Neonatal Pearls
What is the total % body water of a neonate?
75-85%
What are signs/symptoms of pediatric sepsis? (name 3)
fever, malaise, decreased urine output, tachycardia, hypoxia, unusual fussiness, dizziness
Chemotherapy dosing in pediatric obese patients should be based on BSA calculated by using
Lean body weight
Actual body weight
Ideal body weight
Ideal body weight minus extracellular water weight
B. Actual body weight
Using the 4:2:1 rule, calculate the maintenance fluid requirement for a 18kg patient
56 ml/hr
HO is 38 week gestation neonate
TG is 18 month old child
In which patient will ampicillin, an acid-labile medication, have a higher bioavailability? Why?
HO, the higher pH will not break down the medication
Which of the following is not a primary role of the pharmacist as part of the interprofessional team in the neonatal intensive care unit?
A. Diagnosing diseases specific to the neonatal population
B. Conducting clinical research
C. Applying knowledge of age-related pharmacokinetic changes to medication dosing
D. Understanding of technology (eg, “smart” IV pumps, dose-range checking)
A. Diagnosing diseases specific to the neonatal population
Kernicterus associated with sulfonamide in infants develops because of
A. Displacement of albumin by bilirubin
B. Displacement of bilirubin from albumin by a sulfonamide
C. Decreased metabolism of bilirubin
D. Increased concentration of albumin
B. Displacement of bilirubin from albumin by a sulfonamide
Which electrolyte is commonly added to maintenance fluids, but is normally excluded in renal dysfunction/poor urine output?
Potassium / K+
A 6 y/o, 46lb patient is newly diagnosed with hypothyroidism and is prescribed levothyroxine. What is the dosing range and select an appropriate strength for this patient? (use Lexicomp)
range ~ 83mcg-105mcg
strength = 88mcg or 100mcg PO once daily
A pediatric patient received an oral dose of acetaminophen, but did not have any pain relief in the past 10 minutes. What should you do? Why?
Do not immediately give another dose, delayed gastric emptying could cause a delayed response
Which adverse medication reaction is most likely to be experienced by a neonate treated with indomethacin for closure of a patent ductus arteriosus?
A. Thrombosis
B. Neutropenia
C. Acute kidney injury
D. Anaphylaxis
C. Acute kidney injury
How would you implement a liquid oral medication into bottle feeds for an infant/toddler?
Mix medication with a small amount of bottle feeds to get entire dose, then give any additional feeds
Compared with older patients, premature infants may have
A. Increased absorption of oral doses of weak acids such as phenobarbital
B. Decreased absorption of intramuscular doses of all drugs
C. Increased percutaneous absorption of drugs
D. Rectal route should never be used in infants
C. Increased percutaneous absorption of drugs
An 8 y/o pediatric patient weighing 98.3 lbs is receiving continuous IV infusion of fentanyl for pain at a rate of 2.5mcg/kg/hour. After 6 hours, what is the total amount of drug administered (use mcgs + round to whole number)?
670 mcg
SM is a 25 weeks’ gestation preemie who is now 21 days old, postmenstrual age of 28 weeks. Overnight, SM has multiple apneas and desaturations requiring mechanical ventilation. This neonatal intensive care unit does not have a high rate of methicillin-resistant Staphylococcus aureus (MRSA).
The medical team would like to initiate IV antibiotic therapy for presumed sepsis. Which empiric antibiotic regimen is most appropriate for SM at this time?
Gentamicin and vancomycin
Nafcillin and gentamicin
Ampicillin and gentamicin
Cefepime and vancomycin
B. Nafcillin and gentamicin
What is the gastric pH of a full-term neonate at birth? Why?
6-8, amniotic fluid = alkaline
Prior to vaccination, what is the most common cause of gastroenteritis in pediatric patients?
Rotavirus
Premature infants may need higher plasma concentrations of morphine for pain control than older patients because they have
A. Decreased metabolism to the more active metabolite
B. Lower sensitivity to pain
C. Increased urinary excretion of morphine
D. Decreased absorption of morphine
A. Decreased metabolism to the more active metabolite
Calculate the dose of IV/IO epinephrine for a pediatric patient weighing 23kg who is unresponsive/coding. Provide mg & mL units
Product: Epinephrine Injection 1mg/10ml
0.23mg or 2.3 mLs
A 6-year-old child (weight, 20 kg [44 lb]) is brought to the emergency department with a 2-day history of diarrhea and vomiting. In the past 12 hours, the child has not been drinking well, and the parents were concerned for dehydration. The physician confirms mild dehydration and recommends a trial of oral rehydration therapy (ORT). Per WHO guidelines, which of the following is the most appropriate volume and administration recommendations for the oral rehydration solution (ORS) during the first 4 hours?
A. 2,000 mL at a rate of 200 mL every 5 minutes
B. 2,000 mL at a rate of 20 mL every 2-5 minutes
C. 1,000 mL at a rate of at least 50 mL every 15 minutes
D. 1,000 mL at a rate of at least 20 mL every 5 minutes
D. 1,000 mL at a rate of at least 20 mL every 5 minutes
Which parameters are measurements of cardiac instability in neonates?
White blood cell count, urine output, and temperature
Capillary refill time, heart rate, and C-reactive protein level
Temperature, heart rate, and oxygen saturation
Capillary refill time, urine output, and heart rate
D. Capillary refill time, urine output, and heart rate
What is the most common atypical bacteria causing community acquired pneumonia in children >5 years old?
At what weight is "max adult dosing" often used instead of mg/kg dosing (answer in kgs)
50 kg
A 10 month-old, 8.1kg patient is brought into the emergency department due to 3 days of diarrhea, vomiting, and decreased oral intake. Patient is lethargic and has not had any wet diapers in the past 12 hours. Patient has received one 140 mL D51/2NS bolus. Calculate the rehydrated weight, fluid deficit yet to be replaced, maintenance rate, and total fluid rates for the next 24hr.
Rehydrated Weight = 9kg
Remaining Deficit = 740mL
Maintenance = 36ml/hr
Total Fluid Replacement = 72ml/hr x 8hr, then 60 ml/hr x 16hr
JR is a 27 weeks’ gestation infant, birth weight of 840 g, born to a 26-year-old woman with placental abruption. Apgar scores were 1, 3, and 7 at 1, 5, and 10 minutes, respectively. JR was immediately intubated in the delivery room and transferred to the neonatal intensive care unit. At about 20 minutes of life, JR had BP instability with MAP ranging from 20 to 25 mm Hg. One dose of normal saline 0.9% NaCl 20 mL/kg was infused over 30 minutes with minimal improvement of MAP.
The neonatologist would like to initiate a pharmacologic agent for JR’s hypotension. Which medication is the most appropriate first-line treatment for JR’s neonatal hypotension?
Dobutamine
Dopamine
Epinephrine
Hydrocortisone
B. Dopamine