
Carbocysteine (Q8-12h)
Erdosteine (Q12h)
RD: 30-50 mkday
RD: 10mkday
Drops: 50mg/5ml
10-20kg, 2-6y.o: 2.5ml
Syr: 100mg/5ml
21-30kg, 7-12y.o: 5ml
Cap: 500mg
>30kg, >12y.o: 5mlTID/7.5ml
<3mos: 0.25ml
BID
3-5mos: 0.5ml
Susp: 115mg/ml; cap: 300mg
6-8mos: 0.75ml
9-12mos: 1 ml
5y.o: 5ml
Ambroxol (Q8h)
D: 1.2-1.8 mkday
Liq: 15mg/5ml; 30mg/ml
Soln for inhalation: 15ml/2ml
Amp: 15mg/2ml
Ped drops: 6mg/ml
Tab: 30mg; retard cap 75
Bronchodilators
Salbutamol TID
RD: 0.13-0.15 mkdose
Sry: 2mg/5ml
100mg/5ml
Amp: 1mg/ml
Tab: 2mg
Terbutaline BID TID
1-15y.o: 2.5ml
<3y.o: 0.075mkdose
Syr: 1.5mg/5ml
Soln: 2.5mg/5ml
Amp: 0.5mg/ml
Tab: 2.5mg

Procaterol
>/6: 5ml
</=5y.o: 2.5ml
Bambuterol
6-12y.o: 5mkdose
Oral soln: 1mg/ml
Tab: 10mg
Aminophylline/Theophylin
e
3-5mkdose
80mg/5ml; 125mg/tab,
175mg/tab

Cephalosporins
1st generation
Cefalexin Q6h
RD: 30-50 mkday PO
50-100mkday IV
Drops: 100mg/ml
Susp: 125mg/ml
250mg/ml
Cap: 250mg; 500mg
Cefazolin
RD: 50-100mkday IV x 3dose
Vial: 250mg
Inj: 500mg; 1g
2nd generation
Cefaclor Q8h
RD: 20-40mkday
Drops: 50mg/ml
Susp: 125mg/5ml
250mg/5ml
Tab: 315mg; 750mg
Cap: 500mg

Cefuroxime Q6-8h
RD: 20-40mkday PO; 50100mkday IV
Cefamandol
RD: 50-100mkday
Cefprozil
RD: 20-4-mkday
Powder: 125mg/5ml;
250mg/5ml
Tab: 250mg; 500mg
Cefotiam
RD: 50-100mkday
Tab: 200mg
Vial: 0.5g; 1 gm
Cefixime Q12h UTI: 8 TF: 20
RD: 3-6mkday PO,
15mkday
Drops: 20mg/ml
Susp: 100mg/5ml
Cap: 100mg;200mg
Cefdinir
RD: 9-8mkday
Cap: 100mg

3rd Generation
Cefoperazone
RD: 100-150mkday IV
Vial: 1.5g
Ceftriaxone BID
RD: 50-100mkday
Vial: 500mg; 1 g;
250mg
Ceftazidime
RD: 30-50mkday IV
Vial: 250mg; 500mg;
1g; 2g
Cefpodoxime
3-10mkday

4th Generation
Cefepime OD-BID
RD: 50-100
Vial: 500mg; 1g; 2g

Susp: 50mg/5ml
Tab: 100mg

Co-Amoxiclav: 228.5g/5ml; 457/5ml

Aminoglycosides
Gentamycin OD-BID
5-8mkday
Amikacin OD-BID
RD: 12-15mkday
15mkdose OD
\
Vancomycin
RD: 15mkday

Antihypertensives
Furosemide
RD: 0.5-1mkdose
Amp: 20mg/2ml
Tab: 40mg
Hydralazine
RD: 0.1-0.2mkdose
Amp: 20mg/ml
Tab: 10mg; 15mg; 50mg
Aspirin
75-100mkday
Nifedipine Q4-6h
RD: 10mkdose
Max: 10mg/kg/24h
Spironolactone
1.3-3mkday QID PO

Antifungal
Nystatin Q6h
Adult & children: 4-6ml
Infant: 2ml
Tab: 500,000 U
Susp:100, 000 U/ml

Fluconazole OD
RD: 3-6mkday
Vial: 3mg/ml
Cap: 50, 150, 300mg
Griseofulvin
Tab: 125mg/500mg

Amphothericin B
RD: 0.3-0.7mkday
Slow in Infusion
*250mcg/kg/day1mg/kg/day
Vial: 50mg/5ml; 2mg/ml
Cap: 50mg; 100mg;

Ketoconazole x 5 days OD
Adult: 200mg/tab
5-12y.o: 100mg/tab
1-4y.o: 50mg/tab

200mg

Isoprinosine: 50-100mkday
Macrolides
Erythromycin q8h
RD: 35-50mkday
Granules: 200mg/5ml;
400mg/5ml
Drops: 100mg/2.5ml
Tab: 250-500mg
Clarithromycin Q12h
RD: 7.5mkdose;
15mkdose
Susp: 125mg/5ml
Tab: 250; 500mg
Roxithromycin OD-BID
Adult: 150mg/tab;
300mg/tab Q12h
Children: >40kg
Kiddie tab: 100mg

Azithromycin OD-BID
RD: 15-20mkday
Susp: 200mg/5ml
Tab: 250mg; 500mg
Vial: 500mg
Chloramphenicol q6h
RD: 50-100mkday;
75mkday (enteric fever)
FT infant>/=2week: 25-50mg/kg/day
Cotrimoxazole BID
RD: 5-8mkday; 8 UTI; 10 BPN
Susp: 200mg/40mg/5ml(40mg/5ml) (wt/2)
400mg/80mg/5ml-(80mg/5ml)(wt/4)
Tab: 400mg/80mg;
800mg/100mg

Anti- TB drugs
1-10; R-15; S-20; E-35; P-30
Isoniazid
RD: 5-10
Syr: 100mg/5ml; 200mg/5ml
Tab: 100mg; 200mg; 300mg
Pyrazinamide
RD: 15-30mkday
Susp: 250mg/5ml
Tab: 500mg
Streptomycin
RD: 15-20mg/kg/day
Vial: 1gm
Ribavirin
RD: 10mkdose
Syr: 50mg/5ml
Tab: 100mg

