Policy for infants <28wk or BW <1000 gms
1. Indocin Prophylaxis-
a. Dose 0.1 mg/kg/dose per q. day
b. Given w/in first 2-4 hours of life over 2 hours.
i. Preferably IV over 2 hours
ii. Consider PICC w/in 1st 24 hrs. so that most medications (such as caffeine, Indocin) would be given IV and not IA.
a. Given on day 1 and 2: 12 hours after the daily dose of Indocin has been administered.
b. Loading dose is split in 2 days: Day 1: 10 mg/kg, Day 2: 10 mg/kg (both over 2 hours) and as mentioned above 12 hours after daily Indocin has been administered.
c. Maintenance dose remains 5 mg/kg but may get later on, during first week, an additional 5mg/kg if the child continues to have apnea off IPPV or on IPPV at low settings.
d. Past the first week: if continues to have apnea off IPPV or on IPPV at low settings, give on top of maintenance dose give additional boluses of 5 mg/kg. Do not exceed a blood level of 30 mg/ml
e. Can give additional 5 mg/kg bolus for the same indication as long as blood level below 30 mg/ml. No increase in the maintenance dose (which should be at maximum 10 mg/kg)
3. No more maintaining midline head position if one cannot keep ET tube continuously in an appropriate position
4. 02 saturation limits:
a. low limit set at 85%
b. high limit set at 90%
c. if arterial line is in place: Raise lower and higher limits and Fi02 as needed to keep arterial 02 above 40 mm Hg and below 70 mm Hg
5. Whenever possible do not give any medications through UAC, which implies attempting PICC within the first 24 hours