What is the protocol for determining IVF medication regimens in pediatric patients?

Pediatric IVF Medication Dosing Protocol

For pediatric patients requiring intravenous fluid therapy, medication dosing should be weight-based with careful attention to age-specific physiologic differences to prevent hyponatremia and other complications. 1

General Principles for Pediatric IVF Medication Dosing

• Pediatric medication dosing requires precise knowledge of age-specific absorption, distribution, metabolism, and excretion (LADME) characteristics to avoid potentially harmful under or overdosing 2
• Isotonic fluids with appropriate potassium chloride (KCl) and dextrose should be used for maintenance IVF in patients 28 days to 18 years of age to significantly decrease the risk of developing hyponatremia 1
• Pediatric dosages should not exceed normal adult doses, even when calculated by weight 1

Weight-Based Medication Dosing Guidelines

Antibiotics

• Ampicillin-sulbactam: 300 mg·kg⁻¹·d⁻¹ IV in 4–6 equally divided doses 1
• Gentamicin: 3 mg·kg⁻¹·d⁻¹ IV/IM in 3 equally divided doses 1
• Vancomycin: 40 mg·kg⁻¹·d⁻¹ IV in 2 or 3 equally divided doses 1
• Cefepime: 150 mg·kg⁻¹·d⁻¹ IV in 3 equally divided doses 1
• Ceftriaxone: 100 mg·kg⁻¹·d⁻¹ IV/IM in 3 equally divided doses 1
• Ciprofloxacin: 20–30 mg·kg⁻¹·d⁻¹ IV/PO in 2 equally divided doses 1
• Doxycycline: 2–4 mg·kg⁻¹·d⁻¹ IV/PO in 2 equally divided doses 1
• Rifampin: 20 mg·kg⁻¹·d⁻¹ PO/IV in 2-3 equally divided doses 1

Antiviral Medications

• Oseltamivir (based on body weight):
  • ≤15 kg: 30 mg twice daily for treatment; 30 mg once daily for prophylaxis 1

  • 15–23 kg: 45 mg twice daily for treatment; 45 mg once daily for prophylaxis 1

  • 23–40 kg: 60 mg twice daily for treatment; 60 mg once daily for prophylaxis 1

  • 40 kg: 75 mg twice daily for treatment; 75 mg once daily for prophylaxis 1

• Infants 9–11 months: 3.5 mg/kg per dose twice daily for treatment; 3.5 mg/kg once daily for prophylaxis 1
• Term infants 0–8 months: 3 mg/kg per dose twice daily for treatment; 3 mg/kg once daily for prophylaxis (only for infants 3–8 months) 1

Maintenance IVF Administration

• Use isotonic solutions (sodium concentration similar to plasma, 135–144 mEq/L) with appropriate KCl and dextrose for patients 28 days to 18 years of age 1
• Common isotonic solutions include 0.9% NaCl (sodium concentration 154 mEq/L; osmolarity 308 mOsm/L) and PlasmaLyte (sodium concentration 140 mEq/L; osmolarity 294 mOsm/L) 1
• Add dextrose (2.5%–5%) to the IV solution as appropriate based on the patient's condition 1

Special Considerations for Different Age Groups

Neonates (<28 days)

• This guideline does not apply to neonates who are younger than 28 days old or in the NICU 1
• Preterm infants require special dosing considerations:
  • <38 weeks' postmenstrual age: 1.0 mg/kg per dose twice daily (for oseltamivir) 1
  • 38-40 weeks' postmenstrual age: 1.5 mg/kg per dose twice daily (for oseltamivir) 1

  • 40 weeks' postmenstrual age: 3.0 mg/kg per dose twice daily (for oseltamivir) 1

Infants and Young Children

• Children 6 through 35 months of age may receive any licensed IIV at either 0.25 or 0.5 mL per dose, without preference 1
• For children with immature kidney function, all drugs with high renal clearance have a prolonged duration of action in the first months of life 2

Older Children and Adolescents

• Children 36 months (3 years) and older can receive any age-appropriate licensed IIV, administered at a 0.5-mL dose 1
• Pediatric dosage should not exceed that of a normal adult 1

Common Pitfalls and Caveats

• Dose volume vs. number of doses: Dose volume is different from the number of doses needed to complete vaccination or treatment 1
• Multidose vials: For vaccines that include a multidose vial presentation and a 0.25-mL dose, a maximum of 10 doses can be drawn from a multidose vial 1
• Renal function: Due to immature kidney function, all drugs with high renal clearance have a prolonged duration of action in the first months of life 2
• Hepatic function: Biliary excretion is particularly important for substances with a molecular weight of > 500 g/mol and is of limited functionality during the first months of life 2
• Calculation errors: A review of errors in IV therapy indicated calculation skill and a wide knowledge is required, as calculation errors are a common source of medication errors 3

Safe Administration Practices

• Practitioners must have knowledge of reconstituting principles, including aseptic technique, compatibility, stability, storage, labeling, interactions, dosage, calculations, and appropriate equipment use 3
• Training must include the management of anaphylaxis for all practitioners administering IV medications 3
• Follow the "nine rights" of IV medications to ensure safe practice: right patient, right drug, right dose, right time, right route, right documentation, right to education, right to refuse, and right assessment 3