Rifampicin:
RD: 10-15mkday
Drops: 100mg/ml
Cap: 300; 45mg
Ethambutol
RD: 12-25mkday
Syr: 125mg/5ml
Tab: 400mg
Amantadine HCL
RD: 4.4-8.8mkday
Syr: 50mg/5ml
Tab: 100mg

Anticonvulsants/ Sedatives
Phenobarbital
LD: 10mkday
MD: 5mkdose (max 25mkdose)
Diazepam
RD: 0.2-0.8 mkdose

Steroids
Prednisone BID
RD: 1mkday BID; 2mkday
OD
Susp: 10mg/5ml
Syr: 5mg/5ml; 20mg/5ml
Tab: 1, 5, 10, 20, 30, 50mg

Midazolam
RD: 0.2mkdose
Tab: 15mg
Amp: 5mg/ml, 5/5, 15/3
Phenytoin
LD: 10mkdose
MD: 5mkday
Susp: 30/5, 12/5
Cap: 30, 100

Dexamethasone
RD: 0.5 1mkdose
0.3mkdose initial, then
0.1
mkdose 1-2mg/kg Q6h x
4
*xtubate on 3rd dose
Procaterol (Meptin) BIDTID
RD: 0.25mkdose or
0.25xwt
Syr: 5meq/ml
Tab: 25meq, 50meq
Aminophylline
LD: 5-7mkdose
MD: 3-5mkdose

Hydrocortisone
RD: 5mkdose Q6-8h
LB: 10mkdose
MD: 5(max 100)
Vial inj: 100mg; 250mg;
500mg
Erdosteine (Ectrin/Zertin)
175mg/5ml-10mkday
BID;
300mg/cap BID
Combivent: 200ug Ipatropium
<2y.o: 5-8 drops; 2-3 y.o: 3 drops; >4y.o: 20 drops

IVIG
Dose: 2g/kg in 12H or 400mg/kg/dose x 5d
2.5g/vial, dilute w/ 50ml diluents to make 50mg/ml
administer the ffL
Test
1.1
1.2
1.4
1.8

dose:
NAHCO3
0.5ml/kg/H x 15min
BE x wt x 0.3 or 1meq/kg
1ml/kg/H x 15min
can be given IV push or drip
1.5ml/kg/H x 15min
50mcg/kg NA>1-2 meq/kg
2ml/kg/H x 15min
2.5ml/kg/H x 15min
3ml/kg/H x 15min
3.5ml/kg/H x 15min
4ml/kg/H x 15min
*if tolerated in fuse the rest at ____cc/h for 10hr watch out
for headache, flushing, hypotension, fever and chills
Aminosteril
0.5/kg-inc until 3g/kg
Wt x RD x 100/6%/24 or wt x RD/0.694
*start 1g x 48H then resume at 2g
Conversion of Hyponatremia
1ml=2.5 meqs NaCL
Wt: 1.8 kg
S.Na: 131.4
D-A x wt x 0.6 (140-131.4 x 1.8 x 0.6 = 9.2 meqs)+ wt x 3=
maintenance (1.8 x 3=5.4)
- 4.6 1.8 6.4
- 2.3 1.8 4.1
- 2.3 1.8 4.1
1st Shift
D5W- 6.6

HYPONATREMIA
D-A x wt x 0.6 (2-3)
maintenance

HYOPCALCEMIA
K/K (?) 0.1 to 0.3 meqs/k/H
NK of Body= 50meqs
K/R meqs KCL/#Hrs/wt

D5IMB- 50
NaCl- 2.5 (?)
Hypokalemia
D-A x wt x 0.3 + (Wt x 2) ?
Wt x 0.2 x 8 x 3 x 2 x wt
Sk- <3-5% -0.05
<2.5-10%-0.10
Wt X 0.05 x 50 /wt x (2/maintenance)
RESPONSE TO PHOTOTHERAPY
*check rebound B2 for 12-24H after discharge
Bilirubin
<18
</=18
</=14
</=15
Age in
hours
24-48H
49-72H
>72H
Tx/rec

Age
49-7/2
>72
TSB (mg/dl)
<15
<18
<20
OPD

Action
Wean to single photo
D/C home
D/C photo
D/C photo

15-<20
18-<24
20-<25
PHOTO

20-<25
25-<30
25-</=30
INTENSIVE
PHOTO

>/=25
>/=30
>/=30
PHOTO/exc
trans

IDEAL BODY WEIGHT

At birth
3kg
3-12mo
Age (mo)+ 9 /2
1-6 yrs
Age (yrs)x 2 + 8
7-12 yrs
[Age (yrs)x 7 5 ]/2
IDEAL BODY WEIGHT GIVEN BIRTH WIEGHT
<6mo
Age (mo) x 600 + BW in gm
6-12 mo
Age (mo)x 500 + BW in gm
Age

Consid
er

Photo

Exchange
transfusion

Exchange
transfusion

Photo
</=24
d
25-48
49-72
>72

>/=12
(170)
>/=15
(260)
>/=17
(290)

if extensive
photo

>/=15
(260)
>/=18
(310)
>/=20
(340)

>/=20
(340)
>/=25
(430)
>/=25
(430)

if intensive
photo

>/=25
(430)
>/=30
(510)
>/=30
(510)

EXPECTED BODY WEIGHT

Term: EBW= (Age in days - 10) x 20 + BW in gm
Preterm: EBW= (Age in days - 14) x 15 + BW in gm

Where 10: # of days to recover over physiologic wt

loss
20: g/day gained
CARDIAC OUTPUT
Newborn: 180-240ml/kg/min or 4ml/beat
DOPAMINE DRIP
(200mg/250-800conc) 0.0375/26.6
(400mg/250ml-1600conc) 0.075/13.3
Wt x RD x 60 (0.075)
SHORT CUT: wt x RD
WT X 3(50) X dose (10mg/kg)
13.3 (800-conc)
6 (100)
Wt x RD
Rate (1cc/hr)
26.6 (1600-conc)
1.6
To check: AD: dose given x Prep/60/wt
Or WT x RD X 140D/ 1600/24
Max: 20
LEVOPHED
4mg/4ml; 2mg/ml
e.g 2ml/ml
2/100 x 1000= 20 conc

