Newborn Drugs.

Dr Ngugi

Vitamin K
Babies are all mildly deficient with coagulation indices < adults. ~ 1 in 1,000 infants may have a severe deficiency, this can result in:
Haemorrhage from incisions GI haemorrhage Intra-cranial bleeding. Death

1mg Vitamin K im given at birth prevents this (0.5mg if weight < 1.5kg)

Treatment of Convulsions (Birth Asphyxia)

Diazepam is dangerous in babies < 1 month First line treatment is Phenobarbitone 20 mg/kg im Maintenance usually 5mg/kg im, oral or ngt every 24 hours.
Toxic level

Effective level

20mg/kg 5mg/kg

5mg/kg

Phenobarbitone for a fitting baby weighing 3.1kg?

Stat phenobarbitone:
60 mg im NOT as an iv bolus.

If the child continues to convulse after 30 minutes a further 5 - 10 mg / kg im can be given BUT continuous monitoring for respiratory depression is required. Then no more phenobarbitone for 24 hours.

Anti-pyretics?
Febrile fits only occur at ages 6 months Fever can be effectively treated by removing covers / clothes in the first weeks of life. So fever should first be investigated and treated with simple measures. Anti-pyretics may have side effects and there is no routine indication for drugs to reduce temperature
Use them when simple measures fail

Pain is a separate consideration

Gentamicin
Deafness / balance disturbance, rare Renal impairment, uncommon Both above more likely if frusemide also given, especially in high dose. More likely if long term use and / or renal impairment already

Gentamicin
Measured Blood Level Peak Blood Level

Blood Level

Level required to kill bacteria

Time

Gentamicin
Measured Blood Level

Post-antibiotic effect proportional to the peak level

Level required to kill bacteria

Blood Level

Time

To kill bacteria
A high level of gentamicin in the blood is best. So high doses should be used.

What causes gentamicin toxicity?

Blood Level Blood Level

Time

Time

A long time with drug in the body no rest from the drug NOT high levels for a short time.

Current WHO recommendations.

Babies <2kg, <7 days old Babies 2kg, <7 days old Age > 7 days Age > 10 years 3 mg/kg/day OD 5 mg/kg/day OD 7.5 mg/kg/day OD 6 mg/kg/day OD

If < 7 days old a loading dose of 7.5mg/kg on Day 1 would be safe

Pen and Gent for a 4 day old baby weight 2.3kg?

Penicillin, 50,000 iu / kg every 12 hrs Penicillin 115,000 iu 12 hourly Gentamicin, 5mg / kg every 24 hours Gentamicin, 11.5 mg ever 24 hours

Pen and Gent for a 24 day old baby weight 3.8kg?

Penicillin, 50,000 iu / kg every 6 hrs Penicillin 200,000 iu 6 hourly Gentamicin, 7.5mg / kg every 24 hours Gentamicin, 30 mg ever 24 hours

Questions?

Summary
Vitamin K 1mg im stat to all those aged < 2 weeks Use the correct dose of phenobarbitone Give gentamicin once a day Adjust antibiotic doses if the age is < 7 days