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MWells last won the day on April 7 2019

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    Pharmacy Student
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    Wingate University School of Pharmacy
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    Wingate, United States

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  1. Dose & administration Prevention of iron deficiency: Preterm infants: 2-4 mg/kg/day of elemental iron in divided oral doses; initiate no later than 1 month of age and continued through at least 1 year of age, depending on nutritional context and other iron intake. Maximum of 15 mg/day. Term infants: 1 mg/kg/day of elemental iron orally; may not need to initiate until 4 months of age. Low birth weight infants (<2500 g): 2-3 mg/kg/day of elemental iron in divided oral doses during the first 6 months of life. Treatment of iron deficiency: 4-6 mg/kg/day of elemental iron in divided oral doses until serum markers of iron deficiency have normalized. Supplement during epoetin administration: 6 mg/kg/day of elemental iron in divided oral doses. Indications Prevention of iron deficiency. Treatment of iron deficiency. Contraindications and special considerations (incl incompatibilities) Oral products are available in many formulations- verify concentration and dose before use. Consider monitoring iron storage via serum ferritin levels, especially in infants who have received many blood transfusions. If the ferritin level is >350 microgram/L, halt iron supplementation until the level has decreased to <350 microgram/L. Hypersensitivity to iron or any component of the formulation. Hemolytic anemia. Adverse effects Common side effects include nausea, vomiting, constipation, upset stomach, and black stools. Iron toxicity may include an increase in free radical formation, thus increasing oxidative stress. Pharmacological aspects Iron is an essential part of the heme groups forming hemoglobin, the oxygen-binding metalloprotein of red blood cells. Onset of action for oral administration is about 5-10 days. Effects on hemoglobin may be seen in 2-4 weeks. Enteral absorption is about 30%. Iron is not actively excreted in the stool or urine, so virtually all absorbed iron remains in the body. References Baker RD, Greer FR, and Committee on Nutrition American Academy of Pediatrics, "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age)," Pediatrics, 2010, 126(5):1040-50. PMID 20923825. Berglund S, Domellof M, “Meeting iron needs for infants and children,” Curr Opin Clin Nutr Metab Care, 2014, 17(3):267-72. PMID: 24535217. Meyer MP, Haworth C, Meyer JH, et al, "A Comparison of Oral and Intravenous Iron Supplementation in Preterm Infants Receiving Recombinant Erythropoietin," J Pediatr, 1996, 129(2):258-63. PMID 8765624. Rao R and Georgieff MK, "Iron Therapy for Preterm Infants," Clin Perinatol, 2009, 36(1):27-42. PMID 19161863. United Nations Children's Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control. A guide for programme managers, 2001. Available from: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf?ua=1 Document version history Created 2017-01-14 / Maegan Wells
  2. Dose & administration Initial dose: 0.05 to 0.1 microgram/kg/min via continuous IV infusion. Titrate to response, then decrease rate to provide the lowest dose while maintaining effect. Maximum dose: 0.4 microgram/kg/min. Higher initial infusion rates do not produce greater effects and are associated with more adverse effects Indications To maintain patency of the ductus arteriosus in congenital heart diseases dependent on shunting for oxygenation Contraindications and special considerations (incl incompatibilities) There are no known contraindications or incompatibilities. Adverse effects Apnea is experienced by 10-12% of infants with congenital heart defects treated with alprostadil, especially those weighing <2 kg at birth. Apnea usually occurs during the first hour of infusion. Respiratory status should be monitored during treatment. Staff trained in resuscitation and intubation should be available. Other common side-effects: fever, seizures, flushing, bradycardia, hypotension, tachycardia, leukocytosis, diarrhea, hypokalemia Uncommon side-effects (<1%): respiratory distress, wheezing, hyperbilirubinemia, anemia, bleeding, thrombocytopenia, hematuria Pharmacological aspects Alprostadil, or prostaglandin E1, causes vasodilation, inhibits platelet aggregation, and stimulates intestinal and uterine smooth muscle. As much as 80% may be metabolized in the first pass of the lungs. Metabolites are excreted via the kidneys within 24 hours. The half-life is <1 minute, thus necessitating a continuous infusion. References Arav-Boger R, Baggett HC, Spevak PJ, Willoughby RE: Leukocytosis caused by prostaglandin E1 in neonates. J Pediatr 2001;138:263-265. PMID 11174627 Browning Carmo KA, Barr P, West M, et al: Transporting Newborn Infants With Suspected Duct Dependent Congenital Heart Disease on Low-Dose Prostaglandin E1 Without Routine Mechanical Ventilation. Arch Dis Child Fetal Neonatal Ed 2007;92(2):F117-9. PMID 16905574 Cawello W, Schweer H, Muller R, et al: Metabolism and pharmacokinetics of prostaglandin E1 administered by intravenous infusion in human subjects. Eur J Clin Pharmacol 1994;46:275-7. PMID 8070511 Prostin VR Pediatric [package insert]. New York, NY: Pharmacia and Upjohn Company; 2013. Talosi G, Katona M, Turi S: Side-effects of long-term prostaglandin E1 treatment in neonates. Pediatr Int 2007;49:335-340. PMID 17532831 Document version history Created 2016-11-10 / Maegan Wells
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