(WT x dose x 60)= ml

Conc
To check: ml x conc/60/15= dose
DRIP FORMULA
6 x wt (kg)x mcg/kg/min mgin100ml of D5NSS
MI/H
ISOPROTERENOL/EPINEPHRINE/NOREPINEPHRINE
0.6 x wt (kg) = mgin100ml O
*1ml/H will deliver 0.1 mcg/kg/min
DOPAMINE/ DOBUTAMINE/ AMRINONE/ NITROPRUSSIDE
6 x wt (kg)= mg in 100ml
*0.1 ml/H will deliver 1mcg/kg/min
DOPAMINE/ DOBUTAMINE
6 x wt (kg) = # mg to add to diluents to make 100ml volume
DOBUTAMINE DRIP
2.5 15mcg/kg/min (max: 40mcg/kg/min)
Peak effect: 10-20min
Prep: 12.5 mg /ml x 20ml/vial= 250mg/250ml (vial)
Premix: 1000mcg/ml in 250= 250/250 (1mg/ml)
2000mcg/ml in 250 ml= 500mg/250 (2mg/ml)

Dobu-premix
0.06-1000=250/250 D
%W
0.03-2000
x in
dose
x ____mg
0.06/0.03
Wt x RD x 60 or wt x RD x 1400/12500 or 6 Wt
x wt
kg=
in
2000
100ml(1mcg/kg/min)
Ex: 250mg in D5W 250cc(1mg/ml) 500mg in D5W250cc(2mg/ml)
Mcgtt/min= (Wt x DD)/16.6
ugtts/min=(wt x DD)/33.2
= Wt x DD x 0.06
= Wt x DD X 0.03
*to check: 7.5 actual x 2000/ 60 /wt
actual x conc/60/wt

FUROSEMIDE DRIP
20 mg/2ml
**4ml + 20cc PNSS to run @ 1cc/h
(wt)15 x (dose) 0.1 x 24
36 x 2/20 = 3.6
3.6/4ml = 0.9 or 1cc
Prep: 10mg/ml amp (2m)
Dose: infant and child: 0.05 mg/kg/H (titrate to clinical effect)
Adult: 0.1 mg/kg/H (max: 0.4 mg/kg/H)

Wt(kg)x dose x 24 = mg in 24 ml of NS to make: 1ml/H =

0.1mg/kg/H
Wt(kg) x dose x 24 x 5= mg in 120ml NS to make
5ml/H=0.1mg/kg/H

*20mg furo + 20cc distilled water to make conc of 1mg/ml

Infusion rate: 0.05 x wt eg: 0.05 x mg x 1 = 4 cc
EPINEPHRINE DRIP
Wt x 0.6 mg = mg added to 100mgD5W
1cc/H = 0.1 ug/kg/min
5cc/H = 0.5 cc/min
ml/H= wt x dose x 60
10cc/H = 1mg/kg/min
conc
0.1mkd/0.1cc/kg/dose
INSULIN DRIP
1.1 1 cc or ml/H
Wt x 0.1 x 24 = # of ml/cc of insulin to be added to NSS to make
24 ml soln to run for 24H
MIDAZOLAM DRIP
Prep: 5mg/ml amp
Dose: intermittent: 0.05 0.15mg/kg/dose
Continuous: 1-2mcg/kg/dose
6 x wt(kg)x mcg/kg/min = mg in 100ml of D5W/NS

mL/H
Max total dose: 10mg (intermittent); can cause respiratory
depression, hypotension, bradycardia

AMIODARONE DRIP
Prep: 50mg/ml amp
Dose: infant and child: 5mg/kg over 30 min ff by infusion
starting at 5mcg/kg/min
Max dose: 10mcg/kg/min or 20 mg/kg/H must be diluted in
D5W
infusion concentration should not exceed 2 mg/ml
wt(kg)x dose x 60 x 50 = mg in 50mlD5W
1000
To make: 1ml/H= 1mcg/kg/min
INSULIN DRIP
Prep: 1U/ml amp
Dose: Infant and Child 0.1Ukg/H (titrate to clinical effect)
Glucose drop: 80-110mg/dl/H
Wt(kg)x dose x 24 = U in 24ml NS
or
Wt (kg)x dose x 24 x 5 = U in 120ml of NS
*to make: 5ml/H= 0.1U/kg/H
NICARDIPINE DRIP
Prep: 2.5mg/ml= 5mg/10ml ampule
Dose: Child: 0.5-5mcg/kg/min (titrate to clinical effect)
Adult: start with 5mg/H, increase dose as needed by
2.5mg/H Q 5 -15 min (Max dose: 15mg/H) decreased by
3mg/H as needed to maintain desired response
AMINOPHYLLINE DRIP
LD: 5mg/kg BW in 30cc 5W in a soluset (if px is not maintained
on oral theophylline) or
25mg/vial dilute 1ml + 4ml NSS to make 5 mg/ml so;ution.
Aspirate ____mL give per iv infusion for 30 min as LD
(5mg/kg)
D5W250cc + Aminophylline 250mg/amp at ____ugtts/min
Main drip: 0.4 0.8mg/kg/H

Formula ugtts/min = dose x BW

Note: maintenance infusion rate must be induced to 0.2 0.3
mg /kg/H for elderly px, pregnant px and those in CHF. Liver dse
or cor pulmonale watch out for hypoglycemia and tachycardia.

DUET (Double Volume Exchange Transfusion)

Blood volume: 80cc/kg
ABC: no correction if
E.g wt: 3kg
<10 B.D
3 x 80 x 74-60/74 = 3360/74
45cc to be exchanged
160-180cc/kg/FWB
Mothers Blood type wt 80 x 2
INDICATIONS:
Sepsis
S. Bilirubin >20mg/dl
Hypoxia and acidosis
Hemolytic dose of NB
ABO incompatibility
Prematurity

Corrected WBC:
e.g RBC = 7500= 75000/500-15
for every RBC = 1 WBC
WBC = 37-15=22 corrected
RBC

COMPLICATIONS:
Vascular embolism
Infection
Cardiac arrhythmia vol overdose
CP arrest
Electrolyte imbalance
FIO2: 100% target FiO2 X TRF (S)
79
ABDOMINAL UTZ
Stomach LUQ, directly under the L diaphragm
Small Intestines- central abdomen,
can have a random faceted/ tesseliated appearance
when air filled (but not dilated).
Encircling valvulae connivantes visible depending on
degree of air filling.
Valvulae connivantes more widely spaced in ileum

Large Intestines circumferential, tends to frame the small

intestines
Feces of variable consistency
Haustral folds interspaced w/ plicae semilunaris

