Pediatrics

Paediatrics โ€“ pharmaadvance.in
๐Ÿ‘ถ

Paediatrics Module

๐Ÿ’Š Drug Dosing
๐Ÿ”ข Calculators
๐Ÿ’‰ Vaccine Schedule
๐Ÿšจ Emergency
๐Ÿ“ Growth
๐Ÿฉบ Conditions
๐Ÿผ Neonatal
๐Ÿ“‹ PG Case Log

Paracetamol (Acetaminophen)

Dose
10โ€“15 mg/kg/dose
Frequency
Q4โ€“6h (Max 4 doses/day)
Max Dose
75 mg/kg/day ยท Max 4g/day
Route
PO / PR / IV
Indication
Fever, Pain
Note
Hepatotoxic in overdose

Ibuprofen

Dose
5โ€“10 mg/kg/dose
Frequency
Q6โ€“8h
Max Dose
40 mg/kg/day ยท Max 2.4g/day
Route
PO
Age Limit
โ‰ฅ 6 months only
Caution
Avoid in dengue, dehydration, renal disease

Amoxicillin

Standard Dose
25โ€“50 mg/kg/day
High Dose
80โ€“90 mg/kg/day
Frequency
Divided Q8โ€“12h
Route
PO / IV
High Dose for
AOM, Pneumonia (resistant)
Duration
5โ€“10 days depending on indication

Azithromycin

Day 1
10 mg/kg (max 500 mg)
Day 2โ€“5
5 mg/kg/day (max 250 mg)
Route
PO / IV
Indication
Atypical pneumonia, Pertussis, Typhoid
Note
Avoid in hepatic disease, QTc prolongation risk

Cetirizine

2โ€“5 years
2.5 mg ODโ€“BD
6โ€“11 years
5 mg ODโ€“BD
โ‰ฅ12 years
10 mg OD
Route
PO (Syrup / Tablet)
Indication
Allergic rhinitis, Urticaria

Salbutamol (Albuterol)

Nebulization
0.15 mg/kg (min 2.5 mg)
MDI
2โ€“4 puffs Q20 min ร— 3
IV (severe)
15 mcg/kg over 10 min
Oral
0.1โ€“0.15 mg/kg Q6โ€“8h
Indication
Asthma, Bronchospasm, Wheeze

Prednisolone

Asthma Acute
1โ€“2 mg/kg/day ร— 3โ€“5 days
Croup
1 mg/kg single dose (max 40 mg)
Max Dose
40โ€“60 mg/day
Route
PO
Note
Give with food; taper if >2 weeks

Zinc Sulfate (Diarrhoea)

< 6 months
10 mg/day ร— 14 days
โ‰ฅ 6 months
20 mg/day ร— 14 days
Route
PO (Dispersible tablet)
Indication
Acute / Persistent diarrhoea (WHO-UNICEF)

Co-trimoxazole (TMP-SMX)

UTI Dose
4โ€“6 mg/kg/day TMP (รท BD)
PCP Prophylaxis
5 mg/kg/day TMP OD
Route
PO / IV
Note
Avoid in G6PD deficiency, neonates

Metronidazole

Amoebic Dys.
30โ€“40 mg/kg/day รท TDS ร— 7โ€“10d
Giardia
15 mg/kg/day รท TDS ร— 5โ€“7d
Anaerobic Inf.
7.5 mg/kg Q6h
Max
2g/day
Route
PO / IV

Albendazole (Deworming)

1โ€“2 years
200 mg single dose
โ‰ฅ 2 years
400 mg single dose
Hydatid / Neurocysticercosis
15 mg/kg/day รท BD ร— 28 days
Route
PO (with food)
Note
Avoid in <1 year

Phenobarbitone

Loading Dose
20 mg/kg IV slow
Maintenance
3โ€“5 mg/kg/day ODโ€“BD
Neonatal seizure
20 mg/kg IV (may repeat 10 mg/kg ร— 2)
Route
PO / IV / IM
Caution
Respiratory depression with IV; monitor

