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infant age
1-12 months old
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adolescent age
12-16 years old
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definition of premature
< 37 weeks gestation
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low birth weight
< 2500 grams
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moderately low birth weight
1501 - 2500 grams
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very low birth weight
1000 - 1500 grams
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extremely low birth weight
< 1000 grams
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definition of term gestation
37 - 42 weeks
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which book is good for infusions
teddy bear book
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book for infectious disease
red book
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an advantage of useing lexi-comp pediatric dosing handbook
has postnatal age and weight for dosin
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advantage of neofax dosing book
uses gestational age and postnatal age
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harriet lane book
had diagnostic info as well but has less detailed drug information
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sanford guide
antimicrobial therapy
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two sources for pregnancy and lactation
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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
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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
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what does an increased retic count in infants indicate
RBC maturation will begin to develoop
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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
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body water proportion compared to adults
- neonate - 50% extracellular 30% intracellular
- adult - 20% extracellular 40% intracellular
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order of maturation for excretion
- glomerular filtration
- tubular secretion
- tubular reabsorption
- initially all decreased
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which umbilical line is for monitoring
artery UAC
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which umbilical line is for administering
venous UVC
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device used for large volume continuous infusions
volumetric pump with buretrol
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device used for intermittent infusions
syringe pump or is precise titration of continuous infusions
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early onset sepsis EOS
- < 7 days of life (majority within 24 hours)
- commonly present as respiratory distress
- maternal factors play a big role
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late onset sepsis LOS
- > 7 days of life
- less of a maternal impact
- hospital and community acquisition
- clinical presentation often focal
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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
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main organisms responsible for EOS
- group B streptococcus (GBS)
- E. Coli
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main organisms of LOS
- coagulase negative strep (CONS)
- s aureus
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main organisms in LLOS
- coagulase negative strep CONS predominates
- s aureus less common
- large role of IV catheters and TPN
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3 therapies for neonatal sepsis
- ampicillin + gentamicin
- cefotaxime
- vancomycin
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antenatal corticosteroids for preventing RDS
- betamethasone
- dexamethasone
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antepartum antibiotics for preventing RDS
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tocolysis for preventing RDS
- terbutaline
- magnesium sulfate
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beta2 agonist
smooth muscle relaxant
contiuous IV infusion or oral therapy
monitor
heart rate
blood pressure
respiratory rate
potassium
glucose
pulmonary edema (rare)
terbutaline
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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
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12mg IM q 12 h X 2
betamethasone course
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6 mg IM q12h X 4
dexamethasone course
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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)
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what if mother has UTI and comes in for delivery
give ampicillin or penicillin at least 4 hours prior to delivery
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2 mainstays of maternal antibiotic regimen for GBS
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alternative regimens for penicillin allergic pts in maternal antibiotic regimen for GBS
- cefazolin - most evidence
- clindamycin - increase GBS resistance to
- vancomycin
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3 surfactant options for RDS
- curosurf - poractant
- infasurf - calfactant
- survanta - beractant
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3 treatment options for RDS
- surfactant therapy
- antimicrobial therapy
- supportive therapies
- oxygen
- assisted ventilation
- management of acidosis
- fluid & electrolyte management
- analgesia & sedation
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what 3 things are you looking to cover with antimicrobial therapy
- GBS
- listeria
- gram (-) enteric organisms
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what does ampicillin cover
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what does gentamicin cover
- GBS
- gram (-) enteric organisms
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what antimicrobial could be added for late onset RDS to cover staphlococci
vancomycin
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what could be added for RDS if herpes simplex virus (HSV) is suspectd
acyclovir
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2 meds used for supportive therapy with analgesia & sedation
- fentanyl
- lorazepam or midazolam
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supportive therapy for RDS
boluses should be injected slowly over 3-5 minutes
continuous infusion may be used
fentanyl
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supportive therapy for RDS
analgesia and sedation
PRN doses
continuous infusion may be used
lorazpam or midazolam
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viral microbial causes < 5yo
- influenza
- parainfluenza
- adenovirus
- rhinovirus
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bacterial microbial causes < 5 yo
- s pneumoniae +
- h influenzae -
- s aureus +
- s pyrogenes +
- atypicals
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bacterial microbial causes > 5 yo
- s pneumoniae
- m pneumoniae - atypical
- c pneumoniae - atypical
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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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