Department of Paediatrics
NEONATAL DRUG DOSES
ANTIMICROBIALS
Drug
Amount per dose
Route
ACICLOVIR
10 mg/kg
IV
ATRACURIUM
Refer to IV drug
monograph
* To avoid confusion with non-liposomal
preparation ALWAYS prescribe using the Trade
name i.e. AMBISOME **
ONLY TO BE PRESCRIBED AFTER DISCUSSION
WITH CONSULTANT / MICROBIOLOGY.
Test dose:
100microgms/kg
IV
then
1mg/kg\dose
increasing if
necessary
IV
AMOXYCILLIN
50 mg/kg
IV
BENZYLPENICILLIN
50 mg/kg
IV
CEFOTAXIME
50 mg/kg
IV
CEFTAZIDIME
25mg/kg
(Dose may be doubled
in severe infection and
meningitis)
IV
12.5 mg/kg
PO or
IV
ERYTHROMYCIN
Every 8 hours.
Dilute to 5mg/ml for peripheral administration and a
maximum of 25mg/ml for central administration.
Infuse over 60 minutes.
Refer to IV neonatal drug monograph and infusions section of Gosset guidelines
AMBISOME®
LIPOSOMAL
AMPHOTERICIN
Additional information
Initial test dose of 100 micrograms/kg infused over 10
minutes; observe for 30 minutes. If no adverse reaction
observed, infuse remainder of day 1 dose i.e. 900
micrograms/kg/dose over 60 minutes.
ONCE a day. Infuse over 60 minutes.
 Increase dose if necessary to 3mg/kg/day (empirical)
or 5mg/kg/day (proven infection) ONCE a day.
Incompatible with sodium chloride. Infuse and flush
with glucose 5% only.
Age < 7 days
12 hourly
Age 7 – 28 days 8 hourly
Age > 28 days
6 hourly
Age < 7 days
Age 7 – 28 days
Age > 28 days
12 hourly
8 hourly
6 hourly
Age < 7 days
12 hourly
Age 7 – 21 days 8 hourly
Age 21 – 28 days 6 hourly
Age < 7 days
ONCE every 24 hours
Age > 7 days
Every 12 hours.
6 hourly. Infuse over 20 – 60 minutes.
Reduce dose in severe renal impairment. Dilute well
prior to IV administration – potential for extravasation.
Gastro-intestinal stasis
PO 3mg/kg/dose FOUR times a day.
FLUCLOXACILLIN
50 mg/kg
IV
Age <7 days
Age 7 – 21 days
Age > 21 days
12 hourly
8 hourly
6 hourly
5 - FLUCYTOSINE
GENTAMICIN
** ONLY PRESCRIBE AFTER DISCUSSION WITH
CONSULTANT / MICROBIOLOGY**
To be used with Ambisome ® (Amphotericin).
50mg/kg
IV or
PO
4 mg/kg
IV
Every 12 hours. Infuse over 20 – 40 minutes through a
giving set with a 15 micron filter. Need to monitor blood
levels.
Age < 28 weeks: ONCE every 36 hours
Administration: Take extreme care with doses
prescribed to be given every 36 hours. Check when
the last dose was given. Errors have occurred with
doses being given 24 hourly instead of 36 hours.
Age > 28 weeks: ONCE every 24 hours.
Check trough levels immediately before the third dose
and at every fifth dose thereafter (unless more frequent
testing is indicated). Aiming for <2 mg/l.
Peak levels not required.
If renal impairment (Serum creatinine >100 µmol/L) or
oliguric, check trough level before 2nd dose.
Ototoxic and nephrotoxic. Avoid use with other potentially
nephrotoxic drugs e.g. indometacin, furosemide where
possible.
MEROPENEM
METRONIDAZOLE
20mg/kg
(Dose may be doubled
in severe infection and
meningitis)
IV
15 mg/kg
7.5 mg/kg
IV
IV
TEICOPLANIN
16 mg/kg
8 mg/kg
IV
IV
IV
VANCOMYCIN
Refer to IV drug
monograph
15mg/kg
Age > 7 days
Every 8 hours
Adjust dose in renal impairment.
IV
Refer to IV drug
monograph
Age < 7 days
Every 12 hours
IV
Age < 1 month: Single loading dose of 15mg/kg
followed after 24 hrs by maintenance dosing of
7.5mg/kg/dose every 12 hours.
Age > 1 month
7.5mg/kg/dose every 8 hours (no loading dose needed)
Infuse over 20 – 30 minutes.
Reduce dose and frequency when severe hepatic
impairment.
Needs approval from Microbiology before
initiation.
Loading dose 16mg/kg followed after 24 hrs with
maintenance dose of 8mg/kg/dose ONCE every 24 hrs.
Infuse over 30 mins
Age > 1 month
Loading regimen – Give 3 doses of 10mg/kg/dose
every 12 hours. Commence maintenance dosing of
6mg/kg/dose once a day 24 hours after 3rd loading
dose given.
Renal impairment:
Reduce dose on day 4. Refer to cBNF.
