Neonates need tailored drug formulations

Table 1 Reference doses (mg/kg) compared to intravenous formulations to illustrate the need for sequential dilutions in neonates

Active agent	Available concentration	Reference doses	Preterm, 1.5 kg	Term, 3 kg
Amikacin, adult vial	500 mg/2 mL	15-20 mg/kg	130 mg, 0.12 mL	50 mg, 0.2 mL
Amikacin, pediatric vial	100 mg/2 mL	15-20 mg/kg	30 mg, 0.6 mL	50 mg, 1.0 mL
Enoxaparin	40 mg/0.4 mL	1 mg/kg	11.5 mg, 0.015 mL	13 mg, 0.03 mL
Erythromycin	1000 mg/20 mL	5-10 mg/kg	12 mg, 0.24 mL	25 mg, 0.5 mL
Fentanyl	100 μg/2 mL	1-3 μg/kg	13 μg, 0.06 mL	16 μg, 0.12 mL
Insulin	300 U/3 mL	0.1-1 U/kg per hour	10.3 U, 0.03 mL	10.6 U, 0.06 mL
Midazolam	15 mg/3 mL	0.1 mg/kg	10.15 mg, 0.03 mL	10.3 mg, 0.06 mL
Paracetamol	500 mg/50 mL	10 mg/kg	15 mg, 1.5 mL	30 mg, 3 mL
Phenobarbital	200 mg/1 mL	5 mg/kg	17.5 mg, 0.0375 mL	115 mg, 0.075 mL
Propofol	200 mg/20 mL	1-3 mg/kg	2 mg, 0.2 mL	4.5 mg, 0.45 mL
Ranitidine	50 mg/2 mL	0.5-1 mg/kg	11.5 mg, 0.06 mL	13 mg, 0.12 mL

Formulations were sorted alphabetically and reported as available in Belgium, not necessary reflecting the setting in another country. A dose in a 1.5 and 3 kg newborn has been used for illustrative purposes. ¹Initial volumes ≤ 0.2 mL.