Neurotoxicity

Cisplatin ototoxocity, p. neuropathy

Paclitaxel p. sensory, neuropathy

Vinca Alkaloids- motor , sensory, autonomic

neuropathy, adynamic ileus, urinary bladder atony
Cardiac Toxicity

Doxorubicin, Daunomycin cardiomyopathy

Pulmonary Toxicity

Bleomycin interstitial

Alkylating agent pneumonistis w pulmonary

fibrosis
Gastrointestinal Toxicity

Mathotraxate hepatic fibrosis

Vinca Alkaloids- adynamic ileus, urinary bladder

atony
Genitourinary Toxicity

Cisplatin azotemia, Mg wasting

Methotrexate oliguria RF

Cyclophosphamide/ Ifosfamide chronic

hemorrhagic cyctitis
Dermatologic Toxicity

Doxorubicin

Actinomycin D

Vincristine

Skin necrosis, sloughing from

drug extravasation

Gonadal Dysfunction

Azospermia recovery is uncommon

Hematologic toxicity

Granulocytopenia/neutropenuia
6-12 days after administration
Recovery in 21-24 days
ANC= (WBC count)(%segmenters)
Must be 1500 for chemo to proceed

Thrombocytopenia
Recovers 4-5 days later than granulocytes
100,000/mm3 for chemo to proceed
Fontanels anterior closes at 18 mos (as early as 9=12
mos)
Posterior 6-8 weeks
Colostrum 1st 2-4 days postpartum CHON, vitamins,
salt, Ig
fat and sugar
Absolute Contraindications to BF

Galactosemia

Tyrosinemia
Relative Contratindications to BF

Psychosis

Active TB
ET Tube Size
<1000
1000-2000
2000-3000
>3000

Premature
0-3 mo

AOG
<28
28-34
34-38
>38
ET SIZE BY AGE
2.5mm
3.0mm

SIZE
2.5
3.0
3.5
3.5-4.0

3-7 mo
7-15 mo
15-24 mo
2-10 yrs
10-20 yrs

3.5mm
4.0mm
4.5mm
Age (yrs)+16/4 or Age(yrs)+ 4/4
6-8mm

ET level: size of tube x 3

Laryngoscope Blade
Size
Term/Newbor
Size 1
n
2-11 yrs
Size 2
>12yrs
Size 3
ET Tube Size & Depth
Weight
Size
500-1000
2.5
1000-1400
3.0
1400-1900
3.0
1900-2200
3.5
2200-2600
3.5
2600-3000
3.5
3000-3400
3.5
3400-3700
3.5
3700-4100
4.0
4100-4500
4.0
>4500
4.0

1.
2.

Depth
7.0
7.5
8.0
8.5
9.0
9.5
10
10.5
11.0
11.5
12.0

BELL CLINICAL STAGING OF NEC

Suspect,
Infant with suggestive clinical signs but x-ray non
diagnostic
Definitive
Infant w/ pneumatosis intestinalis
2a: mildly ill

3.

2b: moderately ill (acidosis, thrombocytopenia/

ascites)
Advanced
3a: critilac w/ impending perforation
3b: critical w/ proven perforation

MAXIMUM K that can be in cooperated per Liter IVF:

Parenteral: 40meqs

Central: 60-80meqs
KAWASAKI DSE
Fever= 5 days
1.
Bilateral bulbar conjunctival injection with limbic
sparing (-)exudates
2.
Erythematous mouth and pharynx, strawberry
tongue, red, cracked lips
3.
Polymorphous, generalized erythematous rash
4.
Changes in peripheral extremities consisting of
induration of hands and feet
5.
Acute nonsuppurative cervical lymphadenopathy
(uni/bilateral) ~1.5 cm
IVF: D10 1st24hrs of life
D10IMB after 24 hrs of life
How to replace fluids: 1st 24HDL wt x 80cc/kg if NPO
Day 1
90 cc/kg
2
100 cc/kg
3
110 cc/kg
4
120 cc/kg
5
130 cc/kg
6
140 cc/kg
7
150 cc/kg
8
160 cc/kg (max)
D10IMB = Desired Actual x volume
Highest Lowest

Available: D5IMB; D50W, D10W

D10IMB=
10-5 x volume (100)
50-5
= 5 x 100
45
11ccD50W 11 D50W (subtract from the volume 100)
+ 89ccD5IMB 89 D5IMB
D10IMB

UMBILICAL CATHETERIZATION
Wt x 3 + 9 = answer + 1.2 cm
2

Allowable Blood loss in Preterm: 10% of BW

Allowable Blood loss in infants/neonates: 20% of BW

H. Influenzae: 7-10days
S. pneumonia: 10-14 days
N. meningitides: 7 days
E. coli, citrobacter, Senatia: 21 days
Enterococcus: 14 days
MENINGITIS

<1mo: GBS, enterobacteriaceae, listeria,

monocytogenes
Tx: Ampicilin & Cefotaxime
Alt: Ampicilin & gentamycin
(nosocomial- Ampi + gentamycin)

1mo-3mo: GBS, S. Pneumoniae, Hi. Influenza, N.

meningitides, Enterobacteriaceae
Tx: Ampiciliin, Cefotaxine

>3mo & children S. Pneumoniae, N.

meningitides, H. influenza, neonatal pathogens
Tx: Cefotaxime/Ceftiaxone, Vancomycin added
for
possible penicillin resistant S. Pneumoniae

AMINOSTERIL COMPUTATION
Wt x 1gm x 100 = ___ cc to run for 22hrs, rest for 4hrs
6
EX. Wt: 900gms 0.9x 1gm x 100 = 15cc
6
1.
Order: Aminosteril 6% 15cc to run for 22 hrs; rest for 4
hrs x 2 cycles
(TFI 150- 1gm AA - FFP)
ex: FFP x 2 units 18cc/unit
150-15cc-15cc-18cc+18cc x wt = 84 24 = 3-4cc/hr IVF
rate
24H
PIP 8 10 (Pacterm 12)
PEEP 4
100-FIO2 79 x PEEP = level of compressed air
PEEP compressed air level of pure air
RESPIRATORY DISTRESS SYNDROME
Deficiency of pulmonary surfactant, a phospholipid
protein mixture that decreases surface tension &
prevent alveolar collapse.
Type II alveolar cells from 32 weeks AOG
Risk of RDS is decreased in babies born >24hrs and
<7days after maternal steroid administration