Diazepam

Febrile Seizure
0.3โ€“0.5 mg/kg PR or IV
Status Epilepticus
0.3 mg/kg IV slow ยท Max 10 mg
Rectal Gel
0.5 mg/kg PR
Route
IV / PR / Intranasal
Caution
Respiratory depression; have bag-valve-mask ready

Midazolam

Status Epilepticus
0.1โ€“0.2 mg/kg IV / IM
Buccal/Intranasal
0.2โ€“0.3 mg/kg (max 10 mg)
Sedation
0.05โ€“0.1 mg/kg IV titrate
Route
IV / IM / Buccal / IN
Note
Preferred over diazepam in many guidelines

Dexamethasone

Croup
0.6 mg/kg single dose (max 10 mg)
Meningitis
0.15 mg/kg Q6h ร— 4 days
Cerebral Edema
0.5โ€“1 mg/kg load, then 0.25 mg/kg Q6h
Route
PO / IV / IM

ORS (Oral Rehydration Salt)

Mild Dehydration
50 mL/kg over 4 hours
Moderate Dehydration
100 mL/kg over 4 hours
Maintenance
10 mL/kg per loose stool
Route
PO / NG tube
Note
WHO Low-Osmolarity ORS preferred (245 mOsm/L)

๐Ÿ’Š Paediatric Dose Calculator (mg/kg)

Total Daily Dose-
Per Dose-

๐Ÿ’ง Maintenance IV Fluids (Holliday-Segar)

Per 24 Hours-
Per Hour (mL/hr)-
Formula Used-

โš–๏ธ Estimated Weight by Age

Estimated Weight (APLS)-
Formula Used-
NoteAlways use actual weight if available

๐Ÿงด Rehydration Fluid Calculator

Total Rehydration Volume-
Rate (mL/hr)-

๐Ÿฉธ Paediatric Blood Volume & Transfusion

Estimated Blood Volume-
PRBC Transfusion (10 mL/kg)-
Platelets (10 mL/kg)-
FFP (10 mL/kg)-

๐Ÿซ€ Glucose Bolus (Hypoglycaemia)

