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 Formulary Chapter 24: Leeds Children's Hospital Formulary - Full Chapter
Notes:

The Leeds Children's Hospital Formulary is laid out in BNF chapter order. There are custom indexes for the following specialist areas:

Paediatric Intensive Care Unit (PICU)
Neonatal Intensive Care Unit (NICU)
Paediatric Cardiology

Chapter Links...
 Details...
24.16  Expand sub section  Neonatal Formulary
 note 

Pharmacy contact details (neonatal / obstetric wards)

Abidec
(neonatal)
View SPC online View childrens BNF
Formulary
  • Dose: BNFc preterm neonate
  • Administration: BNF-c
  • July 2013 - intermittent supply problems. Use Dalivit in line with local guidelines if Abidec is unavailable 
  • Link  Neonatal Guideline - nutritional supplements
       
    Acetylcysteine (IV, oral, bowel irrigation)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • IV dose and administration for acute liver injury: see prescribing and administration monograph
    • Oral and rectal dose and administration: see meconium ileus monograph
     
    Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal Prescribing and Administration Monograph - acute liver injury (IV)
    Link  Neonatal Prescribing and Administration monograph - meconium ileus (oral and rectal administration)
       
    Aciclovir
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c 
  • Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal Prescribing and Administration Monograph (IV)
       
    Adenosine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal prescribing and administration monograph
       
    Adrenaline
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: Neonatal guideline
  • Administration: Neonatal guideline 
  • Link  Neonatal Guideline - Management of Preterm Infants Born before 28 weeks
    Link  Neonatal prescribing and administration monograph when used as an inotrope
    Link  Resuscitation Council (UK) - Newborn Life Support
       
    Alphatocopheryl (vitamin E)
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal monograph - supplements in cholestasis
       
    Alprostadil
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Follow neonatal unit & paediatric cardiology prescribing and administration monograph (link below) 
     
    Link  Neonatal unit (& paediatric cardiology) prescribing and administration guideline (alprostadil) - network guideline
       
    Amiodarone
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Follow paediatric ICU / cardiology administration guidelines 
  • Link  Paediatric cardiology and PICU administration monograph (amiodarone)
    Link  Paediatric cardiology supporting information (amiodarone)
       
    Amoxicillin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c 
  • Link  Neonatal Prescribing and Administration Monograph (IV)
    Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal guideline - surgical antibiotic prophylaxis
       
    Amphotericin (liposomal) (AmBisome)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
  • Dose and administration: prescribing and administration monograph
  • Only available from pharmacy aseptics
  • Incompatible with sodium chloride solutions  
  • Link  Drug Safety Update (July 2018): Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
    Link  Neonatal Guideline - Management of Invasive Candidiasis
    Link  Neonatal Guideline - Management of Suspected (but unproven) Invasive Candida Infection
    Link  Neonatal Prescribing and Administration Monograph
       
    Atracurium
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal Prescribing and Administration Monograph
       
    Atropine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: prescribing and administration monograph
  • Consult emergency drug prescriber

  • For oral pre-medication: BNFc (use injection orally) 
  • Link  Neonatal Prescribing and Administration Monograph
    Link  BNFc atropine monograph (oral pre-medication)
       
    BCG vaccination
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c 
  • Link  Neonatal BCG immunisation protocol
    Link  Neonatal BNF-c monograph
       
    Benzylpenicillin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • See guideline for early onset sepsis
  • See guideline for syphilis

  • Product no longer available from aseptics 
  • Link  Neonatal Network Prescribing and Administration Monograph - benzylpenicillin
    Link  Neonatal Guideline - antibiotic management of early onset sepsis
    Link  Neonatal Guideline - congenital syphilis
       
    Biotin (vitamin h)
    (neonatal)
    View adult BNF View childrens BNF
    Formulary
  • Dose for seizures is as per BNFc advice for ’defect of biotin metabolism’ (click icon to the left)
  • 5mg tablets available. Can obtain a 5mg/1mL injection 
  •    
    Blood Products
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Not pharmacy products - order from Blood Bank 
  • Link  Use of blood products within neonates (guideline)
       
