Neonatal worksheet

Tubes and Lines
ETT tube size (cm):
ETT length (cm):	Oral: Nasal:
Umbilical catheter size (Fr):
UVC length (cm) [excl cord]:
UAC length (cm) [excl cord]:	[from nicutools.org] [from Auckland]

Medicines for Intubation and Resuscitation
	Atropine	Fentanyl	Suxamethonium	Adrenaline
Concentration	600microgram/mL	100microgram/2mL	100mg/2mL	1:10,000
Route	IV	IV	IV	IV	ETT
Dose/kg	20microgram/kg	5microgram/kg	2mg/kg	0.1-0.3mL/kg	0.5-1mL/kg
g	mL (microg)	mL (microg)	mL (mg)	mL	mL

Drug	Original Preparation	Dilution	Dose/kg	Dose
Analgesia, sedation and muscle relaxant
Morphine (IV)	10 mg/mL	Add 0.9mL NaCl 0.9% to 0.1mL morphine (1mg) = 1mg/mL	100 microg/kg	microgram (mL)
Midazolam (IV)	15 mg/3mL	Add 4mL NaCl 0.9% to 1mL midazolam (5mg) = 1mg/mL (5mg/5mL)	100 microg/kg	microgram (mL)
Pancuronium (IV)	4 mg/2mL	Add 0.5mL WFI to 0.5mL pancuronium (1mg) = 1mg/mL	100 microg/kg	microgram (mL)
Chloral Hydrate (PO)	100 mg/mL		25 mg/kg	mg (mL)
Paracetamol (PO)	24 mg/mL		15 mg/kg	mg (mL)
Sucrose (PO)	24%		0.5 - 1 mL	mL

Drug	Original Preparation	Dilution	Dose/kg	Dose
Other Drugs
Curosurf (poractant alfa)	120mg/1.5mL	Do not dilute (dose calculation rounded to vial)	100-200 mg/kg	mL
Caffeine citrate (IV)	20mg/mL	Give undiluted over 30min	20 mg/kg (Loading)	mg (mL)
Adrenaline Neb	1:1000	made up to 5mL NaCl 0.9%	0.5 mL/kg	mL ()
Sodium Bicarbonate 8.4%	1 mMol/mL	Add 1 mL WFI per 1mL Sodium Bicarbonate 8.4%	Full correction = (BE x Weight)/3	(Full correction for BE -10)
Saline bolus	0.9% NaCl		10 mL/kg	mL

Drug	Original Preparation	Dilution	Dose/kg	Dose
Antibiotics and Anticonvulsants
Phenobarbitone (IV)	200 mg/mL	Add 9mL NaCl 0.9% to 1mL phenobarbitone (200mg) = 20mg/mL	20 mg/kg	mg (mL)
Phenytoin (IV)	100 mg/2mL	Add 9mL NaCl 0.9% to 1mL phenytoin (50mg) = 5mg/mL	20 mg/kg	mg (mL)
Aciclovir (IV)	250 mg/10mL	Add 20mL NaCl 0.9% to 5mL acyclovir (125mg) = 5mg/mL	20 mg/kg	mg (mL)
Amoxycillin (IV)	1 g	Add 9.2mL WFI = 100mg/mL	50 mg/kg	mg (mL)
Benzyl Penicillin (IV)	600mg	Add 5.6mL WFI = 100mg/mL	60 mg/kg	mg (mL)
Cefotaxime (IV)	1g	Add 9.6mL WFI = 100mg/mL	50 mg/kg	mg (mL)
Flucloxacillin (IV)	500mg	Add 4.6mL NaCl 0.9% = 100mg/mL (Further dilute see manual)	50 mg/kg	mg (mL)
Gentamicin (IV)	80mg/2mL	Add 3mL NaCl 0.9% to 1mL gentamicin (40mg) = 10mg/mL (Dilute further if <1500g with 0.5mL NaCl 0.9%)	5 mg/kg	mg (mL of 10mg/mL)
Metronidazole (IV)	5mg/mL	Give undiluted	15 mg/kg (Loading)	mg (mL)
Vancomycin (IV)	500mg	Add 10mL WFI = 50mg/mL (Further dilute to 5mg/mL)	15 mg/kg	mg (mL of 5mg/mL)