Volume to Give-
NoteGive IV over 2โ€“3 min, then glucose infusion
โ„น๏ธ Based on IAP 2023 Immunization Schedule + India National Immunization Programme (NIP). Last updated per UIP guidelines.
๐Ÿ’‰ NIP โ€” National Immunization Programme (Government / Free)
โ–ผ
AgeVaccineDoseRouteSite
BirthBCG0.05 mL (<1 mo) / 0.1 mL (โ‰ฅ1 mo)IDLt upper arm
BirthOPV-0 (bOPV)2 dropsOralOral
BirthHep B โ€“ Birth dose0.5 mLIMAnterolateral thigh
6 weeksDTwP-10.5 mLIMAnterolateral thigh
6 weeksOPV-1 (bOPV)2 dropsOral-
6 weeksHep B-10.5 mLIMAnterolateral thigh
10 weeksDTwP-2, OPV-2, Hep B-2Same as aboveIM/Oral-
14 weeksDTwP-3, OPV-3, Hep B-3, IPVIPV: 0.1 mLIM / ID-
9 monthsMR-1 (Measles-Rubella)0.5 mLSCLt upper arm
9โ€“12 monthsJE-1 (endemic districts)0.5 mLSC-
16โ€“24 monthsDTP Booster-1, OPV Booster0.5 mLIM-
16โ€“24 monthsMR-2 (Measles-Rubella)0.5 mLSCLt upper arm
5โ€“6 yearsDPT Booster-20.5 mLIM-
10 yearsTT0.5 mLIMDeltoid
16 yearsTT0.5 mLIMDeltoid
๐Ÿฅ IAP Advisory โ€” Additional Recommended Vaccines
โ–ผ
VaccineAgeDosesRouteNote
Hib (Haemophilus influenzae b)6 wks โ€“ 5 yrs3+1 (6, 10, 14 wks + 15โ€“18 mo)IMUsually in pentavalent
PCV (Pneumococcal)6 wks โ€“ 5 yrs3+1 or 2+1 scheduleIMPCV13 recommended
Rotavirus6 wks โ€“ 8 months2 (Rotarix) or 3 (RotaTeq)OralDo not start after 15 weeks
MMR9 months + 15 months2 dosesSCAvoid in immunocompromised
Varicella15 months + 4โ€“6 yrs2 dosesSCIf unvaccinated, give 2 doses โ‰ฅ3 months apart
Hepatitis Aโ‰ฅ12 months2 doses (0, 6 months)IMSingle dose after 2 years also acceptable
Typhoid Vi PSโ‰ฅ2 years1 dose; Booster Q3 yrIM/SCVi conjugate preferred
HPV9โ€“14 yrs (girls & boys)2 doses (0, 6 months)IM3 doses if โ‰ฅ15 yrs or immunocompromised
Influenzaโ‰ฅ6 months annually2 doses in first year; 1 dose yearlyIMSeasonal (Octโ€“Nov)
Meningococcalโ‰ฅ2 years (high risk)1โ€“2 dosesIMHigh-risk groups, travellers
โš ๏ธ Vaccine Contraindications & AEFI
โ–ผ
VaccineContraindicationAEFI to Watch
MMR / VaricellaImmunocompromised, pregnancy, anaphylaxis to gelatin/neomycinFebrile seizure (rare), thrombocytopenia
BCGHIV (symptomatic), severe immunodeficiencyBCG-itis, lymphadenitis, disseminated BCG (rare)
RotavirusSCID, intussusception historyIntussusception (rare), mild diarrhoea
DTwP / DPTEncephalopathy within 7 days of prior doseFebrile convulsions, local reactions, HHE (rare)
HPVHypersensitivity to yeast (Gardasil); latex allergySyncope post-injection; observe 15 min
Any Live VaccinePrimary immunodeficiency, on high-dose steroids, active TB-
๐Ÿšจ EMERGENCY REFERENCE ONLY. Always calculate doses using actual patient weight. Doses based on PALS/IAP guidelines.
โšก PALS Emergency Drug Doses โ€” Quick Reference
โ–ผ

๐Ÿซ€ Cardiac Arrest

Adrenaline (Epinephrine)0.01 mg/kg IV/IO Q3โ€“5 min
Amiodarone (VF/pVT)5 mg/kg IV/IO bolus
Lidocaine (alt.)1 mg/kg IV
Sodium Bicarbonate1 mEq/kg IV (prolonged arrest)
Defibrillation2 J/kg โ†’ 4 J/kg โ†’ 4 J/kg
Atropine (Bradycardia)0.02 mg/kg IV ยท Min 0.1 mg

๐Ÿง  Status Epilepticus

Midazolam (1st line)0.1โ€“0.2 mg/kg IV/IM or Buccal
Diazepam PR0.5 mg/kg PR (max 10 mg)
Lorazepam IV0.1 mg/kg IV (max 4 mg)
Phenytoin / Fosphenytoin20 mg/kg IV slow (over 20 min)
Phenobarbitone20 mg/kg IV slow (2nd line)
Levetiracetam40โ€“60 mg/kg IV (max 3g)

๐Ÿ˜ฎโ€๐Ÿ’จ Severe Anaphylaxis

Adrenaline 1:1000 IM0.01 mg/kg IM (max 0.5 mg)
IV Fluid Bolus20 mL/kg NS fast
Chlorpheniramine0.1โ€“0.2 mg/kg IM/IV (slow)
Hydrocortisone4 mg/kg IV (max 200 mg)
Salbutamol neb (wheeze)0.15 mg/kg neb Q20 min

