title: Maintenance dose - Neonatal Intensive Care Drug Manual
text: |
  Neonatal Intensive Care Drug Manual
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  bet | 448/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Maintenance dose: 4 mg/kg/dose (3−5 mg/kg/dose) every 24 hours.
  Indication
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  Loading dose
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  Maintenance dose after 24hours of loading dose
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  Anticonvulsant
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  20 mg/kg/dose
  Additional 10mg/kg/doses to a maximum cumulative of 40mg/kg
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  3−5mg/kg every 24 hours and titrate as per seizure control and therapeutic concentrations.
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  NAS
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  15 mg/kg
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  5 mg/kg/day in 1−2 divided doses and titrate to NAS score.
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  Jaundice
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  -
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  5 mg/kg every 24 hours
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  Liver scintigraphy7
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  -
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  5 mg/kg/day in 2 divided doses for 5 days prior to scan
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  Dose adjustment
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  To be updated.
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  Maximum dose
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  Total cumulative dose
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  Route
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  IV and oral
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  Preparation
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  IV: Draw up 1 mL (200 mg of Phenobarbital) and add 9 mL water for injection to make final volume of 10 mL with a final concentration of 20 mg/mL.
  Oral elixir or liquid: Draw up prescribed dose.
  Oral tablet: Pregnant staff are not to crush or disperse tablets. Crush and dissolve a 30 mg tablet in 3.75 ml of water for injection to make a final concentration of 8 mg/mL solution. Give prescribed amount, discard unused portion.
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  Administration
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  IV:
  Loading dose: Infuse over 20 minutes with a maximum infusion rate 1 mg/kg/minute using a light safe extension set.
  Maintenance dose: Bolus over 5 minutes.
  Oral:
  Give immediately before or with feeds to minimise GI irritation.
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  Monitoring
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  Serum concentrations for seizure control and therapeutic hypothermia:
  24 hours after starting phenobarbital. Serum target: 15−40 mg/L (65-172 micromol/L). Consider repeating concentrations 1 week after the commencement and subsequent concentrations as per clinical need.
  Consider liver function tests.
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