APNEA respiratory pause >20sec or a shorter pause

assoc. w/ cyanosis, pallor, hypotonia or bradycardia
Causes: Thermal instability, prematurity, infection (NEC,
meningitis, neo sepsis), metabolic disorders, CNS problems
(Seizures, malformations), drugs (maternal/fetal), decreased
O2 delivery (anemia, hypoxemia, L to R shunt)

Disturbance

Primary
Change

Acute resp.
Acidosis

PaCO2

Acute Resp.
Alkalosis

PaCO2

Chronic Resp.
Acidosis

PaCO2

Chronic Resp.
Alkalosis

PaCO2

Metabolic
Acidosis
Metabolic
Alkalosis

HCO3
HCO3

PH

Compensatory
Response
HCO3 by 1 meq/l for
pH
each 10mmhg rise in
PaCO2
HCO3 by 1-3meq/L

for each 10mmhg fall

pH
in PaCO2
HCO3 by 4meq/L for

each
pH
10mmhg rise in PaCO2
HCO3 by 2-5meq/L

for each 10mmhg fall

pH
in PaCO2

PaCO2 by 1 1.5 x
pH
fall in HCO3

PaCO2 by 0.25 1 x
pH
rise in HCO3

EPINEPHRINE : 1:10, 000 (0.1mg/ml)

Recommended IV does: 0.1-0.3 mg/kg of 1:10, 000 soln via
umbilical vein
1.5 1mg/kg via ET

FFP 4cc/k/ APTT by 1gm/dL

CEFEPIME

Term and preterm infants greater than 28 days of age:

50mg/kg per dose every 12 hrs

Term and preterm infants 28 days of age and younger:

30 mg/kg per dose every 12 hrs

Meningitis and severe infections due to Pseudomonas

aeruginosa or Enterobacter spp: 50mg/kg per dose
every 12 hrs

Administer via IV infusion by syringe pump over 30

minutes or IM.

To reduce pain at IM injection site, cefepime may be

mixed with 1% Lidocaine without epinephrine
CEFOTAXIME
50 mg/kg dose IV infusion on syringe pump over 30 minutes,
or IM.

PMA
(Weeks)
29

Dosing Interval Chart

PostNatal (day)
Interval (hours)

0 to 28
12
> 28
8
30 to 36
0 to 14
12
> 14
8
37 to 44
0 to 7
12
>7
8
45
All
6
Disseminated Gonococcal Infections: 25 mg/kg per dose
IV over 30 minutes or IM every 12 hrs for 7 days with a
duration of 10 to 14 days if meningitis is documented.
CEFTAZIDIME

30 mg/kg per dose IV infusion by syringe pump over 30

minutes or IM.

To reduce pain at IM injection site, Ceftazidime may be

mixed with 1% Lidocaine without epinephrine.

PMA (Weeks)
29
30 to 36
37 to 44
45

Dosing Interval Chart

PostNatal
(day)
0 to 28
> 28
0 to 14
> 14
0 to 7
>7
All

Interval
(hours)
12
8
12
8
12
8
6

RANITIDINE
Oral: 2mg/kg per dose every 8 hrs.
IV: Term: 1.5 mg/kg per dose every 8 hours slow push
Preterm: 0.5 mg/kg per dose every 12 hours slow push
Continuous IV infusion: 0.0625 mg/kg per hour; dose range.
0.04 to 0.1 mg/kg per hour
FLUCONAZOLE

Invasive Candidiasis: 12 to 25 mg/kg loading dose,

then 6 to 12 mg/kg per dose IV infusion by syringe
pump over 30 minutes or orally.

Consider the higher doses for treating severe infections

or Candida strains with higher MICs (4 to 8 mcg/ml).
Extended dosing intervals should be considered for
neonates with renal insufficiency (serum Creatinine
greater than 1.3 mg/dl)

NOTE: the higher doses are based on recent

pharmacokinetics data but have not been prospectively
tested for efficiency or safety
Prophylaxis: 3 mg/kg per dose via IV infusion twice
weekly or orally. A dose of 6 mg/kg twice weekly may
be considered if Candida strains with higher MICs (4 to

8mcg/ml). Consider prophylaxis only in VLBW infants at

high risk for invasive fungal disease.
Thrush: 6mg/kg on day 1 then 3mg/kg per dose every
24 hrs orally.
INVASIVE CANDIDIASIS DOSING INTERVAL CHART
Gestational age
Post Natal
Interval (hours)
(weeks)
(Days)
29
0 to 4
48
24
>14
30 and Older
0 to 7
48
>7
24
OXACILLIN
Usual Dosage: ____mg/kg per dose IV over at least 10
minutes
Meningitis: 50 mg/kg per dose
DOSING INTERVAL CHART
PMA (Weeks)
PostNatal (day)
Interval (hours)
29
0 to 28
12
> 28
8
30 to 36
0 to 14
12
> 14
8
37 to 44
0 to 7
12
>7
8
45
All
6
MEROPENEM
Sepsis: 20mg/kg per dose IV
Less than 32 weeks GA: less than or equal to 14 days PNA,
every 12 hrs, greater than 14 days PNA, every 8 hrs
32 weeks and older GA: less than or equal to 7 days PNA,
every 12 hours; greater than 7 days PNA, every 8 hours
Meningitis and infections caused by Pseudomonas species,
all ages: 40mg/kg per dose every 8 hours.

Give an IV infusion over 30 minutes, longer infusion

times (up to 4 hrs) may be associated with improved
therapeutic efficacy.