๐Ÿฉธ Shock / Sepsis

IV Fluid Bolus (1st)20 mL/kg NS over 5โ€“10 min
Dopamine5โ€“10 mcg/kg/min infusion
Noradrenaline0.1โ€“2 mcg/kg/min infusion
Adrenaline (refractory)0.1โ€“1 mcg/kg/min
Hydrocortisone (adrenal)2 mg/kg IV Q6h

๐Ÿซ Severe Asthma

Salbutamol neb0.15 mg/kg Q20 min ร— 3
Ipratropium neb250 mcg (<20 kg) / 500 mcg (>20 kg)
Prednisolone PO1โ€“2 mg/kg (max 40 mg) OD
IV MgSO425โ€“75 mg/kg IV over 20 min (max 2g)
Salbutamol IV15 mcg/kg over 10 min
Heliox / NIVIf deteriorating

๐Ÿฌ Hypoglycaemia (BSL <2.6)

D10% โ€” Neonates2 mL/kg IV bolus
D10% โ€” Infants/Children5 mL/kg IV bolus
D25% (if no other)2 mL/kg IV slow
Glucagon IM0.5 mg (<25 kg) / 1 mg (>25 kg)
Maintenance D10%GIR 6โ€“8 mg/kg/min after bolus
๐Ÿšจ Paediatric Advanced Life Support (PALS) Algorithm
โ–ผ
1
Assess โ€” Paediatric Assessment Triangle (PAT)

Appearance (tone, interactability) ยท Breathing (work, sounds) ยท Circulation (skin colour, cap refill)

2
Unresponsive / No breathing โ†’ Start CPR

Ratio 15:2 (2 rescuers) or 30:2 (1 rescuer). Rate: 100โ€“120/min. Depth: โ‰ฅ1/3 AP diameter

3
Attach Monitor / Defibrillator โ€” Shockable?

VF / Pulseless VT โ†’ Shock 2 J/kg โ†’ CPR 2 min โ†’ Adrenaline โ†’ Shock 4 J/kg โ†’ Amiodarone

4
Non-Shockable (PEA / Asystole)

CPR immediately. Adrenaline 0.01 mg/kg IV/IO every 3โ€“5 min. Treat reversible causes (4H + 4T)

5
Reversible Causes โ€” 4H + 4T

Hypovolaemia ยท Hypoxia ยท Hypo/Hyperkalaemia ยท Hypothermia ยท Tension PTX ยท Tamponade ยท Toxins ยท Thrombosis

6
ROSC โ†’ Post-Resuscitation Care

Airway secured ยท Avoid hypoxia (SpOโ‚‚ 94โ€“99%) ยท Avoid hypotension (MAP > 5th percentile for age) ยท Targeted temperature management

