thera II test III peds

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neonate age

0-28days
infant age

1-12 months old
child age

1-12 years old
adolescent age

12-16 years old
adult age

> 16 years old
definition of premature

< 37 weeks gestation
low birth weight

< 2500 grams
moderately low birth weight

1501 - 2500 grams
very low birth weight

1000 - 1500 grams
extremely low birth weight

< 1000 grams
definition of term gestation

37 - 42 weeks
which book is good for infusions

teddy bear book
book for infectious disease

red book
an advantage of useing lexi-comp pediatric dosing handbook

has postnatal age and weight for dosin
advantage of neofax dosing book

uses gestational age and postnatal age
harriet lane book

had diagnostic info as well but has less detailed drug information
sanford guide

antimicrobial therapy
two sources for pregnancy and lactation
- briggs
- hales
peds vital signs
RR
HR
BP
- increased 40-60 seen often
- increased mean heart rate at 2 wks 148beats/min
- decreased - typical is 65-90/30-60
ped lab values
Hgb & Hct
- newborns increased due to low arterial PO2 in utero
- after birth, PO2 increases and erythropoesis decreases ( with increased RBC destruction)
- Hgb lowest in term infants at 6-12 wks
- "physiologic anemia"
- increases with age
what does an increased retic count in infants indicate

RBC maturation will begin to develoop
levels of
liver enzymes
SCr
pH
- increased - alk phos increased from bone growth
- decreased - decreased muscle mass
- decreased - during first few days of life
- can affect the protein binding of drugs
body water proportion compared to adults
- neonate - 50% extracellular 30% intracellular
- adult - 20% extracellular 40% intracellular
order of maturation for excretion
- glomerular filtration
- tubular secretion
- tubular reabsorption
- initially all decreased
which umbilical line is for monitoring

artery UAC
which umbilical line is for administering

venous UVC
device used for large volume continuous infusions

volumetric pump with buretrol
device used for intermittent infusions

syringe pump or is precise titration of continuous infusions
early onset sepsis EOS
- < 7 days of life (majority within 24 hours)
- commonly present as respiratory distress
- maternal factors play a big role
late onset sepsis LOS
- > 7 days of life
- less of a maternal impact
- hospital and community acquisition
- clinical presentation often focal
ups and downs of neonatal sepsis in the last decade
- decrease mortality
- increase overall incidence
- increase awareness
- decrease meningitis complications
- shift to late onset sepsis and fungal
main organisms responsible for EOS
- group B streptococcus (GBS)
- E. Coli
main organisms of LOS
- coagulase negative strep (CONS)
- s aureus
main organisms in LLOS
- coagulase negative strep CONS predominates
- s aureus less common
- large role of IV catheters and TPN
3 therapies for neonatal sepsis
- ampicillin + gentamicin
- cefotaxime
- vancomycin
antenatal corticosteroids for preventing RDS
- betamethasone
- dexamethasone
antepartum antibiotics for preventing RDS
- penicillin
- ampicillin
tocolysis for preventing RDS
- terbutaline
- magnesium sulfate
beta2 agonist
smooth muscle relaxant
contiuous IV infusion or oral therapy
monitor
heart rate
blood pressure
respiratory rate
potassium
glucose
pulmonary edema (rare)

terbutaline
unknown mechanism
likely competes with calcium to reduce myometrial contractility
continuous IV infusion
monitor
blood pressure
RR
presence of deep tendon reflexes
arrhythmias
serum levels

magnesium sulfate
12mg IM q 12 h X 2

betamethasone course
6 mg IM q12h X 4

dexamethasone course
4 guidlelines for intrapartum antibiotic prophylaxis (IAP)
- positive screening culture from vagina or rectum
- given birth to an infant with early-onset GBS disease
- GBS bacteriuria during current pregnancy
- culture status unknown + other risk factors (fever, preterm labor, prolonged rupture of membranes)
what if mother has UTI and comes in for delivery

give ampicillin or penicillin at least 4 hours prior to delivery
2 mainstays of maternal antibiotic regimen for GBS
- penicillin
- ampicillin
alternative regimens for penicillin allergic pts in maternal antibiotic regimen for GBS
- cefazolin - most evidence
- clindamycin - increase GBS resistance to
- vancomycin
3 surfactant options for RDS
- curosurf - poractant
- infasurf - calfactant
- survanta - beractant
3 treatment options for RDS
- surfactant therapy
- antimicrobial therapy
- supportive therapies
- oxygen
- assisted ventilation
- management of acidosis
- fluid & electrolyte management
- analgesia & sedation
what 3 things are you looking to cover with antimicrobial therapy
- GBS
- listeria
- gram (-) enteric organisms
what does ampicillin cover
- GBS
- listeria
what does gentamicin cover
- GBS
- gram (-) enteric organisms
what antimicrobial could be added for late onset RDS to cover staphlococci

vancomycin
what could be added for RDS if herpes simplex virus (HSV) is suspectd

acyclovir
2 meds used for supportive therapy with analgesia & sedation
- fentanyl
- lorazepam or midazolam
supportive therapy for RDS
boluses should be injected slowly over 3-5 minutes
continuous infusion may be used

fentanyl
supportive therapy for RDS
analgesia and sedation
PRN doses
continuous infusion may be used

lorazpam or midazolam
viral microbial causes < 5yo
- influenza
- parainfluenza
- adenovirus
- rhinovirus
bacterial microbial causes < 5 yo
- s pneumoniae +
- h influenzae -
- s aureus +
- s pyrogenes +
- atypicals
bacterial microbial causes > 5 yo
- s pneumoniae
- m pneumoniae - atypical
- c pneumoniae - atypical
6 algorithm areas for Tx of CAP
- age of child
- immunization status
- risk factors
- daycare
- recent antibiotic use
- clinical severity (outpatient vs. inpatient)
- epidemiologic factors
- chest radiography

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thera II test III peds

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thera II test III peds

Updated

5/3/2013, 6:39:02 PM

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