METRONIDAZOLE
Loading dose: 15mg/kg orally or IV infusion by syringe punp
over 60 minutes
Maintainance dose: 7.5 mg/kg per dose orally or IV infusion
over 60 minutes. Begin one dosing interval after dose.
DOSING INTERVAL CHART
PMA (Weeks)
PostNatal (day)
Interval (hours)
29
0 to 28
12
> 28
8
30 to 36
0 to 14
12
> 14
8
37 to 44
0 to 7
12
>7
8
45
All
6
COMPOSITION OF AVAILABLE PARENTERAL FLUIDS
IV
Na
Cl
K
Mg
Ca
HCO3
0.9N
154
154
SS
0.3N
51
51
SS
LR
130
109
4
1.5
Lactate
NR
140
98
5
1.5
Acetate/Glucon
ate
NM
40
40
13
1.5
1.5
Acetate
IMB
25
22
20
1.5
Acetate
Serum Anion Gap (AG)= Na (Cl + HCO3)
Urine Anion Gap= (Na + K) Cl
Delta Gap= Actual AG 10
24-Actual HCO3

EPINEPHRINE DRIP:
6 X Wt in Kg x mcg/K/min = ____mg in 100ml of D5W/NS
mL/Hr

Set your own rate: ex: 4ml/hr

6 x wt x 0.1 mcg/kg/min
4ml/h
If wt is 40 kg: 6 x 40 x 0.1 = 6mg in 100ml D5W
4
Order: Start epinephrine drip: 6mg epinephrine + 100cc
D5w x 4cc/Hr (0.1 mcg/k/min)
BEVV
BEVV x 0.6 x Wt
(1/2 push then to run for _____) or
Desired actual x 0.3 x wt
DOPAMINE
Wt x ug/min 26.6
Ex: 40kg x 15ug/min or 10ug/min 26
DOBUTAMINE
Wt x ug/min 16.6

DOPAMINE DRIP
(5-8mg/k/min)

100cc 6 x wt x dose = 21mg of Dopamine

Rate___
1.6
79cc D5W + 21mg of Dopamine

25cc

1.5 x wt x dose = 5mg of Dopamine

Rate___
1.6
5mg of Dopamine in 20cc D5W

HEMODIALYSIS PRESCRIPTION
Blood Flow Rate: 5ml/kg/min
Dialyzer: F4: BSA 0.7
F5: BSA 1.0
F6: BSA 1.3
NSS Flushing 100ml q 15min or Heparin LD: 10-20IU/kg
MD: 10-20IU/kg
Ultrafiltrate 0.2ml/kg/min x ____ hrs
Duration: initial 1.5 2 hrs
2nd day: 3hrs
3rd day: maintemance 4hrs
Bicarbonate bath: prime solution with NSS 120ml

Weigh pt pre & post HD and record

Monitor VS q15mins while on HD
Watch out for Headache, nausea, disorientation,
hypotension, seizure, muscle cramps & vomiting
Labs: pre & post HD
Intradialytic transfusion (if any )
Initial HD: Mannitol 0.5-1.0g/kg to decrease
disequilibrium syndrome in pt w/ elevated BUN
(>35mmol/L)
Refer accordingly.
MGH orders for KD
Repeat CBC, Plt, ESR, after 2 weeks
Repeat 2D echo after 6 weeks
Home meds: ASA 80mg/tab 1 tab OD x 6 weeks take on
full stomach
No live attenuated vaccine for at least 11 months

KAWASAKI DISEASE

Febrile, examthematous, multisystem vasculitis

Fever for at least 4 days

+ clinical features (at least 4/5)
1.
Bilateral bulbar conjuctival injection w/o exudates
w/ lumbar sparing
2.
Erythematous mouth & pharynx, strawberry
tongue and red, cracked lips
3.
Polymorphous, generalized erythematous rash
(morbilliform, maculopaular or scarlatiniform )
4.
Changes in peripheral extremities (induration of
hands and feet w/ erythematous palm & soles
later w/periungual desquamation)
5.
Acute, nonsuppurative, unilateral cervical
lymphadenopathy at least 1.5cm in diameter or if
w/ coronary actery aneurysims
ATYPICAL KD common in <12 mo old

Coronary artery ectasia/dilatation: confirms

diagnosis (1-4 wks DOI)

Labs: CRP > 3.0mg/dl 1st 2 weeks of illness

ESR > 40mm/h
PLT ct >450 on days 10-12 of illness
without aspirin & IVIg, fever can last upto 2
weeks or longer. After fevr resolves, pt can remain
notablefor 2-3 weeks. Desquamation of groin,
finger, toes after 2-3 weeks may occur.

Labs normalizes w/in 6-8 weeks

Treatment

IVIg high dose

within 10 days

Aspirin

IVIg: 2g/kg as single dose over 10-12hrs

Aspirin: 80-100mg/kg/day x 4 doses

After fever is controlled, Aspirin to 3-5

mg/kg/day, discontinue after 6-8 weeks if no heart
problems

Recommended Dosage and Drip Rate for Kawasaki

Patient
Dosage: 2g/kg/12hrs
EX: Pt: 10kg
Patient total needs: 20g of Immunorel
Total Volume need: 400ml to be divide by 12 hrs
= 33.33ml
Initial Test drip: 33.33ml/4= 8.33ml for 1st
hour
Succeeding Drip Rate
2nd hour: 8.33ml x 16.67ml
Total Volume left: 375ml/10hrs=37.5ml/hr
* Courtesy of Dr. Ana Marie Morelos, Dr. James Angtuaco and
Dr. Edison Ty
GUIDELINES FOR PEDIATRIC PLATELET TRANSFUSION
Children/Adolescents
<50 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and bone marrow failure with age risk factor
<10 x 109/L and bone marrow failure w/o age risk factor
Infants within the 1st 4mos of life
<100 x 109/L and bleeding
<50 x 109/L and invasive procedure
<20 x 109/L and clinically stable
<100 x 109/L and clinically unstable
WHO GRADING OF DHF
I.
Hemocencentration, fever, & constitutional sx; +
TT
II.
Spontaneous bleeding + grade 1
III.
Circulatiry failure, pulse pressure <20mmhg
SBP normal
DSS
IV.
Profound shock, hypotension/unrecordable BP
WHO CASE DEFINITION OF DHF (WHO 1975, 1986)
All of the ff criteria nust be present:

1.
2.
3.
4.

Fever (high and continuous of 2-7 days duration)

Hemorrhagic diathesis (at least a positive tourniquest test
except in shock)
Thrombocytopenia (less than 100,000/mm3)
Hemoconcentration (20% or more relative to baseline or
evidence of increased capillary permeability) or evidence
of plasma leakage (i.e. pleural effusion, ascites and/or
hypoproteinemia)

OTHER CLINICAL MANIFESTATIONS SUGGESTIVE OF DHF ARE:

1.
Hepatomegaly (which may be tender)
2.
Circulatory disturbances (restlessness, cool extremities),
capillary refill time >2 sec., tachycardia)
3.
A fall in hematocrit following volume relacememnt
~ These along with a platelet count below 100,000/mm3 can
justify notification of the case as DHF
~ Hematoconcentration may be absent during earlt fluid
replcemnt or in cases where bleeding has occurred.