    Caffeine citrate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • From Jan 2014, caffeine should be prescribed as citrate on the neonatal units
  • IV and oral dose and administration: prescribing and administration monograph
  • Further information: BNF-c
  • Always prescribe as citrate. Levels are not required unless there is evidence of toxicity or ongoing apnoeas
  • Caffeine citrate 10mg/1ml mixture is an unlicensed preparation 
  • Link  Neonatal Prescribing and Administration Monograph (IV)
    Link  Neonatal BNF-c monograph (oral)
       
    Calcium  (oral)
    (neonatal)
    View adult BNF View SPC online View childrens BNF
    Formulary  
    Link  Dosing in osteopenia of prematurity (LTHT neonatal feeding supplementation guideline)
    Link  Dosing in deficiency (BNF-C: Calcium Carbonate)
    Link  Guidance on administration (LTHT)
       
    Calcium chloride
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Resuscitation Council (UK) Paediatric Advanced Life Support
       
    Calcium folinate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose for seizures is as per BNFc advice for ’metabolic disorders leading to folate deficiency’ (click icon to the left)
  • Available as 15mg tablets and 15mg/2mL injection 
  •    
    Calcium Gluconate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • For correction of hypocalcaemia
  • Preferably administer centrally - destructive to tissues if extravasation occurs 
  • Link  Neonatal Prescribing and Administration Monograph (IV)
    Link  Neonatal BNF-c monograph
       
    Calcium Resonium
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: BNF-c
  • Stop treatment when serum potassium reaches 5mmol/L 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - hyperkalaemia
       
    Carobel
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    Green
  • Dose: Neonatal guideline
  • Administration: See product information (packet) 
  • Link  Neonatal guideline - management of suspected GORD
       
    Cefotaxime
    (neonatal)
    View SPC online View childrens BNF
    Restricted Drug Restricted
  • Cefotaxime for any indication requires microbiology approval, including patients transferred to the unit where cefotaxime has already been initiated

  • Cefotaxime is not stocked on the neonatal units and will need ordering from pharmacy

  • The network administration guide below is for guidance. All use requires approval from microbiology
  • Link  Neonatal guideline - management of conjunctivitis
    Link  Yorkshire and Humber Neonatal Network Guideline - cefotaxime administration monograph
    Link  Neonatal BNFc monograph
       
    Ceftazidime
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Long term supply shortage (May 2017): for any guideline that includes this antibiotic please contact microbiology for advice.

  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal Prescribing and Administration Monograph
    Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - long line sepsis
       
    Cefuroxime
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal Prescribing and Administration Monograph
       
    Chloral hydrate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c
  • Oral or rectal administration 
  • Link  Neonatal BNF-c monograph
       
    Chloramphenicol
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c 
  • Link  Neonatal BNF-c monograph (eye drops)
    Link  Neonatal guideline - management of conjunctivitis
       
    Chlorothiazide
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c
  • Diuretic dose used in guidelines is 12.5mg/kg twice a day (within BNF-c dosing guidance)

  • Unlicensed medicine
  • LTHT QC approved product: Diuril 250mg/5mL oral suspension; manufacturer: Perrigo, USA; LTHT QC reference: QA1502001
     
  • Link  Neonatal BNF-c monograph (chronic hypoglycaemia)
    Link  Neonatal BNF-c monograph (diuretic)
    Link  Neonatal guideline - diuretics for infants at risk of chronic lung disease
       
    Clarithromycin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c 
  • Link  Neonatal Prescribing and Administration Monograph (IV)
    Link  Neonatal BNF-c monograph (oral)
       
    Clonidine
    (neonatal)
    View adult BNF View SPC online View childrens BNF
    Formulary  
    Link  Neonatal prescribing and administration monograph
       
    Co-amoxiclav
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Oral dosing for chest infections in neonates without IV access (providing there have been no previous resistant gram negative bacteria isolated): dose as per BNFc (click icon to the left). When prescribed ensure the concentration (125/31) is clearly written on the prescription.
  • IV dosing on the recommendation of microbiology only: dose as per BNFc (click icon to the left), administration as per Paediatric Medusa IV Guide (see link below) 
  • Link  Paediatric Medusa IV administration guide - co-amoxiclav
       
    Dalivit
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c (use child 1-18 year dose for liver patients)
  • Administration: BNF-c 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - nutritional supplements
    Link  Neonatal guideline - supplements in cholestasis
       