Drug	Original Preparation	To make up	Dose equivilant	Dose
Infusions
Dobutamine	12.5 mg/mL	60mg/kg in 50mL of 10% glucose	1 mL/hr = 20 microg/kg/min	mg (mL)
Dopamine	40 mg/mL	60mg/kg in 50mL of 10% glucose	1 mL/hr = 20 microg/kg/min	mg (mL)
Morphine	10 mg/mL	1mg/kg in 50mL of 10% glucose	1 mL/hr = 20 microg/kg/hr	mg (mL)
Midazolam	5 mg/mL	3mg/kg in 50mL of 10% glucose	1 mL/hr = 1 microg/kg/min	mg (mL)
Prostaglandin E1 (alprostadil)	500 microg/mL	60microg/kg in 50mL 0.9%NaCL	1 mL/hr = 20 nanog/kg/min	mg (mL)
Adrenaline	1 mg/mL (1:1000)	0.6mg/kg in 50mL saline or glucose	1 mL/hr = 0.2 microg/kg/min	mg (mL)
Noradrenaline	1 mg/mL	0.3mg/kg in 50mL saline or glucose	1 mL/hr = 0.1 microg/kg/min	mg (mL)

TFI (mL/kg/day)	Hourly Rate	Glucose Delivery (mg/kg/min)
Maintenance Fluids
TFI (mL/kg/day)	Hourly Rate	10%	12.5%	15%
40	mL/hr
60	mL/hr
80	mL/hr
100	mL/hr
120	mL/hr

Gestation calculator

Use this calculator to work out the gestation at birth, if all you know is the EDD
Enter EDD (Must be in future):
Changing the EDD will change the Gestation shown in the section above (make sure DOB is filled in appropriately). Once you have filled in the EDD click anywhere outside the box for it to update.

For more complicated scenarios please visit: http://www.adhb.govt.nz/newborn/guidelines/admission/GACalc.htm

Glucose Calculator

Dextrose Percentage
Fluid rate (mL/hr)
TFI (mL/kg/day)
Glucose Utilisation Rate

Please double check all the calculations.
Enter Drug Name: or pick from dropdown list:

New Version Coming Soon!

This worksheet was used about 10,000 times in the last year - I hope you have found it helpful. A complete update is underway with new features - which will be launching soon. I would love to hear your feedback or suggestions for improvements. Please send me an email - Dr Jubal John

Usage instructions

Start by entering the date of birth, gestation and weight in the form above. Calculations should update as the weight is entered.
This application is intended for use primarily by the Paediatric Infant and Perinatal Emergency Retrieval Service clinicians.
Detailed usage instructions, including instructions on creating a shortcut on mobile devices is available here.

Disclaimer

Whilst every effort has been taken to ensure the accuracy of the information in this web application, it is still possible that errors may have been missed. I make no warranties or representations, expressed or implied, as to the accuracy of information contained in this application. Furthermore, the contents are subject to review and change from time to time. Please double check all calculations yourself before prescribing and administering medications, I am in no way liable for any errors that may arise from using this web application. Additionally the Royal Children's Pharmacy disclaimer applies.

About

This web application automates various calculations that are useful in the care of a neonate. Feedback and suggestions are welcome.
Developed by Jubal John. Based on RCH PIPER and Royal Womens Hospital Melbourne drug guidelines.

Acknowledgements

Dr Michael Stewart, Dr Jenni Sokol and Dr Risha Bhatia for reviewing and testing this tool. Rosemarie Boland for providing the average weights by gestation (based on 13,000+ preterm-infants born alive in Victoria between 1990 and 2009).

Emergency Drugs
Adrenaline (0.1ml/kg) [1:1000 adrenaline equivalent to 1mg/ml]:	ml of 1:10000 IV or UVC	micrograms (10micrograms/kg)
Adrenaline [via ETT] (0.3ml/kg) [1:1000 adrenaline equivalent to 1mg/ml]:	ml
Naloxone (0.25ml/kg, 0.4mg per ml):	ml	mg
Bicarbonate (2mmol/kg) [dilute to 4.2%, i.e. 0.5mmol/ml] :	ml of 0.5mmol/ml solution
Dextrose (2ml/kg):	ml of 10% Dextrose
Volume expansion (10ml/kg):	ml
Volume expansion (20ml/kg):	ml

Total Fluids (ml/kg/day):
Oral component:	ml, given
Base infusion:
Intralipid 20%:

Fluid	ml/day	ml/kg/day	ml/hr


Infusions can be added here by selecting them from the 'Drug Calculations' screen and clicking the add to fluid calculations option at the bottom [clear]
[clear]
[clear]

Indication:	Maintenance of blood pressure in cardiogenic or septic shock if Dopamine unsuccessful
Dosage guideline:	Continuous infusion 0.05 - 1 micrograms/kg/min
Desired Dosage:	micrograms/kg/min

Indication:	Suspected or proven late-onset neonatal sepsis
Dosage guideline:	15mg/kg/dose (or 18/mg/kg/dose) as IV infusion over 30min
Dont use this calculator if significant renal impairment, asphyxia, PDA or treatment with indomethacin, ref to protocol instead Drug levels need to be monitored when amikacin is being used.