Unstable VS, urine

output
Signs of shock
Immediate rapid volume replacement 10-20ml/kg (or rapid bolus)normal
saline or LR solution

Improvem
ent
Adjust IVT

No
Improvement

O2 to Correct
Acidosis

Hematocri
t

Hematocri
t

Blood transfusion
10ml/kg

Colloid infusion 10-20 ml/kg IV

Plasma/Hemaccel / 5%
Albumin/ Dextran 40

~ Treatment for dengue shock syndrome

grades 3 and 4

SCABIES
Crotamion (Eurax)lotion apply from neck down x 24h
then rinse
DOPAMINE DRIP
200mg in D5W 200cc
mcgtt/mins = wt x DD/13.3
= wt x DD x 0.75
400mg in D5W 250cc
mgtt/min = wt x DD/26.6
= wt x DD x 0.375
6 x wt in kg = ___ mg in 100ml (1ml/hr = 1mcg/k/min)
Light index
D2 diameter of collapsed lung
DH diameter of hemithorax on the collapsed side
% of pneumothorax= 100-(D23/DH3 x 100)
DOBUTAMINE DRIP
6 X WT in Kg = ______mg in 100ml
250mg in D5W 250cc (1mg/ml)
Mcgtt/min= wt x DD/16.6
= wt x DD x 0.06
500mg in D5W 250cc (2mg/ml)
Mgtts/min = wt x DD/33.2
= wt x DD x 0.03
EPINEPHRINE/NOREPINEPHRINE DRIP
0.6 X WT = ______mg in 100ml
1ml/hr will deliver 0.1mcg/kg/min
Treatment for Chicken Pox
Children: 800mg/tag, 1tab QID
>40mg (3, 200mg PO in 4 divided doses)

Nasal Cannula
Oxygen Flow rate
1
2
3
4
5
6

Est. FIO2 in %
24%
28%
32%
36%
40%
44%

SIMPLE FACE MASK

5-6
6-7
7-8

40%
50%
60%

Anion gap (serum)= Na- (Cl + HCO3)

Corrected Ca= Actual Ca + [(40-alb)x 0.02]
Sodium deficit= DNa-Ana x BW x 0.6
Potassium deficit = DK AK /0.27 x 100%
Sodium

The needed to infuse

DNa-Ana
0.5 meqs / hr
L

Amount of PNSS needed =

Computed Na deficiency 154

Drip rate = amount of PNSS needed

Time needed to infuse
Methylmed
30mkdose + 100cc D5W x 2h q 24H via
infusion pump x 3 doses
SCLEREMA NEONATORUM

In an infant, fat has higher saturated-to-unsaturated

fatty acid ration compared to adult fat and thus a
higher melting point. Prematurity, hypothermia, shock
and metabolic abnormalities have been postulated to
further increase this ratio, possibly as a result of
enzymatic alteration allowing precipitation of fatty acid
crystals within the lipocytes. This condition has been
suggested to result in the dramatic clinical findings in
affected skin. X-ray diffraction techniques have
confirmed that infants with sclerema neonatorum have
an increase in saturated fats and that the crystals
within the fat cells are composed of triglycerides.

Fluids and Electrolytes

> 5 years old (>20kgs)D5LR
> 3 years old (<15kg)D50.3Nacl/ D5IMB
(>15kg)D5NM
Deficit
Mild
Moderate
Severe

<10 kg
50
100
150

Maintenance
0-3 kg
3-10 kg
10-20kg
20-30kg
30-40kg
>40kg
Newborn
0-1 day
old

(24 H)
75cc/kg
100cc/kg
75cc/kg
60cc/kg
50cc/kg
40cc/kg

80cc/kg/hr

>10kg
30
60
90

2
3
4
5
6
7
8

90cc/kg/hr
100cc/kg/hr
110cc/kg/hr
120cc/kg/hr
130cc/kg/hr
140cc/kg/hr
150cc/kg/hr

Mild Dehydration
30-50cc/kg/6h D50.3Nacl
Moderate Dehydration
60-90cc/kg/6h
of computed deficit give D5LRX2hrs then to be
given for the next 6hrs D50.6Nacl
Severe Dehydration
>100cc/kg/6h
1/3 with D5LRX2H then 2/3 with D50.3Nacl X 6H
Medical Prophylaxis
Diphtheria update DPT immunization status for all
age
groups and Erythromycin 4-050mkd in 4
days divided doses X 10 days (max 2g/day).
Alternative: Benzathine Pen G IM single dose

<30kg 600,000 units

>30kg 1.2 Million units

NOTE: Close contact should be observed for 7 days
for evidence of the disease.
Endocarditis prophylaxis given 30-60 mins after
procedure

Oral: Amoxicillin 50mg/kg

Unable to tolerate PO
Ampicillin 50mkdose
IM/IV or
Cefazolin/Ceftriaxone
50mg/kg

Allergic to Penicillin
Cephalexin 50mg/kg or
CLindamycin 20mg/kg or
Azithromycin/Clarithromycin 15mg/kg

Allergic & unable to tolerate PO:

Cefazolin/ceftriaxone 50mg/kg IM or IV or
Clindamycin 20mg/kg IM or IV

Note: No prophylaxis for procedures

________ Respiratory, GI or
Genitourinary Tract

Hepatitis B

Newborn with HBsAg (+) mother

HBIG 0.5mL and Hep B vaccine 0.5ml IM at
birth or w/in 12 hrs followed by Hep B
vaccine at 6 weeks after and after 6
months.

