Neonatal Formulary nnf7 About the companion website A free companion resources site for this book is available at: www.neonatalformulary.com The website lists each drug described in the book, with: Updates and new material New – Monographs on new drugs available since the publication of the book Updates – Revisions to monographs revised since the publication of the book Comments – Temporary postings, e.g., a change in usage Commentaries – Permanent website commentaries about a drug Web archive – Drug monographs for little-used drugs no longer included in the book Useful links Cochrane reviews – Links to relevant Cochrane reviews for listed drugs UK guidelines – Links to UK management guidelines for listed drugs WHO – Identification of drugs classified as essential by the World Health Organisation E-mail alerting Sign up for the e-mail alerting service and we will let you know whenever a new batch of updates is added to the site Feedback If you would like to see any drug not currently mentioned appear in the next edition or to provide feedback on the text, please contact the editorial team using drug.information@neonatalformulary.com Neonatal Formulary Drug Use in Pregnancy and the First Year of Life nnf7 This edition first published 2015 © 2015 by John Wiley & Sons, Ltd Registered office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication data is applied for ISBN 978-1-118-81959-3 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Set in 9.5/12.5pt Meridien by SPi Publisher Services, Pondicherry, India 1 2015 Contents Introduction, viii Important advisory statement, xi Further reading, xiii Acknowledgements, xv Part 1: Drug prescribing and drug administration, Terms, symbols, abbreviations and units, Drug storage and administration, Drugs and the body, 12 Drugs and the law, 14 The care and use of intravascular lines, 17 Minimising IV infusion and other drug hazards, 24 Patient safety initiatives, 27 Writing a hospital prescription, 30 Adverse reactions and overtreatment, 33 Maternal drug abuse, 36 Renal failure, 39 Body weight and surface area, 42 Effects of therapeutic hypothermia on medications, 44 Useful websites, 48 Part 2: Drug monographs, 55 Part 3: Maternal medication and its effect on the baby, 555 Introduction, 556 Further reading, 558 Maternal medication and the baby, 560 Index, 608 vii Introduction NNF7 has been designed to provide compact, up-to-date, referenced advice on the prescribing of drugs and their safe and accurate administration, during pregnancy, labour and the first year of life While the book’s main focus is on the baby, many drugs that are given to women during pregnancy or lactation have a potential impact on the fetus or baby in a way that is equally important This compendium therefore also gives advice on maternal medications The number of drugs used in late pregnancy and the first few weeks of life continues to rise rapidly, although, in many cases, manufacturers have not yet sought market authorisation to recommend neonatal use Globally the use of medications that are either not licensed or, if they are licensed, are used for indications out with the terms of their product license (‘off label’) is common in neonatal units While a lot of general information on drugs may be given in the manufacturer’s summary of product characteristics (SPC), advice on use in young children is often non-existent Since advice in the SPC is all that has been seen and approved by regulatory bodies such as the Commission on Human Medicines in the United Kingdom, and since the British National Formulary (BNF) normally limits itself to summarising information that has been so validated, much drug use in the neonate occurs in a hazardous information vacuum The same can be said for the use of many drugs during pregnancy and lactation All this makes it increasingly important for midwives and nurses, as well as pharmacists and doctors, to be able to access a reference text that summarises the scattered but extensive therapeutic and pharmacokinetic information that is available on the safe and appropriate use of these products Information on placental transfer and teratogenicity, and on the extent to which each drug appears in human milk (and the extent to which this matters), is provided for each drug Where the text merely says that treatment during lactation is safe, it can be taken that the dose ingested by the baby is likely to be less than 5% of the dose taken by the mother on a weight for weight basis, and that no reports have appeared suggesting that the baby could be clinically affected Special attention has been paid to the rapid changes that occur in the renal and hepatic handling of some drugs in the first few weeks of life, and the impact of illness and severe prematurity on drug metabolism and drug elimination Widespread use of therapeutic hypothermia in the treatment of asphyxiated newborn infants brought with it a need to understand the effects of temperature on the medications used in these infants The symptoms associated with overtreatment are summarised, and the management of toxicity is outlined Information is also included on the best way to use the few drugs so far known to be of therapeutic benefit to the fetus NNF7 also provides information on the main drugs used to modify the diet of babies with congenital enzyme deficiencies (‘inborn errors of metabolism’), a monograph on breast milk fortifiers, and a monograph on the artificial milks (‘formula’ milks) for viii ... not currently mentioned appear in the next edition or to provide feedback on the text, please contact the editorial team using drug.information@neonatalformulary.com Neonatal Formulary Drug Use... used in the neonatal period some 50 years ago led to many hundreds of deaths that might have otherwise been avoided Hexachlorophene baths and vitamin K injections also killed several hundred... edn Philadelphia: American College of Physicians, 2007 Guy’s, St Thomas’ and Lewisham Hospitals Paediatric formulary, 9th edn London: Guy’s Hospital Pharmacy, 2012 Isaacs D, ed Evidenced-based