๐Ÿซ Croup โ€” Assessment & Management
โ–ผ
Westley Croup ScoreMild (0โ€“2)Moderate (3โ€“7)Severe (โ‰ฅ8)
StridorNone or mildAt restSevere at rest
RetractionsNoneModerateSevere
Air EntryNormalDecreasedMarkedly decreased
CyanosisNoneNoneWith agitation/at rest
ConsciousnessNormalNormalAltered
โœ… Treatment: Dexamethasone 0.6 mg/kg PO/IV (all grades) ยท Nebulised Adrenaline 0.5 mL/kg of 1:1000 (max 5 mL) for moderate-severe ยท Heliox / Intubation if deteriorating
๐Ÿ“ Weight-for-Age Reference (WHO / IAP)
โ–ผ
AgeBoys (median kg)Girls (median kg)Milestones
Birth3.33.2Birth weight; regains by 10โ€“14 days
3 months6.05.4Doubles birth weight by ~4โ€“5 months
6 months7.97.2Starts solids; sits with support
9 months9.28.5Crawls, pulls to stand
12 months10.29.5Triples birth weight; walks with support
18 months11.510.8Runs, speaks a few words
2 years12.512.0Quadruples birth weight
3 years14.514.0Gains ~2 kg/year after age 2
5 years18.518.2School-age start
10 years32.033.0Pre-pubertal; Girls gain earlier
๐Ÿ“ Height / Length for Age Reference
โ–ผ
AgeBoys (cm)Girls (cm)Rule of Thumb
Birth5049Avg. 50 cm
3 months6261+12 cm in first 3 months
6 months686650% increase by 1 year
1 year767475 cm at 1 year
2 years8887Half adult height at ~2 years
4 years103102Doubles birth length by 4 years
10 years138140Girls taller pre-puberty
๐Ÿง  Head Circumference & Developmental Milestones
โ–ผ
AgeHC (cm)Gross MotorFine MotorLanguageSocial
Birth35Head lagGrasp reflexCryRegards face
3 mo40Head controlHands openCooingSocial smile
6 mo43Sits with supportTransfersBabblingStranger anxiety
9 mo45Stands holdingPincer (crude)Mama/Dada (non-specific)Wave bye-bye
12 mo47Walks with supportFine pincer1โ€“2 words meaningfulSeparation anxiety
18 mo48RunsScribbles10โ€“20 wordsDomestic mimicry
2 yr49Up stairs 2 feetTower 6 cubes2-word phraseParallel play
3 yr50TricycleCopies circleFull sentencesGroup play
โš ๏ธ Malnutrition Classification (SAM / MAM)
โ–ผ
TypeCriteriaAction
SAM (Severe Acute)WHZ < -3 SD ยท MUAC <11.5 cm ยท Bilateral pitting oedemaInpatient CMAM / NRC
MAM (Moderate Acute)WHZ -3 to -2 SD ยท MUAC 11.5โ€“12.5 cmOutpatient supplementary feeding
StuntingHAZ < -2 SD (chronic undernutrition)Long-term dietary intervention
UnderweightWAZ < -2 SDDietary counselling + monitoring
โš ๏ธ MUAC <11.5 cm = SAM โ†’ refer immediately. Measure MUAC at left mid-arm, arm at 90ยฐ.

๐Ÿ’ฉ Acute Diarrhoea / AGE

  • ORS: 50โ€“100 mL/kg over 3โ€“4 hrs (mild-mod dehydration)
  • Zinc: 10 mg/day (<6 mo) / 20 mg/day (โ‰ฅ6 mo) ร— 14 days
  • Ondansetron 0.15 mg/kg PO (for vomiting)
  • Antibiotics: Bloody diarrhoea โ†’ Azithromycin 10 mg/kg/day ร— 3 days
  • Probiotics: Lactobacillus GG / Saccharomyces boulardii (adjuvant)
  • Avoid: Antidiarrhoeals (Loperamide) in children

๐ŸŒก๏ธ Fever / ARI

  • Paracetamol 10โ€“15 mg/kg Q4โ€“6h (first line)
  • Ibuprofen 5โ€“10 mg/kg Q6โ€“8h (โ‰ฅ6 months, alternate)
  • Avoid Aspirin in children (Reye syndrome risk)
  • Tepid sponging: No benefit over antipyretics alone
  • ARI with bacterial features โ†’ Amoxicillin 40โ€“45 mg/kg/day
  • Danger signs โ†’ refer: fast breathing, chest indrawing, cyanosis

๐Ÿง  Febrile Seizure

  • Simple FS: Duration <15 min, generalized, resolves spontaneously
  • Acute: Diazepam 0.3 mg/kg IV or 0.5 mg/kg PR
  • Midazolam 0.2 mg/kg buccal/IN if IV not available
  • Treat underlying fever with Paracetamol
  • No long-term AED for simple FS (AAP/IAP recommendation)
  • Complex FS (>15 min / focal): full evaluation, EEG, imaging

