Medication & Pharmacology

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

I'd like to discuss an old topic again. Which pain scale do you use for premature babies? And what are the consequences for you when dealing with pain in premature babies? We're currently having a discussion on this and I would be grateful for advice and discussion.

Hello again, as you know there are several surfactant brands around. Which surfactant do you use and why?

Hi, While working the past couple of weeks, there has been some discussion on the possible membrane stabilizing effects of hydrocortisone. Is this something you would consider in your practice, in which cases, and what dose would you use? Whats is the evidence and rationale behind it? Best, Gustaf

Hi Everyone! Our Pharmacy told us, that there is an rising shortage of phenobarbital. Being 1st line treatment for neonatal seizures again, this brings some problems with it. What would you prefer as 1st line treatment instead? - Guidelines are kind of favouring Phenytoin as an alternative - but has more significant sideefects. - Levetiracetam? Not that promising, right? Any alternatives? Best wishes, Bernhard

We have come across that medicinal products have become unavailable. Our three latest examples are dextrose gel used for hypoglycemia management (I think this is a food supplement, but still) iron drops for supplementation preterm infants (so, used a lot!) multivitamin drops for preterm infants (finally back on the shelf...) @Bernhard Csillag also posted about phenobarb (see link below) Do you share this experience in your various contexts? I understand that newborns and especially preterm infants are small patient groups for companies to "build business around", and that we have less "power" than say cardiologists working with much la…

I just came across some papers about etomidate for sedation - causing no haemodynamic problems, but I hardly find any paper or recommendation for or against using etomidate in neonates. What I learned so far: - No haemodynamic suppression - Not analgetic - very often onset of myocloni - High tone of pharyngeal muscels - so relaxation needed - Adrenal suppression - in a relevant duration? That one could be a relevant argument against using it in neonates. - 0,3 mg/kg/Dose - Don't know anything about neuroapoptosis. Any experiences? Thank you! best wishes, Bernhard