    Dexamethasone
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c monograph
  • Available from pharmacy aseptics (100micrograms/mL) 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal Guideline - use of dexamethasone in the ventilator dependant preterm infant
    Link  Neonatal Prescribing and Administration Monograph
       
    Dobutamine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal Network Prescribing and Administration Monograph - dobutamine
    Link  Neonatal guideline - management of hypotension
       
    Dopamine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  Neonatal Network Prescribing and Administration Monograph - dopamine
    Link  Neonatal guideline - management of hypotension
       
    Dornase alfa (DNase)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
    • Dose: BNF-c (use half the recommended dose for 5-18 years)
    • Administration: BNF-c
     
    Link  Neonatal BNF-c monograph
       
    Doxapram
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Use caffeine as first line treatment
    • Contact pharmacy for dosing and administration advice for doxapram
     
       
    Drugs in lactation resources
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Information in the following resources is for babies who are well and born at term. Professional interpretation must be used for babies who are unwell or who are born prematurely
  • Drugs During Pregnancy and Lactation (C Schaefer) - paper copies available on the neonatal units
  • Further guidance available from neonatal pharmacists, or Medicines Information on ext 65377 
  • Link  LactMed
    Link  UKMI q+a’s - medicines in lactation
       
    Erythromycin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Oral dose and administration (GORD): BNF-c
  • Oral/IV dose and administration (infection): BNF-c 
  • Link  Neonatal BNF-c monograph (gastrointestinal stasis)
    Link  Neonatal BNF-c monograph (infection)
    Link  Neonatal guideline - management of conjunctivitis
    Link  Neonatal guideline - management of suspected GORD
       
    Esomeprazole
    (paediatrics)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    • Injection only
     
    Link  Paediatric intravenous prescribing and administration monograph - esomeprazole
       
    Extravasation
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • See guideline below 
  • Link  Neonatal extravasation guideline
       
    Fentanyl
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: prescribing and administration monograph
  • Administration: prescribing and administration monograph 
  • Link  MHRA Drug Safety Update (Oct 18): Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
    Link  Neonatal Prescribing and Administration Monograph
       
    Flucloxacillin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c
  • Only use on microbiology advice or if culture and sensitivity results indicate
  • For use in cystic fibrosis, contact paediatric pharmacist

    Products available:
  • 250mg injection powder for reconstitution
  • 50mg/mL syringes in water for injection available from pharmacy aseptics 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal Network Prescribing and Administration Monograph - flucloxacillin
       
    Fluconazole
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c
  • From November 2011, nystatin will be the first line antifungal for the prophylaxis of invasive candida. Fluconazole will remain a second line choice - see guideline below
     
  • Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal Guideline - Management of Invasive Candidiasis
    Link  Neonatal Guideline - Management of Suspected (but unproven) Invasive Candida Infection
    Link  Neonatal guideline - prophylaxis of candida infection
    Link  Neonatal Network Prescribing and Administration Monograph (fluconazole)
       
    Flucytosine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c
  • Made in pharmacy aseptics 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal Guideline - Management of Invasive Candidiasis
       
    Fluids
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Fluids available on neonatal units
    Link  Guidance on adding glucose 50% to infusion fluids
    Link  LTHT: Intravenous Fluids and How to Prescribe them on Neonatal Unit
    Link  Potassium-containing fluids available within LTHT
       
    Furosemide
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: BNF-c
     
  • Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal guideline - diuretics for infants at risk of chronic lung disease
    Link  Neonatal guideline - patent ductus arteriosus
    Link  Neonatal guideline - use of blood products
    Link  Neonatal Prescribing and Administration monograph (IV)
       
    Gentamicin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Dose and administration: prescribing and administration monograph
    • Neonatal gentamicin is prescribed on emeds (neonatal units, transitional care units, postnatal wards and delivery suites only)
    • All other wards at Leeds Childrens Hospital will continue to use paper copies of the gentamicin prescription chart
     
    Link  Sepsis - Antibiotics for Early Onset Sepsis in the Newborn
    Link  Late Onset ( after 72 hours ) Neonatal Sepsis
    Link  Neonatal gentamicin prescribing guideline
    Link  Neonatal guideline - surgical antibiotic prophylaxis
       
