Anemia of Prematurity - Portal Neonatal

MEDICATION Section 7 of 10
Providing standard intensive care support, correcting metabolic acidosis, limiting fluid intake to twothirds
the maintenance volume for the first 3-4 days, and seizure control are the main elements of
treatment. Anticonvulsants are the only specific drugs used often in this condition.
Treat seizures early and control them as fully as possible. Even asymptomatic seizures (ie, seen only
on EEG) may continue to injure the brain.
Drug Category: Anticonvulsants -- Used to control seizures.
Phenobarbital (Luminal) -- DOC when clinical or EEG seizures are noted;
is continued on the basis of both EEG and clinical status. In most cases,
can be weaned and stopped during the first month of life; however,
treatment is continued for several months to 1 year in infants with
Drug Name persistent neurological abnormalities and clinical or EEG evidence of
seizures; EEG and clinical status should guide decision. In high doses,
has been used prophylactically by a few researchers, but its efficacy has
not been established. In infants who are heavily sedated or paralyzed,
phenobarbital may be used prophylactically at standard dose.
20 mg/kg IV over 10-15 min as loading dose; in refractory cases,
additional 5-10 mg/kg IV as loading dose; followed by 3-5 mg/kg/d
PO/IV/IM/PR divided bid, to begin no earlier than 12-24 h after loading
Pediatric Dose dose; slow IV push gives most rapid control
In a few experimental studies, 20-40 mg/kg IV has been given
prophylactically to achieve higher serum concentrations; however, this is
not universally accepted
Documented hypersensitivity; severe respiratory disease, marked
Contraindications
impairment of liver function, and nephritic patients
May decrease effects of digitoxin, corticosteroids, carbamazepine,
theophylline, metronidazole, and anticoagulants (patients stabilized on
anticoagulants may require dosage adjustments if added to or withdrawn
Interactions
from their regimen); coadministration with alcohol may produce additive
CNS effects and death; valproic acid may increase phenobarbital
toxicity; rifampin may decrease phenobarbital effects
Pregnancy D - Unsafe in pregnancy
May lead to respiratory distress, so respiratory status should be
monitored; immediate assisted ventilatory support should be available
Monitor serum therapeutic concentrations, which should be 15-30
mcg/mL; prolonged serum half-life during the first 1-2 wk of life may
Precautions cause drug accumulation, requiring adjustment of maintenance doses,
due to low GFR in the first week of life and ATN (if present)
Allowing serum concentrations of 40 mcg/mL is not a universally
accepted practice
Observe IV sites for extravasation and phlebitis
Phenytoin (Dilantin) -- Usually the third DOC in neonatal seizures; may
be used in patients with seizures that do not respond to phenobarbital or
Drug Name lorazepam. Oral absorption is negligible for the first several months of
life.
15-20 mg/kg IV over >30 min as loading dose; followed by 4-8 mg/kg IV
Pediatric Dose slow push q24h; rate of infusion not to exceed 0.5 mg/kg/min; flush IV
line with 0.9% NaCl before and after administration
Documented hypersensitivity; sinoatrial block, second- and third-degree
Contraindications
AV block, sinus bradycardia, or Adams-Stokes synd; IM administration