๐Ÿซ Acute Asthma

  • Salbutamol neb 0.15 mg/kg Q20 min ร— 3 (initial)
  • Ipratropium 250/500 mcg neb (add in moderate-severe)
  • Prednisolone 1โ€“2 mg/kg/day ร— 3โ€“5 days PO
  • IV MgSO4 25โ€“75 mg/kg over 20 min (severe, โ‰ฅ6 years)
  • SpO2 target: โ‰ฅ95% ยท Supplemental O2 if <94%
  • ICU/Intubation if no response, exhaustion, altered consciousness

๐Ÿซ€ Dengue

  • Group A (No warning signs): ORS, Paracetamol, monitor
  • Group B (Warning signs): IV fluids NS 5โ€“10 mL/kg/hr
  • Group C (Severe dengue): 20 mL/kg NS bolus, admit ICU
  • Avoid Ibuprofen / Aspirin (bleeding risk)
  • Platelets: Transfuse if <10,000 or active bleeding
  • Monitor CBC, PCV Q6โ€“12h in warning signs group

๐Ÿฆ  Typhoid (Enteric Fever)

  • Azithromycin 10โ€“20 mg/kg/day PO ร— 7 days (uncomplicated, 1st line)
  • Ceftriaxone 75 mg/kg/day IV ร— 10โ€“14 days (severe/MDR)
  • Cefixime 20 mg/kg/day PO BD ร— 10โ€“14 days (oral alt.)
  • Chloramphenicol/Amoxicillin if sensitive (resource-limited)
  • Dexamethasone: Only for severe typhoid with altered sensorium
  • Widal: Titres โ‰ฅ1:160 suggestive; confirm with culture

๐ŸฆŸ Malaria

  • P. vivax: Chloroquine 25 mg/kg over 3 days + Primaquine (check G6PD)
  • P. falciparum: Artemether-Lumefantrine (AL) weight-based
  • Severe malaria: Artesunate IV 2.4 mg/kg at 0, 12, 24h then daily
  • Quinine IV (alt if artesunate not available): 10 mg/kg Q8h
  • Paracetamol for fever; avoid Ibuprofen in severe malaria
  • Primaquine contraindicated in G6PD def, <1 yr, pregnancy

๐Ÿฉบ Neonatal Jaundice (Pathological)

  • Phototherapy: Bilirubin โ‰ฅ phototherapy threshold (by age in hours)
  • Exchange transfusion: Bilirubin โ‰ฅ exchange threshold or kernicterus signs
  • Intensive phototherapy: Multiple lights, fibreoptic blanket
  • IVIG 0.5โ€“1 g/kg over 2h (Rh/ABO isoimmunization)
  • Monitor: Repeat TSB Q4โ€“12h on phototherapy
  • Breastfeeding: Continue; supplement if poor intake

๐Ÿฉธ Iron Deficiency Anaemia

  • Elemental Iron: 3โ€“6 mg/kg/day รท BDโ€“TDS ร— 3 months
  • Ferrous sulphate: 200 mg tab = 65 mg elemental iron
  • Give 1 hour before meal for max absorption
  • Vitamin C co-administration enhances absorption
  • Response: Retics rise in 5โ€“10 days; Hb rises 1โ€“2 g/dL/month
  • Continue 3 months after Hb normalises to replete stores

๐Ÿฆด Rickets (Vitamin D Deficiency)