    Heparin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration (arterial line patency): prescribing and administration monograph
  • Note: May 2012 - concentration and diluent used for arterial line patency has changed - see monograph below.
  • Note: May 2014 - concentration used for thrombosis has changed - see monograph below
     
  • Link  LTHT guideline - anti-thrombotic treatment in children
    Link  Neonatal Prescribing and Administration Monograph (arterial line patency)
    Link  Neonatal Prescribing and Administration Monograph (thrombosis)
       
    Hepatitis B vaccine and immunoglobulin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNF-c
  • Administration: BNF-c
  • Supply: Hepatitis B immunoglobulin is not stocked by pharmacy. It is pre-ordered via the HPA and held on the relevant delivery suite in anticipation. If an unanticipated patient presents, an emergency supply can be obtained from virology. The product is not supplied by pharmacy and is not stocked. See neonatal guideline link below for more detail. 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - infants at risk of Hepatitis B infection
       
    Hydralazine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: Neonatal BNF-c monograph 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal prescribing and administration monograph
       
    Hydrocortisone
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • IV dose and administration: prescribing and administration monograph for NEONATES on the NEONATAL unit
    • Oral dose and administration: neonatal BNF-c monograph
    • <LTHT aseptics - 10mg/mL in sodium chloride 0.9%
     
    Link  MHRA: Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks (Dec 2018)
    Link  Neonatal BNF-c monograph (oral dosing)
    Link  Neonatal guideline - management of hypotension in the newborn
    Link  Neonatal prescribing and administration monograph
       
    Ibuprofen
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Aug 2015 - product change to Pedea. Take care to use the correct monograph
  • Dose and administration: prescribing and administration monograph 
  • Link  Neonatal guideline - patent ductus arteriosus
    Link  Neonatal prescribing and administration monograph
       
    Immunisations
    (neonatal)
    View SPC online View childrens BNF
    Formulary See vaccines (below) 
       
    Immunoglobulins (Octagam)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
  • To request immunoglobulin, a clinician request form (see link below) needs to be completed before discussion with pharmacy
  • Approved indications: haemolytic disease of the newborn (red), alloimmune thrombocytopenia (red). Other indications require immunology and funding approval before use
  • Octagam monograph below (2g vials usually used)
  • Prescribe on immunoglobulin prescription chart (available from pharmacy)(see example below)
  • Other immunoglobulin brands can also be used - contact your pharmacy team
  • Dose: see DoH guidance (see link below)
  • An additional 0.15micron filter is not required for Octagam 
  • Link  LTHT Immunoglobulins information (forms / guidance / DMP)
    Link  LTHT Neonatal Monograph: Octagam (Human Immunoglobulin)
    Link  LTHT NNU: Octagam prescribing example
       
    Insulin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: prescribing and administration monograph 
  • Link  Neonatal guideline - hyperglycaemia
    Link  Neonatal prescribing and administration monograph
       
    Isoniazid
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • For treatment of congenital tuberculosis see BNFc 
  • Link  Neonatal BNF-c monograph (tuberculosis treatment)
    Link  Neonatal guideline - infants exposed to maternal tuberculosis
       
    Isoprenaline
    (neonatal)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
    Link  Paediatric cardiology and PICU Prescribing and Administration guide (isoprenaline)
       
    Lamivudine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
  • Lamivudine 10mg/mL liquid expires 1 month after first opening. To prevent wastage transfer opened bottle with the patient from delivery suite.
  • Stocked in LGI and SJUH delivery suites 
  • Link  Neonatal guideline - management of infants born to to mothers known to be HIV positive
       
    Levetiracetam
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • IV and enteral dose and administration - see monograph below
     
    Link  Neonatal levetiracetam - prescribing and administration monograph
       
    Levothyroxine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: neonatal BNF-c monograph 
  • Link  Neonatal BNF-c monograph
       
    Lidocaine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Infiltration anaesthesia: BNFc 
  • Link  Drug Safety Update (Dec 18) Oral lidocaine-containing products for infant teething: only to be available under the supervision of a pharmacist
    Link  Neonatal BNFc monograph
       
    Liothyronine
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal BNF-c monograph
       