Age < 29 weeks: 15mg/kg every 24 hours
29 – 35 weeks : 15mg/kg every 12 hours
Age > 35 weeks: 15mg/kg every 8 hours.
Give over a minimum of 1 hour and take a trough level
pre 3rd dose. If oliguric or concomitant potentially
nephrotoxic drugs e.g. indometacin, take level pre-2nd
dose.
Desired range of trough level is 5 - 10 mg/
RESUSCITATION DRUGS
Drug
ADRENALINE 1:10,000
(100 micrograms/ml)
SODIUM BICARBONATE 4.2%
(containing 0.5mmol/ml of
bicarbonate)
GLUCOSE 10%
(100mg/ml)
VOLUME – BLOOD/0.9% SALINE/
4.5% albumin
Amount per dose
Initial dose
10 micrograms/kg
(0.1ml/kg)
Route
IV/Intracardiac
/
ETT
Subsequent doses if
required.
10 – 30microgms/kg
(0.1ml/kg-0.3ml/kg)
.
2 - 4 ml/kg
(1- 2 mmol/kg)
IV
2.5 - 5 ml/kg
(250mg – 500mg/kg)
10 ml/kg
IV
IV
Additional information
Most effective route of
administration is via IV/UVC.
Standard doses given via ETT
are unlikely to be effective.
Designated neonatal pack of O
negative, CMV negative,
irradiated blood in Labour
Ward fridge.
CORRECTION OF METABOLIC ACIDAEMIA
HALF CORRECTION
Pre-term babies
Number of mmol of base required = 0.6 x weight (kg) x base deficit (mmol/l
2
Term babies
Number of mmol of base required = 0.4 x weight (kg) x base deficit (mmol/l)
2
Give half or full correction over 12 - 24 hours as slow infusion
Use 4.2% sodium bicarbonate (8.4% too hyperosmolar) diluted in an equal volume of 5% dextrose
THAM® (Trometamol) may be used where Na or pCO2 high: Full correction (ml of 3.6% THAM) = Weight (kg) x
Base Deficit
Refer to IV monograph for Tham®.
INTUBATION DRUGS (PRE-MED)
Drug
Morphine
Suxamethonium
Atropine
Amount per dose
100 micrograms/kg
Route
IV
2 mg/kg
IV
20 micrograms/kg
IV
Additional information
Give 1st. Where possible wait for 2 mins
for onset of action before administering
suxamethonium. Repeat doses may be
necessary in term vigorous infants. Be
prepared for respiratory depression.
Give 2nd. Do not give if significant
hyperkalaemia or family history of
malignant hyperthermia.
Infant’s airway must be maintainable
prior to giving suxamethonium.
Initially IV bolus 2mg/kg/dose which
provides 5 – 10 minutes of muscular
paralysis.
Atropine 20micrograms/kg should be
drawn up and given along with muscle
relaxant.
Give 3rd.
Administer over 1 minute
OTHER DRUGS
Drug
BUDESONIDE
(Pulmicort ® )
Amount per dose
500 micrograms
200 - 400 micrograms
Route
NEB
INH
Additional information
12 hourly via nebuliser
12 hourly via aerochamber - can be used in
ventilator circuit
CAFFEINE CITRATE
20 mg/kg
5 mg/kg
IV
IV/PO
CHLORAL HYDRATE
30 - 50 mg/kg
PO/PR
Loading dose
24 hourly maintenance (can be increased to 10
mg/kg)
To avoid confusion prescribe in terms of
Caffeine citrate.
Single dose. Review after 48 hours as
may accumulate. Monitor BP.
6 hourly - long term sedation.
Adjust dose in mild/moderate hepatic
impairment. Avoid in severe hepatic
impairment.
20 - 30 mg/kg
CHLOROTHIAZIDE
12.5 mg/kg
PO
12 hourly (named patient basis)
Adjust dose in hepatic impairment and renal
impairment.
CHLORPROMAZINE
0.5 - 1 mg/kg
PO
6 - 8 hourly
Dose for prophylaxis
Age <30 weeks :120 mg ETT.
If estimated birth weight is
Wt>1.2kg: 240 mg via ETT
ETT
Single bolus via catheter cut 1 cm shorter than
ETT with head in midline. Followed by 1 ml of
air.
CUROSURF®
(Poractant Alfa)
Dose for treatment
Wt < 1.2 kg : 1 x 120 mg
Wt 1.2 kg - 2.4 kg: 1 x 240mg
Wt >2.4 kg : 1 x 360 mg i.e.
1 x 120mg vial + 1 x 240 mg
vial via ETT
DIGOXIN
Dosing is based on whole vials and dependant
on birth weight.
ETT
ETT
ETT
Following the administration of the initial dose,
the timing and necessity for further doses
should be discussed with a Consultant.
Preterm newborn <1.5 kg
1.5-2.5 kg
>2.5 kg
IV Loading Dose
IV Loading Dose
IV Loading Dose
IV 15 micrograms/kg
over 10 min
IV 17.5 micrograms/kg
over 10 min