Indication:	First line penicillin, administered in combination with an aminoglycoside, to treat suspected septicaemia and meningitis. Effective against group B beta haemolytic Strep, E. Coli, Enterococcus and Listeria Monocytogenes
Dosage guideline:	Suspected sepsis: 50mg/kg/dose IV, For severe sepsis/meningitis 100mg/kg/dose
Check here to use severe sepsis/meningitis dosage

Indication:	Antibiotic of choice for group B strep and in congenital syphilis
Dosage guideline:	Bacteraemia or Congenital Syphilis: 30mg/kg/dose IV, For Meningitis: 60mg/kg/dose
Check here to use Meningitis dosage

Indication:	An aminoglycoside used to treat sepsis and meningitis often in combination with penicillin primarily active against gram negative bacilli
Dosage guideline:	4-5mg/kg/dose as IV infusion over 30min
Dont use this calculator if significant renal impairment, asphyxia, PDA, ref to protocol instead
Consider stat dose and check levels for babies with possible renal impairment including acute renal failure, indomethaciin, birth asphyxia, etc. Check trough level half hour before second dose on all babies on a course of >48hr and adjust interval appropriately. Babies on 48 or 36 hour dosing only require a single dose if treatment is to be stopped at 48 hours.

Indication:	Resuscitation in cardiorespiratory arrest (See Protocol on Asphyxia). Use emergency drug calc for resus dosage. Correction of metabolic acidosis due to bicarbonate losses (renal or GI). In PPHN to achieve alkalosis without hyperventilation.
Dosage guideline:	Metabolic Acidosis: HCO3 needed [m Eq] = [HCO3 deficit] (base excess) x (0.3 x weight [kg]). Administer half of calculated dose over 30-60 minutes then assess need for remainder (maximum rate 0.25 to 0.5 mmol/kg/hour). Dilute 1:1 with sterile water.
base excess:
Desired rate:	minutes
Use emergency drug calc for resus dosage.
Never mix with Calcium Bicarbonate is rarely indicated in resuscitation of VLBW babies. IV hypertonic fluids may increase risk of intraventricular haemorrhage. Oral bicarbonate therapy may be a risk factor for NEC. When using bicarbonate by continuous infusion, monitor serum Na and blood gases. Not recommended for hypercapnia or hypernatraemic states.

Indication:	Apnoea of prematurity.
Dosage guideline:	Loading Dose: - 25 mg/kg caffeine base IV over 20-30 minutes. Give two doses of 12.5 mg/kg one hour apart (see below). OR - 25 mg/kg caffeine base orally. Give two doses of 12.5 mg/kg two hours apart. Maintenance Dose: - 6 mg/kg/day IV or orally.
Select route:
Maintenance dose starts 24h after loading dose. Dosage of 3mg/kg maybe more appropriate for babies that have outgrown their 6mg/kg dose NB: 2mg caffeine citrate = 1mg caffeine base

Indication:	Severe neonatal sepsis/meningitis caused by a gram negative agent with known sensitivities.
Dosage guideline:	Dose: 50 mg/kg per dose 24 hourly. May increase to 50 mg/kg/dose 12 hourly or 80-100 mg/kg/dose 24 hourly.
Desired Dosage:	mg/kg
Note: Ceftriaxone is rarely used in neonates. Contraindicated in jaundiced neonates (displaces bilirubin from albumin binding sites) Eosinophilia, leukopaenia, thrombocytosis. Elevated creatinine, urea, LFTs. Rash, diarrhoea.
Each gram contains 3.6 mmol of Na+.

Indication:	A second generation cephalosporin used in management of neonatal sepsis.
Dosage guideline:	50 mg/kg/dose q12h. (Total 100 mg/kg/day).
In proven (i.e. culture-positive sepsis), Cefuroxime should only be used if sensitivities are known.

Indication:	Sedation
Dosage guideline:	25 - 50 mg/kg/dose PO Q6 - 8h p.r.n. [MAXIMUM DOSE = 50 mg/kg/DAY]
Desired Dosage:	mg/kg
Primary use is sedation for procedures or sedation (in "older" babies) for ventilation. Not appropriate to sedate acutely ill or preterm babies for the purposes of ventilation. Effectiveness tends to wear off after approximately one week. Not analgesic.
Each gram contains 3.6 mmol of Na+.