    Loperamide
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: neonatal BNF-c monograph
  • Do not use liquid, disperse the contents of 1 x 2mg capsule in 2mL of water to give a 1mg/mL solution and give the appropriate proportion 
  • Link  Neonatal BNF-c monograph
       
    Magnesium sulphate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: prescribing and administration monograph 
  • Link  Neonatal Prescribing and Administration Monograph
    Link  MHRA: Drug Safety Update (May 19) Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
    Link  Drug Safety Update (Sep 17): serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse
       
    Meningococcal group C conjugate vaccine
    (neonatal)
    View SPC online View childrens BNF
    Formulary June 2013 - change to primary immunisation schedule
  • One dose of Menjugate Kit or Neisvac-C should be used for primary course (Neisvac-C stocked at LTHT)
  • Meningitec should not be used for one-dose schedule
  • If Meningitec used at 3 months (e.g. if vaccination initiated abroad, or if used in error), the child will require an additional dose at least one month after the first injections 
  • Link  Neonatal immunisation protocol
       
    Meropenem
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose and administration: prescribing and administration monograph 
  • Link  Neonatal prescribing and administration monograph
    Link  Neonatal sepsis guideline
       
    Metanium
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal BNF-c monograph
       
    Metronidazole
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
  • Oral dose and administration: Neonatal BNF-c monograph 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - surgical antibiotic prophylaxis
    Link  Neonatal Network prescribing and administration monograph - metronidazole
       
    Miconazole oral gel / topical cream (Daktarin)
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Drug Safety Update (Sept 17): risk of bleeding (possibly fatal) with warfarin
    Link  Drug Safety Update (June 2016): reminder of potential for serious interaction with warfarin
    Link  Neonatal BNF-c monograph (oral AND topical application)
    Link  Neonatal guideline - management of superficial candidiasis
       
    Controlled Drug Midazolam
    (neonatal)
    View SPC online View childrens BNF
    Formulary Products available:
  • 5mg in 5mL injection
  • 5mg, 10mg and 20mg in 50mL glucose 10% available from pharmacy aseptics
     
  • Link  Neonatal Network Prescribing and Administration Monograph - midazolam
    Link  Neonatal guideline - hypoxic ischaemic encephalopathy
    Link  Neonatal guideline - neonatal convulsions
    Link  Neonatal guideline - sedation of mechanically ventilated infants
       
    Milrinone
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • For prescribing and administration, follow paediatric cardiology information linked below 
  • Link  Paediatric cardiology prescribing and administration monograph (milrinone)
       
    Controlled Drug Morphine sulphate
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal Prescribing and Administration Monograph
    Link  Neonatal guideline - neonatal abstinence syndrome
    Link  Neonatal guideline - sedation of mechanically ventilated infants
    Link  Medication Safety Alert: mis-selection of morphine (LTHT access only)
       
    Naloxone
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal BNF-c monograph
       
    Nevirapine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
  • Nevirapine 10mg/mL liquid expires 6 months after first opening. To prevent wastage transfer opened bottle with the patient from delivery suite
  • Stocked in LGI and SJUH delivery suites. 
  • Link  Neonatal guideline - management of infants born to to mothers known to be HIV positive
       
    Noradrenaline
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph
     
  • Link  Neonatal network prescribing and administration monograph
       
    Nystatin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Topical cream discontinued (follow guideline below for alternative)
  • Oral drops available
  • From November 2011, nystatin will be the first line antifungal for the prophylaxis of invasive candida - see guideline below 
  • Link  Neonatal guideline - prophylaxis of invasive candida
    Link  Neonatal guideline - superficial candidiasis
    Link  Neonatal network: administration guideline
       
    Octenisan
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Use daily as a wash from 28 weeks of age 
  •    
    Octreotide
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal Prescribing and Administration Monograph - octreotide
    Link  Paediatric cardiology supporting information (octreotide)
       
    Omeprazole
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Losec brand IV injection has been withdrawn from the market. There is no IV omeprazole product suitable for use in neonates - if indicated, consider IV esomeprazole (see paediatric monograph for dosing information)
  • Oral dose and administration: neonatal BNFc monograph 
  • Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - management of suspected GORD
       
    Controlled Drug Oxycodone
    (neonatal)
    View adult BNF View SPC online View childrens BNF
    Formulary
  • For use in line with paediatric pain team advice 
  • Link  Neonatal prescribing and administration monograph
       