After 6 hours IV
7.5 micrograms/kg over
10 min

After a further 6 hours
7.5 micrograms/kg over
10 min

After 6 hours
IV 8.75 micrograms/kg
over 10 min

After a further 6 hours IV
8.75 micrograms/kg over
10 min
10 micrograms/kg IV over 10 min

After 6 hrs 5 micrograms/kg
over 10 min

After further 6 hours
5 micrograms/kg over 10 min
Oral Loading Dose
12.5 micrograms/kg PO

After 6 hours 6.25 micrograms/kg

After further 6 hours
6.25 micrograms/kg
Maintenance IV/PO
2.5 micrograms/kg 12 hourly
Oral Loading dose
15 micrograms/kg PO

After 6 hours
7.5 micrograms/kg

After a further 6 hours
7.5 micrograms/kg
Maintenance IV/PO
3 micrograms /kg 12
hourly
Oral loading dose
22.5 micrograms/kg PO

After 6 hours
11.25 micrograms/kg

After a further 6 hours
11.25 micrograms/kg
Maintenance IV/PO
5 micrograms/kg 12 hourly
DOMPERIDONE
200 - 400 micrograms/kg
PO
FRUSEMIDE
(Furosemide)
0-5 - 1 mg/kg
IV/PO
GLUCAGON
20 micrograms/kg bolus
1 - 10 mcg/kg/hr
IV/IM/SC
IV
INDOMETACIN
(Indomethacin)
Refer to Gosset IV
monograph for
administration details.
MORPHINE SULPHATE
PANCURONIUM
PARACETAMOL
Prior to start of or half way through blood
transfusion
12 hourly or 24 hourly for CLD - discuss
with consultant
Over 30 mins in 5% Dextrose
In 5% Dextrose
Prescribe and check this dose with great care. Potential to give 10 times too much,
particularly in babies weighing less than 1 kg
100 micrograms/kg/dose
IV
ONCE every 24 hours for SIX doses
Always prescribe in
micrograms
Check dose carefully.
If baby weighs <1 kg, the dose should be
<100 micrograms.
Initial prescription to be
checked by a Consultant
NALOXONE
TDS/QDS before food and at night
10 micrograms/kg test dose
Followed by doses up to
100 micrograms/kg at 2-3 min
intervals
100 micrograms/kg
40 - 80 micrograms/kg
Infuse over 20-30 mins. Refer to Gosset IV
monograph for administration details.
IV
Reversal of opioid induced respiratory
depression.
IM
PO/IV
bolus
4 hourly
No longer available. Discontinued July 2008
Dependant on gestation – refer
PO/PR
Age 28 – 32 weeks: 20mg/kg as a single
to other column.
dose then 15mg/kg every 8 – 12 hours as
necessary. Max 30mg/kg/day.
Age > 32 weeks: 20mg/kg as a single dose
then 15mg/kg every 6 – 8 hours as
necessary.
Max 60mg/kg/day
PHENOBARBITONE
PHENYTOIN
RANITIDINE
SALBUTAMOL
SPIRONOLACTONE
Loading dose 20 mg/kg
IV
Over 20 mins. May be followed up after 30