Indication:	Treatment of RDS in pre-term babies after discussion with the Consultant on call.
Dosage guideline:	1.25 ml/kg (100 mg phospholipids/kg) per dose. (2 doses of Curosurf are usually given 6-8 hours apart if the baby is still intubated. Further doses should be discussed with the Neonatologist but up to four doses can be administered in the first 48 hours of life).

Indication:	Apnoea of prematurity unresponsive to caffeine and in conjunction with caffeine. Contraindications: Seizures, recent intraventricular haemorrhage, cardiac failure, hypertension, hyperthyroidism.
Dosage guideline:	Start at 0.5 mg/kg/hour - Increase step wise to 1.5 mg/kg/hour as required and tolerated.
Desired Dosage:	mg/kg/hour

Indication:	Treatment of hypoperfusion and hypotension. Blood pressure support in babies with shock/hypotension.
Dosage guideline:	Start with 5 micrograms/kg/minute by continuous IV infusion and increase up to 20 micrograms/kg/ minute as indicated.
Desired Dosage:	micrograms/kg/min
Predominantly b1 adrenergic. Dobutamine has a more prominent effect on cardiac output than dopamine but less of an effect on blood pressure. Potential increase in pulmonary vascular resistance. May cause hypotension if baby is hypovolaemic. Consider volume loading before starting dobutamine.

Indication:	Given Prior to the Ophthalmologists Examination of Neonatal Unit Babies
PHENYLEPHERINE 2.5%	Phenylepherine is a sympathomimetic agent. It is used as an eyedrop to produce mydriasis and as a conjunctival decongestant. Time to maximum effect is 60 to 90 minutes.
CYCLOPENTOLATE 0.5%	Cyclopentolate is an antimuscarinic agent. It is used was an eyedrop to produce mydriasis and cycloplegia. Time to maximum effect is 30 to 60 minutes. Duration of action is up to 24 hours. Can be associated with reduction in gastrointestinal motility and feed intolerance. Application of pressure over lacrimal sac is recommended to minimise absorption through the nasal mucosa.

Indication:	Treatment of symptomatic hypocalcaemia (serum Ca++ < 1.7 mmol/litre, ionised Ca++ < 0.64 mmol/litre). There is often associated hypomagnesaemia (<0.68 mmol/litre) and ECG changes (QTc <0.2 sec). Treatment of asymptomatic neonatal hypocalcaemia is controversial. Adjuvant treatment in the management of hyperkalaemia.
Dosage guideline:	Symptomatic hypocalcaemia - Acute treatment: - 1 - 2 ml/kg/dose of 10% Calcium Gluconate. - Infuse over 10-30 minutes while monitoring for bradycardia (stop if HR <100). - DO NOT GIVE intra-arterially/IM or subcutaneously. Adjuvant treatment in management of hyperkalaemia: - Give 0.5 - 1 ml/kg diluted 1:1 with water for injection over 10 minutes.
Desired Dosage:	ml/kg/dose
Correct hypomagnesaemia if present. Calcium should not be regarded as a standard drug for resuscitation of asphyxiated neonates. Watch and adjust dose in renal failure.

Indication:	Treatment of symptomatic hypocalcaemia (serum Ca++ < 1.7 mmol/litre, ionised Ca++ < 0.64 mmol/litre). There is often associated hypomagnesaemia (<0.68 mmol/litre) and ECG changes (QTc <0.2 sec). Treatment of asymptomatic neonatal hypocalcaemia is controversial.
Dosage guideline:	Maintenance treatment (IV): 2 - 8 ml/kg/day of 10% Calcium Gluconate
Desired Dosage:	ml/kg/day of 10% Calcium Gluconate
Desired Rate:	ml/hr (Min recommended rate: ml/hr)
Correct hypomagnesaemia if present. Watch and adjust dose in renal failure.

Indication:	An inotropic agent used to increase blood pressure and cardiac output and improve renal blood flow in shock due to perinatal asphyxia.
Dosage guideline:	RENAL PERFUSION EFFECT: 2 - 5 microgram/kg/minute INOTROPIC EFFECT: 5 - 10 microgram/kg/minute
Desired Dosage:	micrograms/kg/min
Dopamine should not be given as a bolus to increase blood pressure

Indication:	An ACE inhibitor used in the treatment of hypertension and heart failure, refractory to digoxin and diuretics.
Dosage guideline:	Initially 0.01-0.05 mg/kg/dose PO every 8 hours. Increase if necessary to a maximum of 2 mg/kg/day in 2-3 divided doses. Start at lower end of dose range and titrate up if necessary to the lowest effective dose.
Desired Dosage:	mg/kg/dose
Desired Frequency:
Monitor for hypotensive episode after first dose.