    Palivizumab
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
  • Restricted to use for RSV prophylaxis in patients who meet the NHS England commissioning position (matches Green Book Guidance)

  • Discuss with a specialist pharmacist before initiating in a new patient  
  • Link  Green Book guidance - palivizumab
    Link  LTHT prescription chart - palivizumab
    Link  Neonatal BNF-c monograph
    Link  Paediatric Congenital Cardiac Network palivizumab guidance
       
    Palliative care
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - palliative or end-of-life care
       
    Pancreatin (Creon Micro)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Dose: BNFc link to the left  
  •    
    Pancuronium
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Dose and administration: neonatal prescribing and administration monograph
    • See also vecuronium if pancuronium is unavailable
     
    Link  Neonatal Network prescribing and administration monograph - pancuronium
       
    Paracetamol
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • LTHT prescribing and administration monographs for intravenous, oral and rectal doses below
  • These are different to the guidance in the BNF-C 
  • Link  Neonatal Prescribing and Administration Monograph (IV)
    Link  Neonatal Prescribing and Administration Monograph (Oral and Rectal)
    Link  LHP: patent ductus arteriosus in the neonate
    Link  The Safe Use of Paracetamol
       
    Parenteral Nutrition
    (neonatal, PICU)
    View SPC online View childrens BNF
    Formulary
    High Cost Medicine
     
    Link  LTHT: Administration of Parenteral Nutrition to Neonates, Infants and Children
    Link  LTHT prescription chart - neonatal parenteral nutrition
    Link  PICU Prescribing and Administration Guide (Parenteral Nutrition)
    Link  Risk of severe harm and death from infusing TPN too rapidly in babies (Nov 17)
       
    Controlled Drug Phenobarbital (Phenobarbitone)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    Amber 2
    • Dose and administration (IV): prescribing and administration monograph
    • Use BNF-c status dose regime initially. For long term treatment consider once daily dosing
    • Oral trough level reached after 1-2 week(steady state levels not reached for 2-3 weeks)

     

    • Note: standard phenobarbital 5mg/5mL oral solution contains 38% alcohol - LTHT purchase an alcohol-free 'special' containing 25mg in 5mL phenobarbital for use on the neonatal units and it has been agreed that this strength will be used for all patients for safety reasons
    • Please ensure the correct dose is prescribed for the child and parents/carers and child are made aware if any changes to the strength being prescribed are made by primary care
     
    Link  Neonatal BNF-c monograph
    Link  Neonatal guideline - neonatal abstinence syndrome
    Link  Neonatal Network prescribing and administration monograph (IV) - phenobarbital
       
    Phenylephrine
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  PICU and paediatric cardiology prescribing and administration guide (phenylephrine)
       
    Phenylephrine 2.5% minims
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - retinopathy of prematurity
       
    Phenytoin
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - hypoxic ischaemic encephalopathy
    Link  Neonatal guideline - neonatal convulsions
    Link  Neonatal prescribing and administration monograph
    Link  Medication Safety Alert: Risk of death and severe harm from error with injectable phenytoin (LTHT access only)
       
    Phosphate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Use BNFc oral dosing regime (see link below)
    • First line product at LTHT is Joulies Solution (1mmol/mL phosphate, 0.75mmol/mL sodium)
    • Refer to Neonatal Feeding Supplementation and Osteopenia guidance (link below) for dosing information
    • Once opened, store Joulies Solution in the fridge and reduce expiry to 7 days from opening
    • For patients who also require sodium supplementation, consider using sodium phosphate (1mmol/mL phosphate, 1mmol/mL sodium). LTHT purchase from St Thomas' Hospital, London ("St Thomas' formula")
    • In exceptional circumstances, potassium phosphate solution containing 1mmol/mL phosphate, 1mmol/mL potassium can be prepared by pharmacy. For short term use only - discuss with your ward pharmacist before prescribing. 
    • Unlicensed medicine
     
    Link  LHP: Neonatal Feeding Supplementation and Osteopenia
    Link  Neonatal BNF-c monograph
       
    Potassium canrenoate
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • 100mL bags no longer stocked on the units. Instructions for making out of hours available in the prescribing and administration monograph below 
  • Link  Neonatal guideline - patent ductus arteriosus
    Link  Neonatal prescribing and administration monograph
       
