NICU Calc

Name:

DOB:

select

Gestation at birth [23-42]:

weeks days Check if born after midday

Day of life:

CGA: weeks days

Birth

Weight:

g [500-5500g]

Followup
[alt-1]:

Emergency Calculations
[alt-2]:

Drug Calculations
[alt-3]:

Fluid Calculations
[alt-4]:

Gest Calculation
[alt-5]:

Useful Links

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

Disclaimer

Whilst every effort has been taken to ensure the accuracy of the information in this web application, the contents are subject to review and change from time to time. I make no warranties or representations, expressed or implied, as to the accuracy of information contained in this application. Furthermore, this application is still under development and may contain errors, therefore it is important to treat results with a healthy degree of skepticism and double check all calculations.

What's new

[2008-08-14] Minor changes to caffeine calculator
[2008-08-12] Added ADHB UAV measurement
[2008-08-12] 'Comments' now show closer to the drug order in red
[2008-08-12] Fixed other issues raised by Jacqui Beavis
[2008-08-04] Added cefotaxime
[2008-08-04] Update Gentamicin to use new protocol
[2008-08-04] Implemented various suggestions by Jacqui Beavis
[2008-08-03] Added what's new section

Known Issues

Usage instructions

1. Enter DOB, gestation and weight

2. then select the required tab;

Followup
- will show all the follow up this child with require, and the dates when they need to happen.

Emergency calculations
- will give all resus calculations and doses
- I'm using nicutools.org algorithm for calculation of UVC/UAC and ETT sizes.

Drug calculations
- This allows easy prescribing of infusions and drugs and is based on Middlemore NICU drug protocol
- There is a link at the bottom (once a drug is selected) to the full protocol.

Fluid calculations
- this is still rudementary, but it does the calculations required for prescribing fluids
- infusions from the drug tab can be added into here

Gest Calculation
- If EDD is entered here, in then calculates what the gestation at birth would be (the calculated gestation is filled into the section on top, where you would usually enter the gestation).

Tips

If you want the calculations to update with a new value you have entered, you may have to click outside the input box or press the Tab button.
Please make sure the weight entered is appropriate for the tab that you are in. i.e. use birth weight for follow-up tab, or when lower than current weight in other tabs.
You can use keyboard shortcuts, using a combination of 'Alt' and the numbers 1-7 for the appropriate tab.

About

This web application automates various calculations that are useful in a Neonatal Intensive Care Unit (NICU). Feedback and suggestions are welcome.

Application coded by Jubal John. Any javascript functions used are credited accordingly in the source code. Middlemore hospital drug guidelines used.

This program comes with ABSOLUTELY NO WARRANTY; This is free software, and you are welcome to redistribute it under the conditions specified in the GNU General Public License version 3 or later.

This project is hosted at sourceforge. Source code is managed via CVS.

Umblical catheter size (Fr):
UVC length (in cm) [excl cord]:
UAC length (in cm) [excl cord] [from nicutools.org]:
UAC length (in cm) [excl cord] [from ADHB]:

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

Intubation Drugs [in order]
Morphine (200micrograms/kg over 5min):	ml of 1mg/ml solution	micrograms
Atropine (20micrograms/kg over 1min):	ml of 30microgram/ml solution	micrograms
Suxamethonium (3mg/kg over 10-30s):	ml of 5mg/ml solution	mg

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+.

ET tube size:
ET length (in cm at mouth):

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 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:	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:	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:	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

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.