Drug

Calcium (Calvive) 1000mg effervescent tablets

Route

Oral, NG

Dosage

0.25mmol/kg 6 hourly
Refer to calcium gluconate monograph for parenteral use.

Uses

Hypocalcaemia at serum calcium <1.6mmol/L. Some hypocalcaemia in the first 2 weeks of life is physiological. If it persists, investigate cause

Administration

Prescribe at separate times at least 2 hours apart from oral phosphate supplements.

Adverse and side effects

Mild GI intolerance and diarrhoea by oral route.

Comments

Dissolve 1 tablet in 45mL of water for injection (this will take a few minutes) to give 50mL of a 0.5mmol/mL solution (after displacement).

Monitor serum calcium daily initially then alternate days and then weekly.

Each table contains 2263mg of calcium lactate gluconate and 1750mg of calcium carbonate (equivalent to 1000mg or 25mmol of calcium).

Drug

Phosphate solution 1mmol/ml

Route

Oral, NG

Dosage

0.5mmol/kg 12 hourly prescribed as Phosphate Solution
Refer to phosphate monograph for parenteral use.
Use oral route whenever possible.

Uses

• Serum phosphate <1mmol/L.
• Predominantly breast fed babies with serum phosphate <1mmol/L or AP>1000 units/L

Rarely, supplements at discharge will be needed, discuss with consultant.

Administration

Prescribe at least 2 hours apart from oral calcium supplements

Adverse and side effects

Comments

Monitor serum Ca, PO4 and AP. Check serum Ca and PO4 24hr after starting to check for hypocalcaemia then monitor weekly. Check urinary creatinine and phosphate after 2 weeks if serum phosphate is still low or AP >1000 units/L. Urine phosphate:creatinine ratio <2 implies phosphate deficiency. Store opened bottle in the refrigerator, discard after 12 months.

References

2,4,6

Drug

Potassium chloride 7.5% (1mmol/ml) solution (Kay-Cee L)

Route

Oral, NG

Dosage

1-1.5mmol/kg 12 hourly.
Refer to potassium monograph for parenteral use.

Uses

Hypokalaemia with serum potassium <3mmol/L.

Administration

Adverse and side effects

Mild GI intolerance such as vomiting and oesophageal irritation.

Comments

Monitor U/Es daily for 1-2 days initially then if serum potassium is increasing repeat weekly. Store in refrigerator once opened. Discard 1 month after first opening.

References

4.  Link to Potassium patient group direction (PGD2)

Drug

Sodium Chloride solution 1mmol/ml

Route

Oral, NG

Dosage

1mmol/kg 6 hourly.
Refer to clinical guidelines for parenteral use.

Uses

Hyponatraemia at serum sodium <132mmol/L.

Administration

Wean sodium supplements before stopping over 1 week

Adverse and side effects

Hypernatraemia

Comments

Monitor U/Es and body weight for 1-2 days daily. If serum sodium is increasing, check weekly thereafter. Store opened bottle in refrigerator and discard 1 week after first opening.

References

4.  Link to Sodium Chloride patient group direction (PGD2)

Drug

Sodium Feredetate 5.5mg iron/ml

Route

Oral, NG

Dosage

Do not prescribe iron for babies on SMA BMF. Commence on iron at 0.2ml (1.1mg Fe)/kg once daily in <35 weeks gestation or 1.8kg at birth once receiving full enteral feeds (and SMA BMF is discontinued) and at least 6 weeks old.
If discharged home before starting Iron then a supply of Sodium Feredetate will be given to the parents to be given once baby is 6 weeks of age - the starting dose will be 0.5mls once daily regardless of weight of the baby.

Uses

Anaemia of prematurity

Administration

Continue until a full weaning diet at least 9 months corrected age. Be guided by growth and well being of infant. Vitamin C (contained in fruit juices and drink) can increase the absorption of iron when given at the same time.

Adverse and side effects

Mild GI intolerance such as diarrhoea, constipation and possibly vomiting. Stools are darkened.

Comments

If baby has not started oral iron on ward, the discharge prescription must specify the starting date.

References

2,4,5.  Link to Sytron patient group direction (PGD2)

Drug

Multivitamin Drops A, B group, C and D
(Dalivit or Abidec)

Route

Oral, NG

Dosage

0.6ml daily in infants less than 35 weeks gestation or 1.8kg at birth, once receiving full enteral feeds unless on breast milk fortifier. Aditionally infants over 35 weeks who are still inpatients after 2 weeks of age, but not to be prescribed at discharge.

Uses

Vitamins supplementation. Preterm babies have little hepatic reserve of vitamin A and D and are at risk of deficiency.

Administration

Our policy is that parents of preterm babies discharged on Abidec or Dalivit should be advised to continue a vitamin supplement containing vitamin D from the time of discharge from NNU until the age of 5 years.

Adverse and side effects

Toxicity from normal dosages unlikely. Parents must follow dosage.

Excess vitamin D can lead to hypercalcaemia and results in vomiting, constipation and growth retardation.

Although moderate and regular sunlight defined as exposure of legs and face for no more than 30 minutes a day in summer is advised. Infants should not be placed in direct sunlight where there may be a risk of sunburn by about 15 minutes at midday in summer. These conditions are infrequent in Scotland

Dalivit contains more than the required daily amount of vitamin A

Comments

Abidec is the preferred multivitamin A, B group, C and D.
Dalivit should only be prescribed when not available.

• Abidec Drops contains:
  1333 i.u. Retinol as vitamin A
  400 i.u. ergocalciferol solution
  0.4 mg thiamine hydrochloride
  0.8 mg riboflavin
  0.8 mg pyridoxine hydrochloride
  8 mg nicotinamide
  40 mg ascorbic acid
  in each 0.6 ml dose
• Dalivit Drops contains:
  5000 i.u. Retinol as vitamin A
  400 i.u. ergocalciferol solution
  1 mg thiamine hydrochloride
  0.4 mg riboflavin
  0.5 mg pyridoxine hydrochloride
  5mg nicotinamide
  50 mg ascorbic acid
  in each 0.6 ml dose

References

Drug

Colecalciferol (previously known as calciferol) solution 3000units/ml

Route

Oral, NG

Dosage

Colecalciferol is not to be used routinely for babies. Babies less than 32 weeks gestation or less than 1.5kg at birth may be given 600 units (0.2ml) daily once on full enteral feeds on an individual patient basis. Discuss indications with the attending Consultant. There is no good indication to increase dose to 900 units daily.
When maternal milk is fortified with Nutriprem Breast Milk Fortifier (BMF), colecalciferol can be discontinued.

Uses

Prevention of rickets of prematurity

Administration

600 units = 15 microgram

Adverse and side effects

Excess vitamin D can lead to hypercalcaemia and result in vomiting, constipation and growth retardation

Comments

Monitor serum calcium, phosphate and alkaline phosphatase (AP) weekly. Store opened bottle in refrigerator and discard 2 weeks after first opening.

Rarely, supplements at discharge will be needed, discuss with consultant

FEED

VITAMIN SUPPLEMENT

IRON SUPPLEMENT

Exclusive formula milk

Yes

Yes, start when 6 weeks old

Fortified Breast Milk (SMA BMF)

No

No

Unfortified Breast Milk

Yes: 0.6 ml Dalivit / day (as per guideline)

Yes, start when 6 weeks old

Breast milk and formula milk (when breast milk supply is low)

Yes: 0.6 ml Dalivit / day (as per guideline)

Yes, start when 6 weeks old