    Potassium chloride
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • All additions of potassium to intravenous fluids must be made by a pharmacy aseptic unit
  • For oral potassium chloride use Kay-Cee-L syrup 7.5% (1mL of Kay-Cee-L syrup contains 1mmol potassium chloride - see BNFc link below)
  • High strength potassium (1mmol/mL) available from pharmacy aseptics. Managed as a controlled drug 
  • Link  Neonatal BNF-c monograph (intravenous)
    Link  Neonatal BNF-c monograph (oral)
    Link  Neonatal Guideline - hypokalaemia
    Link  Neonatal prescribing and administration monograph - concentrated potassium
       
    Probiotics (unlicensed products)
    (neonatal)
    Formulary
    Red
    • for necrotising enterocolitis in children
    • Acidophilus Extra 4® (or Infloran® or other equivalent product approved by LTHT QA)
     
    Link  Neonatal Feeding Supplementation and Osteopenia Guideline (includes acidophilus)
    Link  Neonatal guideline: Acidophilus Extra 4 (probiotics)
       
    Propofol 0.5%
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • For prescribing and administration information see links below 
  • Link  Neonatal prescribing and administration monograph
    Link  Sedation and analgesia for non-emergency neonatal intubation
       
    Pyridoxal-5-phosphate (Unlicensed Medicine (ULM))
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • 50mg tablets and capsules available. Dose as per neurology advice
    • Manufacturers state that 50 mg pyridoxal-5-phosphate is equivalent to      30 mg vitamin B6 (MiDatabank 155490)
     
       
    Pyridoxine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • unlicensed 100mg in 2ml injection available at LTH for use in neonates
  • For seizures, 10mg and 50mg tablets are available - dose as per BNFc information for 'metabolic diseases' (click on icon to the left) 
  • Link  Neonatal guideline - infants exposed to maternal tuberculosis
       
    Ranitidine
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal BNF-c monograph (oral dose)
    Link  Neonatal guideline - management of suspected GORD
    Link  Neonatal guideline - use of dexamethasone in ventilator dependant infants
    Link  Neonatal Prescribing and Administration monograph (IV)
       
    Rocuronium
    (paediatrics)
    View SPC online View childrens BNF
    Formulary
    Red
     
    Link  PICU Prescribing and Administration Guide (rocuronium)
       
    Salbutamol
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • For the management of hyperkalaemia, follow local guidance (link below). If IV route is unavailable, follow guidance in BNFc (link below). 
  • Link  Neonatal BNF-c monograph - nebulised (if IV route unavailable)
    Link  Neonatal guideline - hyperkalaemia
    Link  Neonatal prescribing and administration monograph
       
    Sildenafil
    (neonatal)
    View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
  • For use in persistent pulmonary hypertension of the newborn - see clinical trial documentation at LGI and administration monograph below
  • For use in pulmonary hypertension in liaison with Great Ormond Street - discuss with pharmacy before intiation
  • Also for use when weaning from nitric oxide circuits - see PICU information  
  • Link  PICU weaning from nitric oxide information
    Link  Drug Safety Update (Nov 18) Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
       
    Sodium bicarbonate
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - hyperkalaemia
    Link  Neonatal guidelines - management of infants born before 28 weeks
    Link  Yorkshire and Humber Neonatal Network administration monograph - sodium bicarbonate
       
    Sodium chloride
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Oral product used at LTHT is sodium chloride 1mmol/1mL 200mL (unlicensed medicine) 
  • Link  Neonatal BNFc monograph
       
    Spironolactone
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - diuretics for infants at risk of chronic lung disease
    Link  Neonatal guideline - patent ductus arteriosus
    Link  Neonatal network: administration guideline
       
    Sucrose 24%
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Product has changed - see information below 
  • Link  Neonatal guideline - procedural pain in newborns
    Link  Oral sucrose - new product information
       
    Suxamethonium
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    • Dose and administration: prescribing and administration monograph
       
     
    Link  Neonatal prescribing and administration monograph
       
    Sytron (Sodium feredetate)
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal guideline - nutritional supplements
       
