ph-adil

In our unit we started any one of them as long we are flashing the line before administering the second agent. For the new admission the are using their floor stock to start the dose then a after all the iv preparation should be prepared and send from pharmacy. Usually they make the ampicillin final concentration 100mg/ml then according to that they calculate the dose following neofax guidline. For gentamycin the final concentration is to be 4mg/ml for the first dose. The rest of the doses we prepare in pharmacy. For stability reason we prepared less concentrated i mean 50mg/ml for ampicillin and 2 mg/ml for gentamycin. For gentamycin as it is concentration dependent we give the total dose once daily and peck and trough level to be obtained 30 mins pre and post administration of the third dose. For ampicillin as it is time dependent we give the total dose in divided dose and over 30 mins.

The best recommendation is to use the dexamethason iv for ten days using dart protocol.

In such case, We only recommend the maximum intake of lipid to be 0,5g /kg/day. And to monitor the Tgd level as well as the liver enzymes. I have read a lot of articles including the one you posted but still no one of them shows that omegaven is the lipid of chose in sepsis neonate.

I will be highly appreciated if u send to me to at : adil@smc.com.sa

As far as i know it is stable as long as the tpn is protected from light ,prepared under aseptic condition and stored probarly, (2-8 c'). It should be inspected if there is any turbidity or precipitation. To be in the safe side it should be used withen 24 hours from prepration time. Regarding the amino and lipid we dont call them tpn unless the mixed together along with dextrose and additives if any like mineral,electrolytes.multivitamis using specialize calculation and mixing order.

Dear all: Recently we start to use the gentamycin 40 mg nebulaization 2 times daily. We take 1 ml from amp 40mg/ml and adding 3 ml normal saline to it(total volume 4 ml). The dose given 30 mins post ventolin 0.25 ml(1.25mg) nebulazation. And chest massage post genta dose. the patient has a lot of white clear excretion. We sent the sample of that secretion to the lab the result is negative. The patient has been incubated more than 2 weeks. We started the dexamethason inj (dart protocol). But still the patient not improved. Any one has experience with genta neb. And for how long it should be used.

I've no experience with that. We never used in nicu.we only use the 10% or 20% lipoven/ lipofundin. But they are using that for adult in our hospital in case patient has liver disorder. In nice we use the lipid when we need high calories and patient is on peripheral line as it had not that effect of osmolarity.

Purpose of total parenteral nutrition is to prevent the adverse effect of malnutrition in neonate who are unable to obtain adequate nutrients by oral or enteral route (necrotising enterocolitis or nec, respiratory distress syndrom/bpd, extreme prematurity, sepsis and malabsorption. In our hospital we prepare the tpn according to each patient needs(calories,protein ,lipid,carbohydrate,multi-vitmns and electrolyts). As clinical pharmacist my part is to insure accuracy,stability and compatibilty as well as making sure all nutritions required are met. According to that before the physician start the tpn order he/she call me to discuse the patient nutrition requirement. Here are some points, which may help you to get the consept of tpn. 1-total volume= 80 to 200 ml/kg/day 2-total caloreis = 60-120 kcal (gaining weight) 1 g of dextrose =3.4 kcal, 1 g protien= 4 kcal ,10% lipid(1 ml=1 kcal)20% (1ml= 2 kcal) 3-carbohydrate = 3-12 mg/kg/mins and maximum 12.5% dextrose for peripheral line. 4-amino acid =0.5 -4 g/kg/day 5- lipids = 0.5-3 g/kg/day 6-osmorality<900 osmol/l peripheral and 1600 osmol/l centeral. Hope this will be usefull. It is my pleasure to share my skill and knowldge with you in case of any inquires.