  • Therapeutic: Vit D 2000โ€“6000 IU/day PO ร— 3 months
  • Stoss therapy: 3โ€“6 lakh IU single dose IM (severe, poor compliance)
  • Calcium: 500โ€“1000 mg/day elemental calcium (concurrent)
  • Maintenance after treatment: 400โ€“1000 IU/day Vit D
  • Monitor: ALP, Ca, Phosphate, 25-OH Vitamin D
  • Sun exposure: 15โ€“20 min daily (arms/face)
โš ๏ธ Neonates require special dosing. Hepatic and renal immaturity alter drug metabolism significantly. Always verify doses for gestational age (GA) and postnatal age (PNA).
๐Ÿ’Š Neonatal Drug Dosing Quick Reference
โ–ผ
DrugDoseFrequencyRouteIndication
PhenobarbitoneLoading: 20 mg/kg
Maint: 3โ€“5 mg/kg/day
ODIV/PONeonatal seizures (1st line)
PhenytoinLoading: 20 mg/kg
Maint: 4โ€“8 mg/kg/day
BDIV slowSeizures (2nd line)
Ampicillin50โ€“100 mg/kg/doseQ12h (<7d) / Q8h (โ‰ฅ7d)IVSepsis, Meningitis
Gentamicin4โ€“5 mg/kg/doseQ24โ€“36h (depending on GA)IV/IMNeonatal sepsis
Cefotaxime50 mg/kg/doseQ8โ€“12hIVNeonatal sepsis, Meningitis
Meropenem20 mg/kg/doseQ8โ€“12hIVLate-onset sepsis, resistant organisms
Caffeine CitrateLoading: 20 mg/kg
Maint: 5โ€“10 mg/kg/day
ODPO/IVApnoea of prematurity
Surfactant (Poractant)100โ€“200 mg/kgMay repeat Q6โ€“12h ร— 2ITRDS in prematurity
Indomethacin0.1โ€“0.2 mg/kgQ12โ€“24h ร— 3 dosesIV/POPDA closure (preterm)
Ibuprofen (PDA)10 mg/kg โ†’ 5 โ†’ 5 mg/kgQ24h ร— 3 dosesPO/IVPDA closure (alt to indomethacin)
Dopamine2โ€“20 mcg/kg/minContinuous infusionIVHypotension, shock
Vitamin K1 mg (>1.5 kg) / 0.5 mg (<1.5 kg)Single dose at birthIMVKDB prophylaxis
Erythromycin Eye Oint.1 cm ribbon each eyeSingle dose at birthTopicalOphthalmia neonatorum prophylaxis
๐Ÿšซ Drugs Contraindicated / Avoid in Neonates
โ–ผ

Chloramphenicol

Grey Baby Syndrome โ€” cardiovascular collapse. Immature glucuronyl transferase cannot conjugate chloramphenicol โ†’ toxic accumulation.

Aspirin

Kernicterus risk (displaces bilirubin from albumin) + Reye syndrome risk. Absolutely contraindicated.

Sulphonamides (incl. Co-trimoxazole)

Displaces bilirubin from albumin โ†’ kernicterus. Avoid in first 2 months of life.

Tetracyclines

Deposits in growing bone and teeth โ†’ enamel hypoplasia, bone growth inhibition. Avoid <8 years.

Fluoroquinolones (Ciprofloxacin etc.)

Arthropathy risk โ€” cartilage damage in animal studies. Avoid in children unless no alternative.

Benzyl Alcohol (Preservative)

"Gasping Syndrome" โ€” metabolic acidosis, CNS depression, cardiovascular collapse in neonates. Use preservative-free formulations only.

Metoclopramide

High risk of extrapyramidal reactions (acute dystonia) in neonates and infants. Avoid.

Ibuprofen / NSAIDs (general)

Risk of renal failure, PDA reopening (except specific PDA closure indication). Avoid for fever/pain.

๐Ÿผ Neonatal Fluid Requirements
โ–ผ
Day of LifeTerm Neonate (mL/kg/day)Preterm (mL/kg/day)
Day 160โ€“8080โ€“100
Day 280โ€“100100โ€“120
Day 3100โ€“120120โ€“140
Day 4120โ€“150140โ€“160
Day 5+150โ€“180150โ€“180
โ„น๏ธ Use D10% for neonatal IV fluids (not D5%). Add electrolytes (NaCl, KCl) after Day 2 based on serum levels.

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