NICU Code Meds and Drips

MOST COMMONLY AND APPROPRIATELY USED CODE MEDICATIONS IN THE NICU

  • DRUG                                              DOSE                                  ROUTE
  • Epinephrine (1:10,000)            0.1 ml/kg                            ET, IV
  • Dextrose (10%)                      2 ml/kg                              IV
  • Phenobarbital Load               20 mg/kg                             IV
  • Packed Red Blood Cells (O-)    10 ml/kg                             IV
  • IV bolus of normal saline         10 ml/kg                             IV

IV PRESSOR DRIPS                                  DOSE RANGE

  • Dopamine                                      3-20 µg/kg/min
  • Dobutamine                                 5-20 µg/kg/min

 

Dopamine & Dobutamine Titration Chart
Concentration (mcg/mL)   Dose   (mcg/kg/min) IV Rate (mL/kg/hour)
500 2.5                           5                              7.5                                 10 0.3                                0.6                                   0.9                                       1.2
  • Epinephrine                                 0.1-1.0 µg/kg/min (Adrenalin)
Epinephrine Titration Chart
Concentration (mcg/mL)    Dose   (mcg/kg/min) IV Rate (mL/kg/hour)
10 0.05                           0.1                              0.5                                 1 0.3                                0.6                                   3                                       6
  • Insulin                                     0.01-0.1 unit/kg/h (consider a subcutaneous bolus of insulin instead as appropriate)
Insulin Titration Chart
Concentration (U/mL) Dose   (U/kg/h) IV Rate (mL/kg/hour)
0.1 0.02                           0.04                              0.08                         0.1         0.2                                0.4                                   0.8                       1               
  • Prostagladin E1                          0.05-0.1 µg/kg/min (Alprostadil) watch for apnea at higher doses
Prostaglandin E1 Titration Chart
Concentration (mcg/mL) Dose   (mcg/kg/min) IV Rate (mL/kg/hour)
10 0.2                           0.5                              1                                  1.2                                3                                   6                                       

Click below for more concentrated versions of these drips (or other drugs), per Tulane Pharmacy:

Standard Infusion Concentrations Chart

A Note of Caution: certain drugs on the Tulane Master list should never be used in the NICU. For example, levophed is often called “leave ’em dead” in the NICU. It should never be used for any reason. The degree of peripheral tissue ischemia and metaboic acidosis burden generated by this drug out weighs any central pressor effect in premature infants (in such extreme care scenarios, dopamine escalating to low dose epinephrine is always the better choice). Always consult an attending before writing for a drip that is not a standard NICU medication (i.e. not on one of our common NICU med lists). In neonatology, the first maxim is “do no harm” and the easiest way to fail in that regard is to write for an inappropriate medication due to a premature neonate’s novel developmental vulnerabilities to so many medications. Drips represent the absolute most concentrated and direct form of delivery of medication and thus pose special risks in the NICU. This issue is compounded by the fact that infants have a small volume of distribution when compared to older patients.

  • NICU Code Meds and Drips

  • E.D. Quick Guidelines for the Newborn

  • Antibiotic Guidelines (Cheat-sheet)

  • Go to NICU Brain

  • Go to NICU Library

  • Go to NICU Vault (Guidelines)

  • Go to Follow Up Clinic

  • Dr Gordon believes in using the right tool for the job

  • Flow Diagram of Neonatal Resuscitation

  • NICU Common Med List (Cheat Sheet)

  • General NICU Formulary (limited)

  • Drug Reference Tool I

  • Drug Reference Tool II

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