Medication & Pharmacology

Key Takeaways from the Pharmacology, Neurology & Neonatal Exposures SessionWe have reached the end of an incredible day at CEPAS 2026! The final session delivered fascinating insights into pharmacology, the microbiome, and early neuroprotection. We were also thrilled to see one of our very own 99nicu team members take the stage! Here is the breakdown of the core messages from the final session: Neonatal Opioid Safety Attitudes: Türkiye vs. the UK (Esra Ardahan Akgül) A cross-sectional study of 64 healthcare professionals compared knowledge and practices regarding neonatal opioid use. Common Ground: Both countries demonstrated high agreement on the importance of strict…

I recently received a question on the optimal dosing and administration of nitroglycerin in the NICU when vasodilation is required due to limb ischemia. As mentioned here, these cases are rare, therefore, experience is limited. Nevertheless, we can use available data and pharmacological reasoning to suggest optimal care. While 2% nitroglycerin ointment is perceived as preferable for neonates, mainly due to better control of dosing and extent of exposure, sometimes nitroglycerin patches may be the only available option. Properties of nitroglycerin transdermal patches:Most nitroglycerin transdermal systems contain 25 or 50 mg of nitroglycerin dispersed over an area of 10 o…

Dear colleague, Together with a group of neonatologists, I developed a survey on procedural sedation and analgesia in neonates. Procedures like intubations, LISA/MIST, catheter placements and chest drain insertions are amongst the painful procedures performed in NICUs. Currently, there are no clear international guidelines for sedation and analgesia for neonates undergoing these procedures. The aim of this study to get insights in current practices of procedural sedation and analgesia across Europe. We would like to reach neonatologists (in training) working in European hospitals and kindly ask them to complete this survey. Responses from multiple neonatologists within th…

Branching off my other thread about acute limb ischemia in neonates, I would like to focus on using transdermal patches in neonates. In that case we used a nitroglycerin patch to localize vasodilation and facilitate blood flow to the ischemic limb. Sometimes topical administration of drugs may be required (e.g., palliative analgesia with fentanyl patches, local vasodilation with nitroglycerin patches), or treatment with a drug only available as a transdermal patch (scopolamine/hyoscine). Since there are no transdermal patches approved for use in children, as well as neonates, neonatal clinicians should understand how to safely manipulate transdermal patches and adapt them…

Dear colleagues, In relation to cope with hyperbilirubinemia in term babies, we have managed to order Kiovig 10% Intravenous Immunoglobulin I have had some though time trying to understand the dosage, could you possibly help with the dosage? Do you have protocols for Kiovig? And also do you have some protocols for so called IVIG usage for neonates?

Hi all, This is an open request to the community to share your policy about vancomycin therapeutic drug monitoring in your units. I anticipate a lot of variability 🙂 You may follow my structure or write your take freeform. Indications:Suspected or proven infection with gram-positive bacteria, usually MRSA. Also as prophylaxis around surgery (often as a single dose). Dosage:We currently strive to administer a loading dose of 20 mg/kg (this is a relatively new practice for us, for years our neonatologists refrained from vancomycin loading doses, possibly due to habit/tradition) regardless of infant age and renal function to reach steady state as quickly as possible. Accordi…

Hi all, Yesterday, the Tiny Baby Collaborative held a webinar about using hydrocortisone in extremely preterm infants (under 23 weeks of gestational age), which featured Dr. Satoshi Kusuda from the Neonatal Research Network of Japan and Dr. Erik Jensen from Stanford University (the webinar will probably be available in the near future here: https://www.tinybabycollaborative.org/webinars) I was unable to attend the entire event, but was wondering if anyone here also attended and maybe we can discuss this issue. My understanding is that in such extremely preterm infants, adrenal insufficiency is very common (which makes sense) and with the added stress of premature deliver…

Dear colleagues, I was wondering what your practice is regarding preparation of drugs for intravenous administration in the NICU? Are your units employing an individualized approach, whereby each drug is prepared for each infant in the prescribed dose and thus administered, or a 'standard concentration' approach, whereby a drug solution is prepared in a fixed concentration and the volume to be administered is calculated from that concentration? In our unit we employ the latter approach, as can be observed in the attached figure. The doctor prescribes a weight-based dose, the pharmacist prepares a standard concentration solution in sufficient volume to account for dose a…

Hi everybody. Which drugs/ doses/ rotation of sedatives do you use in extremely preterm infants on prolonged mechanical ventilation. We commonly use non-pharmacological strategies, fentanyl and dexmedetomidine, but after 1-2 weeks, they trend to tolerate them and need a progressive increase... We're managing now a 24weeker on HFOV wiht a severe pulmonary emphysema (after RDS and pulmonary hemorrhage on firts days), The weaning is not possible, and she is needing high doses of fentanyl and dexmedetomidine + extra bolus of fentanyl. Would anybody use benzodiacepines? Or rotate to morphine sulfate?

Hello Guys, I consider giving brief anaesthesia for administration of Lucentis in babies already imi-intensive ward . Do you rely only on local anaesthetic given by ophtalmologist ? Would oral 20 % glucose be sufficient, or perhaps some midazolam apart form local ? Thank you