Abstract
Background In 2021 the RCPCH (The Royal College of Paediatrics and Child Health) accepted and published the NPPG (Neonatal and Paediatric Pharmacy Group) framework for standard infusion concentrations for patients over 2 kg.1 The Get It Right First Time (GIRFT) neonatology review2 published in 2022 recommended the development of standard concentration infusions for neonates less than 2 kg in weight.
Aim To propose neonatal standardised intravenous infusion concentrations for commonly used intravenous medications to work in tandem with the 2021 NPPG and RCPCH framework for children over 2 kg.1
Method Three large tertiary neonatal units worked together to model a range of concentrations that would provide flexibility in dosing whilst taking into account nutritional requirements and total fluid allowances in the neonatal population. A number of UK published neonatal standardised concentrations were identified. For each drug, standard concentrations were assessed for suitability in under 2 kg using computer aided models. The following factors were considered in decision making: population; infusion rate; availability of ready to use products; fluid volume; stability; ease of manufacture; safety and reproducibility; current UK products and alignment with NPPG/RCPCH framework.
Results 22 medicines were modelled and following discussion with representatives from BAPM (British Association of Perinatal Medicine) and NPPG the five most commonly used infusions were presented for ratification. These were adrenaline, dobutamine, dopamine, dinoprostone and morphine. These five standard concentration recommendations have been included in the framework which is endorsed by RCPCH and BAPM.3
Conclusion It is possible to standardise IV drug infusion concentrations for patients weighing less than 2 kg and the first 5 medicines have been ratified by BAPM and adopted into the national framework.3 BAPM ratification is ongoing and the next six medications for approval are insulin, milrinone, rocuronium, atracurium, midazolam and noradrenaline. Future work proposed includes ratification of the remaining 17 commonly used medicines; assessing the uptake of this framework throughout the UK neonatal sites; identifying any potential barriers to implementation; developing a tool kit to support safe implementation and developing a framework for regular monitoring. Feedback should be sought from a range of units looking after patients with differing levels of acuity. The lead pharmacist in each Neonatal Operational Delivery Network would be well placed to support this work.
References
Neonatal and Paediatric Pharmacist Group: Standardising intravenous infusion concentrations for children in the UK [April 2021].
Adams E, Harvey K, Sweeting M: Neonatology GIRFT programme National Specialty Report [April 2022] https://gettingitrightfirsttime.co.uk/girft-reports/
Neonatal and Paediatric Pharmacist Group: Standardising intravenous infusion concentrations for neonates and children in the UK, A proposal for a national approach [February 2023] https://www.rcpch.ac.uk/sites/default/files/2023-12/standard_infusions_feb_2023.pdf