Premature & HbsAg (-) mother

Hep B vaccine delayed until child 2000
gm

Sexual contact with HBsAg (+) partner, exposure

to blood/ body fluids
Hep B vaccine + HBIG 0.06ml/kg IM (not
later than 14 days from exposure from
sexual contact and with in 7 days for
percutaneous exposure)

Household/Sexual Contact with Chronic Causes

Hap B vaccine only

Malaria

Mefloquine (250mg/tab) to start 1 week before

travel then weekly until 4 weeks after leaving
endemic area as ff:

< 45kg = 5mg/kg (max: 250mg)

>45kg = 1 tab once a week

Doxycycline daily to start 2-3 days before travel

then daily until 4 weeks after leaving endemic
area

8 years old = 2mg/kg up to adult dose of

100mg/day

Note: Contraindicated for < 8years and pregnant

women

Meningococcemia

Rifampicin in 2 divided doses X 2days

1 month 5mkdose every 12 hrs
1 month 10mkdose every 12 hrs (max
600mg)

Alternative: Ceftriaxone single IM dose

< 15 years old 125mg
15 years old 250mg or
Ceprofloxacin (not for 18 years old)
18 years old: 20mk PO as SD (max 500mg)
Rheumatic Fever

Benzathine Penicillin 1.2 Million U IM every 4

weeks
<27kg (60lbs)- 600,000 U IM or

Penicillin V 250mg PO twice daily for

patients allergic to Penicillin: Erythromycin
250mg PO BID
Duration:
RF, (-) carditis: 5 years since last episode ao
ARF or until 21 years old whichever is longer
RF, (+) carditis w/o residual heart disease
(no valvular disease): 10 years or until 21
years old whichever is longer
RF, (+) carditis, (+) residual heart disease:
10 years since last episode or at least until
40 years old whichever is longer
Note: Consider lifelong prophylaxis for people
with severe valvular disease

VACCINATION
Absolute Contraindications

Severe anaphylactic/allergic reaction to previous

vaccine

Moderate severe illness fever

Encephalopathy within 7 days of vaccine (pertussis)

Immunodeficiency (Congenital all live vaccines ) or

households contact (OPV)

Pregnancy (MMR, OPV/IPV )

Relative Contraindications

Immunosuppressive therapy (all live vaccines)

Egg allergy (MMR)

Seizure w/in 3 days of last dose (Pertussis)

Shock w/in 48 hrs of last dose (Pertussis)

Fever >40.5C w/in 48hrs of last dose (Pertussis)

Not Contraindications
Mild illness low grade fever

Current antibiotic therapy

Positive PPD
Prematurity
Nursery

Please admit to NICU under the service of Dr.

_____

TPR Q15minutes until stable

Breastfeeding

Labs: CBC, APC, BT, RH typing, NBS at 24h old

Medications:
1
Terramycin ophthalmic ointment OU
2
Vit. K 1mg IM
3
Hep B vaccine 0.5mL IM
S/O:
Routine newborn care
Gastric lavage
Suction secretion PRN
Thermoregulate at 36.5-37.5C
Daily cord care w/70% IPA
Watch out for tachypnea, tachycardia, alar
flaring, retractions
Refer PRN
Newborn Final Diagnosis:
Fullterm (__wks), AGA, BW=__kg, cephalic via NSVD,
Live, Bb.Girl/Boy AS 9,10; Neonatal sepsis;
Uninvestigated physiologic jaundice
IVF:

TFR x wt/24h/20% (if with phototherapy)

TFR x wt/24h-fdg-Aminosteril (use formula if

w/ Aminosteril & fdg)

eg: wt: 3kg TFR: 80

80x3/24/20%= 20 or
80x3=240x0.2= 48, next
240/48= 288/24h= 12cc/hr
1st 24h D10w, then
D10IMB
D5IMB
Preterm

Please admit

TPR q15 minutes until stable

NPO

D10W 250ccx7cc/hr

Labs:
CBC, APC @24HDL
Blood & RH typing
Na, K, Ca
BUN, Creatinine
24HDL
NBS
ABG, Blood C/S, CBG q6H
CXR, APL

Vit. K 1mg IM now

Hep B 0.5 ml Im now

Terramycin/Erythromycin ophthalmic ointment

Ampicillin q12h

Oxygen

Attach to pulse oximeter

HBsAg Reactive Mother

Give HBIg 0.5ml deep IM w/in 12HOL

CRP at 24HOL
Blood C/S anytime after birth
Normal CBG: 60-140
Bilirubin: B1B2: 17.1 (start phototherapy if
15)
WBC: 20,000 start meds
IT Ratio- stabs/juvenile/total neutrophils = 0.2
(+) infection
Reticulocyte actual Hct/0.40 (desired Hct)X
Reticulocyte = N 1-1.5
1.0 = hemolysis
1 = bone marrow failure (CRT 2)

Seizure Disorder
Please admit
TPR q4h and record
NPO temporarily
Labs: CBS, APC, Urinalysis, fecalysis, CBG now
then q6h while on NPO
IVF: D50.3Nacl 500cc+2meq KCL/150ccIVF post
voiding
Meds:

S/O:

MIO qshift & record

Monitor VS q4h & NVS qhour & record

Seizure precaution at bedside

Standby O2, padded tongue depressor

at bedside

Replace GI loses volume/volume w/

PLR as sidedrip

Refer PRN

Benign Febrile Seizure

Please admit
TPR q4h & record
NPO temporarily
Labs: CBC, APC, Urinalysis, Fecalysis, CBC now
then q6h while on NPO
IVF: D50.3Nacl 50cc+ 2meq KCl/100cc IVF
IVF post voiding
Meds: Paracetamol, Ibuprofen, Diazepam
(0.2mkdose)
S/O:

MIO qshift & record

Monitor VS q4h, neuroVS qhour &

record

Seizure precaution

Standby O2, tongue depressor at

bedside

Replace GI losses V/V w/ PLR as sidedrip

Refer PRN
Status Post Lumbar Puncture Orders
Flat on Bed x 4h
NPO x 4h
Send the following specimen to lab as ff:

TT#3 CSF cell ct, diff ct

TT#2 CSF, sugar & protein

TT#1 CSF GS/CS, AFB, KOH

RBS now
Monitor VSq15min until stable
Refer patient for any untoward s/sx
Status Post Extubation Orders

Nebulizer with Racemic epinephrine now

Extubate patient now
Nebulize w/ Racemic epinephrine
q15minx3doses
Nebulize w/ Salbutamol 1nebule q6h
NPO x 6h
CXR, APG 6h post extubation
O2 6-10LPM
Watch out for secretions, tachypnea, etc.
Note: Racemic Epi: PNSS: 4.7ml Epi: 0.3ml

Body Surface Area

=

wtxht
3600

ANC= WBC x Differentials x 10

IT = stabs seg >0.2 bacterial
BMI = wt (kg) ht (m)2
MIO + intake output = +/- balance
Output + output wt 24h = ____cc/k
(Output of chemo px: output 24hBSA =
_____cc/m2)

Dopamine

0.5-4gm/kg/min renal vasodilation

>10gm/kg/min vasodilation & decreased

peripheral and renal perfusion

5-10 gm/kg/min increase inotropic effect and

cardiac output = increase BP