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RSPT 2353 – Neonatal/Pediatric Respiratory Care
Caring for the Neonatal/Pediatric Patient
Neonatal/Pediatric Pharmacology
Lecture Notes,
Reference & Reading: Whitaker Chapter 8
I. SURFACTANT
a. Indications
 Pulmonary Surfactant Deficiency
 Decreases Surface Tension
 Begin surfactant production
b. Prophylactic vs. Rescue Treatment
 Prophylactic
 Rescue
c. Dosage and Types of Surfactant
Brand
Generic
Types
Dose/ frequency
5 mL/ kg
Exosurf™
Colfosceril Palmitate
Protein free Artificial
Survanta™
Beractant
Modified natural from
bovine lungs
Infasurf™
Calfactant
Modified natural from
calves’ lungs
Q12h up to 3
doses
(Vial holds 8 mL)
Delivered in 2 aliquots
4 mL/kg Q6h x24h up to
4 doses
(Vial holds 8 mL)
Delivered in 4 aliquots
3 mL/ kg Q12h up to 3
doses
Delivered in 4 aliquots
d. Generic Protocol
 Warm surfactant
 Verify ETT placement
 Note baseline parameters
 Change ventilator settings
 Patient should be supine. After each aliquot pt is placed in
four positions as follows for 30 seconds:
1. head down, body turn to left (R side up)
2. head down , body turn to right (L side up)
3. head up, body turn to left (R side up)
4. head up, body turn to right (L side up)
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 Assess pt after each aliquot is administered and adjust as
needed:
1. Decreased SpO2Increase FiO2
2. Decreased chest excursion  Increase PIP
3. Bradycardia  Increase PIP
4. Hand bagging
 After administration
*Note: If the patient can not tolerate his original settings,
notify MD.
II. PENTAMADINE (NebuPent®, Pentam-300®)
a. Indications:
Treatment and prevention of Pneumosystic Carinii
Pneumonia (PCP ) who can not tolerate co-trimoxazole or fail to
respond to this drug.
b. Dosage:
 Inhalation - Prophylaxis
1. < 5years
2. > 5 years
3. Adults
 Inhalation – treatment;
 Administer via Respigard II, with minimal people in room.
Nose plugs if necessary.
 All persons in room must wear N95 HEPA mask.
c. Side Effects
 Most common is bronchospasm
 Throat irritation
 Nausea
III. PULMOZYME (Dornase Alfa)
a. Indications
b. An DNA enzyme produced by recombinant gene technology, derived
from Chinese hamster ovary cell products (epoetin alfa)
c. Dosage: 2.5 mL in 3mL NS. Qday or BID.
d. This drug is not to be mixed with other drugs, and is to be
administered via Pari LC neb.
e. Side effects:
 Excessive coughing
 Induced bronchospasm
 Throat irritation
IV. TOBRAMYCIN (TOBI ®)
a. Indication
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b. Dosage:
 Low dose
 Prophylaxis in CF
c. To be administered via Pari LC nebulizer. TOBI ® can sometimes
be coordinated with Tobramycin IV, the RT must coordinate with
the RN to ensure an accurate trough.
d. Side effects
 Induced bronchospasm
 Excessive coughing/hemoptysis
 Dyspnea.
 Hyperventilation
 Toxicity
e. Other antibiotics that can be inhaled include: Gentamycin, Colistin,
amikacin, and Amphotericin B.
V. Caffeine
a. Indication:
b. Dose:
 Loading
 Maintenance
c. Caffeine level