Indication:	A penicillin used to treat infections caused by penicillinase producing organisms, i.e. Staphylococcus aureus.
Dosage guideline:	25-50mg/kg/dose as IV or PO
Desired Dosage:	mg/kg/dose
Desired Route:

Indication:	A diuretic used in managing chronic lung disease.
Dosage guideline:	10 to 20 mg/kg per dose, q 12h orally.
Desired Dosage:	mg/kg
Note: Do not confuse with hydochlorothiazide.

Indication:	A potent loop diuretic used to treat oliguria and fluid overload associated with patent ductus arteriosus, congestive heart failure, interstitial oedema or bronchopulmonary dysplasia.
Dosage guideline:	0.5 - 2 mg/kg/dose IV, PO p.r.n. MAINTENANCE DOSE: 0.5 - 1 mg/kg/day IV, PO divided q12-24 hours Larger doses are sometimes necessary in resistant cases but should not exceed a maximum single dose of 6 mg/kg/dose orally or 2 mg/kg/dose IV.
Desired Dosage:	mg/kg
Monitor serum sodium and potassium.
Desired Route:
Desired Frequency:

Indication:	Treatment of persistent hyperglycaemia in VLBW babies. Treatment of hyperkalaemia in combination with sodium bicarbonate to facilitate intracellular shift of potassium.
Dosage guideline:	In hyperglycaemia - Start at 0.05 units/kg/hour and increase as needed to 0.1 units/kg/hour. May need up to 0.2 units/kg/hr; titrate against blood sugars. Monitor q2hr glucoses (Glucocard Â± lab. glucoses) for first 8 hrs then if stable q4hr. Check urine for glucose q8hr. In hyperkalaemia (and in conjunction with glucose infusions) - Start at 0.1 units/kg/hr.
Desired Dosage:	units/kg/hour

Indication:	Bactericidal antibiotic used in treatment of anaerobic organisms. Necrotizing Enterocolitis if perforation has occurred.
Dosage guideline:	Loading dose: 15 mg/kg Maintenance: 7.5 mg/kg/dose Maintenance dose should begin one dosing interval after loading dose.

Indication:	Narcotic analgesic used for pain relief. Sedation for ventilated neonates.
Dosage guideline:	Load (optional): 0.1 mg/kg slow bolus. [NOT IN CALCULATIONS BELOW] Continuous infusion: 0.01 - 0.03 mg/kg/hour.
Desired Dosage:	mg/kg/hour

Indication:	Antipyretic and for mild to moderate analgesia.
Dosage guideline:	10-15 mg/kg/dose PO, PR q4 - 6h to MAXIMUM DOSE of 60 mg/kg/day.
Desired Dosage:
Caution in neonates with G-6-PD deficiency.

Indication:	Hyperbilirubinaemia Drug of first choice for seizure disorders of the newborn.
Dosage guideline:	Loading dose: 20 mg/kg IV over 10-15 minutes; additional. 10 mg/kg doses may be given to a MAXIMUM. TOTAL DOSE of 40 mg/kg. Maintenance: 3 - 5 mg/kg/day IV, PO q24h, given a minimum of 12-24 hrs after LD. HIDA Scan: 5 mg/kg/day IV/PO until HIDA scan. [NOT IN CALCULATIONS BELOW]
Desired Maintenance Dosage:	mg/kg/day

Neonatal Worksheet

New Version Coming Soon!

Usage instructions

Disclaimer

About

Acknowledgements

Indication:	Treatment of neonatal seizures which are refractory to maximal doses of Phenobarbital.
Dosage guideline:	Loading dose: 20 mg/kg IV over 30 minutes Maintenance: 4 - 8 mg/kg/day IV, PO in divided doses q12h, beginning 12-24 hours after LD.
Desired Maintenance Dosage:	mg/kg/day

Indication:	Hyponatraemia
Dosage guideline:	As required, typically 3-6 mmol/kg/day in divided doses.
Desired Dosage:	mmol/kg/day
Give with or prior to feeds
Desired Frequency:

Indication:	A third generation cephalosporin used in the treatment of sepsis and meningitis caused by Klebsiella, Proteus, E. Coli, and ampicillin resistant H. Influenza.
Dosage guideline:	50 mg/kg/dose IV give over 30min
This drug should not be considered in CNS infections caused by Streptococcus faecalis, Pseudomonas Aeruginosa, Bacteroides fragilis and Listeriosis.