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Dosing for commonly used medications during neonatal hypothermia for term and late preterm infants

Dosing for commonly used medications during neonatal hypothermia for term and late preterm infants
Medication Gestational age (GA) or weight Dosing
Antibiotics
Benzylpenicillin[1] 36 to <38 weeks 75,000 units/kg per day, given every 8 hours.
38 to <42 weeks 150,000 units/kg per day, given every 8 hours.
>42 weeks 200,000 units/kg per day, given every 8 hours.
Amoxicillin[2] 36 to <38 weeks 50 mg/kg per day, given every 8 hours.
>38 weeks 75 mg/kg per day, given every 8 hours.
Gentamicin[3,4] 36 to <42 weeks 5 mg/kg given every 36 hours.
>42 weeks 5 mg/kg given every 24 hours.
Morphine[5,6] 36 weeks and greater Loading dose 50 mcg/kg followed by continuous infusion of 5 mcg/kg per hour.
Antiseizure medications
Phenobarbital[5] 36 weeks and greater Loading dose 30 mg/kg, additional dose of 10 mg/kg if seizures persist.
Midazolam[6] 36 weeks and greater Loading dose 0.1 mg/kg followed by continuous infusion of 0.15 mg/kg per hour.
Lidocaine[7] Weight 2 to <2.5 kg Initial loading dose of 2 mg/kg administered over 10 minutes, followed by infusion rate of 6 mg/kg per hour over 3.5 hours. Maintenance dosing starts at 3 mg/kg for first 12 hours and is decreased to 1.5 mg/kg per hour.
Weight 2.5 and greater Initial loading dose of 2 mg/kg administered over 10 minutes, followed by infusion rate of 6 mg/kg per hour over 3.5 hours. Maintenance dosing starts at 3 mg/kg for first 12 hours and is decreased to 1.5 mg/kg per hour.
Levetiracetam[8,9] 36 weeks and greater and weight greater than 2.5 kg Loading dose 20 mg/kg, to be repeated if needed. Maintenance dose 10 to 20 mg/kg, given every 12 hours.
References:
  1. Bijleveld YA, de Haan TR, van der Lee JH, et al. Evaluation of a System-Specific Function To Describe the Pharmacokinetics of Benzylpenicillin in Term Neonates Undergoing Moderate Hypothermia. Antimicrob Agents Chemother 2018; 62:e02311.
  2. Bijleveld YA, Mathot R, van der Lee JH, et al. Population Pharmacokinetics of Amoxicillin in Term Neonates Undergoing Moderate Hypothermia. Clin Pharmacol Ther 2018; 103:458.
  3. Bijleveld YA, de Haan TR, van der Lee JH, et al. Altered gentamicin pharmacokinetics in term neonates undergoing controlled hypothermia. Br J Clin Pharmacol 2016; 81:1067.
  4. Frymoyer A, Lee S, Bonifacio SL, et al. Every 36-h gentamicin dosing in neonates with hypoxic-ischemic encephalopathy receiving hypothermia. J Perinatol 2013; 33:778.
  5. van den Broek MP, Groenendaal F, Toet MC, et al. Pharmacokinetics and clinical efficacy of phenobarbital in asphyxiated newborns treated with hypothermia: a thermopharmacological approach. Clin Pharmacokinet 2012; 51:671.
  6. van den Broek MP, van Straaten HL, Huitema AD, et al. Anticonvulsant effectiveness and hemodynamic safety of midazolam in full-term infants treated with hypothermia. Neonatology 2015; 107:150.
  7. van den Broek MP, Rademaker CM, van Straaten HL, et al. Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: efficacy, safety and dosing. Arch Dis Child Fetal Neonatal Ed 2013; 98:F341.
  8. Lima-Rogel V, Lopez-Lopez EJ, Medellin-Garibay SE, et al. Population pharmacokinetics of levetiracetam in neonates with seizures. J Clin Pharm Ther 2018; 43:422.
  9. Ahrens S, Ream MA, Slaughter LA. Status Epilepticus in the Neonate: Updates in Treatment Strategies. Curr Treat Options Neurol 2019; 21:8.
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