    Taurolidine (Taurolock 2%)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    Red
  • Restricted for use in PN dependant infants after their first episode of CRBSI where lack of venous access may be life limiting
     
  • Link  Further Taurolock information
    Link  Paediatric Guideline for the management of CVC infections
       
    Tetracaine (Ametop)
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal Guideline - Procedural Pain in the Newborn
       
    THAM (trometamol)
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph 
  • Link  IV prescribing and administration monograph
       
    Trimethoprim
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal BNF-c monograph
       
    Ursodeoxycholic acid
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Neonatal monograph - supplements in cholestasis
       
    Vaccines - primary immunisation course
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  Association of Paediatric Anaesthetists of Great Britain and Ireland - vaccines and surgery
    Link  DoH primary immunisation schedule
    Link  Neonatal guideline - immunisation schedule
       
    Valganciclovir
    (neonatal)
    View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
  • See ToRCH screening guideline below for approved indications and durations
  • Treatment lying outside of these guidelines would need approval from the Drug and Therapeutics Group before initiation 
  • Link  ToRCH screening guideline
       
    Vancomycin
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • IV dose and administration: prescribing and administration monograph (use prescription chart and prescribing guideline)

    Oral vancomycin for enterocolitis.
    Dose: 5mg/kg/dose 4 times daily (click on BNFC icon on the left.) If requested within working hours, pharmacy can prepare a 50mg in 1mL vancomycin solution (7 day expiry, store in fridge). Alternatively vancomycin injection can be reconstituted and given orally as specified in the manufacturers information leaflet.
     
  • Link  Neonatal guideline - long line sepsis
    Link  Neonatal guideline - vancomycin prescribing
    Link  Neonatal prescribing and administration monograph
    Link  Neonatal sepsis guideline (late onset >72hours)
    Link  Neonatal Vancomycin prescription chart
       
    Vecuronium
    (neonatal)
    View adult BNF View SPC online View childrens BNF
    Formulary
  • Dose and administration: neonatal prescribing and administration monograph 
  • Link  Neonatal prescribing and administration monograph - vecuronium
       
    Vitamin K (phytomenadione)
    (neonatal)
    View SPC online View childrens BNF
    Formulary  
    Link  LTHT Patient Info Leaflet:Vitamin K for newborn babies
    Link  Neonatal administration monograph: phytomenadione
    Link  Neonatal guideline - vitamin K prophylaxis
    Link  Neonatal monograph - supplements in cholestasis
       
    Zidovudine
    (neonatal)
    View SPC online View childrens BNF
    Formulary
  • Follow neonatal guideline (see below)
    To allow the first dose to be administer promptly (within 6 hours of birth):
  • Intravenous zidovudine is kept as stock on L44, L45 (LGI delivery suite), SJ03 (SJUH delivery suite) and SJ04.
  • Oral zidovudine liquid is kept as stock on L36, L44, L45 (LGI delivery suite), SJ03 (SJUH delivery suite), SJ04 and SJ05
  • Zidovudine 10mg/mL liquid expires 1 month after first opening. To prevent wastage transfer opened bottle with the patient between wards

  • Unlabelled stock bottles must not be used at discharge - all medicines leaving with the patient must be labelled with dosing instructions by pharmacy 
  • Link  IV dose and administration: prescribing and administration monograph
    Link  Neonatal guideline - management of infants born to to mothers known to be HIV positive
       
     ....
     Non Formulary Items
    Dinoprostone (Prostaglandin E2)
    (neonatal)

    View SPC online View childrens BNF
    Non Formulary
  • Dinoprostone not licensed for this indication - use alprostadil
  • Oral dinoprostone may be considered in extreme circumstances as an alternative to continuous intravenous infusion of alprostadil if intravenous access is lost. Before commencing this must be discussed with a paediatric cardiology and / or neonatal consultant. Dosage and administration guidance is available on L51 HDU drug file.
  •  
    Indometacin
    (neonatal)

    View SPC online View childrens BNF
    Non Formulary
  • 2014: product discontinued by manufacturer - consider ibuprofen as an alternative agent
  • Link  Neonatal guideline - patent ductus arteriosus
     
    LB2  (unlicensed medicine)
    (neonatal)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Probiotic - not recommended for prescribing within the Leeds Health Economy
  •  
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.

    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

    netFormulary