minutes by another 10 mg/kg if fits continue
and ventilated. Monitor levels
Maintenance 2.5 - 5 mg/kg
IV/PO
ONCE a day started 24 hours after loading
dose. (Long half life in neonates)
Loading dose 20 mg/kg
IV
Slowly over 30 mins with ECG monitoring.
Dilute 1:9 in 0.9% saline only. Use 0.22
micron filter because of risk of
crystallisation. Monitor levels
Maintenance 2.5 - 5 mg/kg
IV/PO
12 hourly
1 mg/kg
IV/PO
8 hourly. Give over 2 mins. Do not give to
patients on Tolazoline.
Give over at least 3 minutes.
1.25 - 2.5 mg
1 - 5 micrograms/kg/min
4 micrograms/kg
NEB
IV
IV
Dilute in 2 ml 0.9% saline
Watch potassium. Infuse in 0.9% saline.
For hyperkalaemia.
1 - 2 mg/kg
PO
12 hourly
TPA (Tissue
Plasminogen Activator)
700 mcg/kg/loading dose
200-500 mcg/kg/hr
IV
IV
Over 30-60 minutes
Continuous infusion. Monitor fibrinogen
levels 6-8 hourly and give FFP if <1.0.
Pre-treatment and daily cerebral USS.
Not to be used without advice from
consultant
URSODEOXYCHOLIC
ACID
5-7 mg/kg
PO
TDS
125 – 250mg/kg
PR
0.3 ml/kg
IV
QDS
Repeated as necessary every 4 – 6 hours.
Oral route not recommended in neonates.
If acidotic, will require correction.
TREATMENT OF HYPERKALAEMIA
CALCIUM RESONIUM
CALCIUM GLUCONATE
10%
(0.22mmol of calcium/ml)
SALBUTAMOL
INSULIN
4 micrograms/kg
IV
Over 20 minutes
Refer to infusion section and IV neonatal drug monograph
VITAMINS AND MINERALS
VITAMIN A
VITAMIN D (Alfacalcidol)
VITAMIN E
(Alpha Tocopheryl)
VITAMIN K
DALIVIT
FOLIC ACID
SYTRON
PHOSPHATE
CALCIUM
5000 IU
PO
OD
50 - 100 nanograms/kg/day
PO
Can be given on alternate days
50 mg
PO
OD
1 mg (0.1 ml) if >36/40
1 mg (0.1 ml) if <36/40 but BW
>2.5 kg
0.4 mg/kg (0.04 ml/kg) if
<36/40 and <2.5 kg
0.3 ml od
IM/IV
Parental consent. Konakion MM (lower
volume/half vial from 01/04/06)
If parents would like oral Vitamin K document and see protocol
PO
If <36/40 or <2.5 kg start when >7/7 and fully
fed. Stop when 1 year old.
0.3 mg od
PO
If <36/40 or <2.5 kg start when >7/7 and fully
fed. Stop when fully weaned.
1 ml od
PO
If <36/40 or <2.5 kg start when >28/7 and fully
fed.
Stop when fully weaned
Start at 0.5 mmol bd
IV/PO
Start when PO4 <1.5 mmol/l
See osteopenia protocol for dose changes
(page 18)
Start at 0.5 mmol/100ml feeds
PO
See osteopenia protocol for dose changes
(page 18)
FJT/LAW July 2005 (Review 2 years)
Gosset Guidelines/neonatal drug doses
Updated September 2008 SP
Amended July 2009 SP