Compatibility of Neonatal Parenteral Nutrient Solutions with Commonly Used Drugs during Y-site Delivery in NICU

PURPOSE: Because vascular access sites in neonates are limited, intravenous (IV) medications must often be mixed with maintenance fluids, including parenteral nutrient (PN) solutions. This study was done to determine whether IV medications commonly prescribed in the neonatal in- tensive care unit (NICU) are compatible with the two neonatal PN solutions. METHODS: The compatibility of neonatal PN solutions and selected other drugs during Y-site delivery was evaluated. Secondary drugs were administered at selected concentrations, rates and delivery by method commonly used at the NICU. Drugs administered by syringe pump over 30min : amikacin, cefotaxime, ceftriaxone, piperacillin, phenytoin, aminophylline, ceftazidime, fluconazole, indomethacin. Drugs administered by IV push : ampicillin+sulbactam, penicillin G potassium, NaHCO3, ranitidine, epinephrine, furosemide, dexamethasone. Drugs administered by IV infusion for at least 60min : acyclovir, amphotericin B, vancomycin, dobutamine, dopamine, doxapram. After each test, the Y injection site and tube below the Y injection site were visually inspected for precipitation and color change. If no particles or color change was detected, the solution was tested and analyzed by a liquid borne particle analyzer (LBPA). RESULTS: White precipitate formed immediately after Y-site administration : phenytoin, aminophylline (undiluted solution), ampicillin+sulbactam (undiluted solution). Number of particles observed with LBPA exceeded the KP guideline limit immediately after Y-site administration and white precipitate formed after 3-4 hour : ceftriaxone, NaHCO3 (1 : 2 diluted solution). CONCLUSION: These results revealed that several lV drugs prescribed in NICU formed precipitate and had a color change, when mixed with neonatal TPN solutions.

Compatibility of Neonatal Parenteral Nutrient Solutions with Commonly Used Drugs during Y-site Delivery in NICU

PURPOSE: Because vascular access sites in neonates are limited, intravenous (IV) medications must often be mixed with maintenance fluids, including parenteral nutrient (PN) solutions. This study was done to determine whether IV medications commonly prescribed in the neonatal in- tensive care unit (NICU) are compatible with the two neonatal PN solutions. METHODS: The compatibility of neonatal PN solutions and selected other drugs during Y-site delivery was evaluated. Secondary drugs were administered at selected concentrations, rates and delivery by method commonly used at the NICU. Drugs administered by syringe pump over 30min : amikacin, cefotaxime, ceftriaxone, piperacillin, phenytoin, aminophylline, ceftazidime, fluconazole, indomethacin. Drugs administered by IV push : ampicillin+sulbactam, penicillin G potassium, NaHCO3, ranitidine, epinephrine, furosemide, dexamethasone. Drugs administered by IV infusion for at least 60min : acyclovir, amphotericin B, vancomycin, dobutamine, dopamine, doxapram. After each test, the Y injection site and tube below the Y injection site were visually inspected for precipitation and color change. If no particles or color change was detected, the solution was tested and analyzed by a liquid borne particle analyzer (LBPA). RESULTS: White precipitate formed immediately after Y-site administration : phenytoin, aminophylline (undiluted solution), ampicillin+sulbactam (undiluted solution). Number of particles observed with LBPA exceeded the KP guideline limit immediately after Y-site administration and white precipitate formed after 3-4 hour : ceftriaxone, NaHCO3 (1 : 2 diluted solution). CONCLUSION: These results revealed that several lV drugs prescribed in NICU formed precipitate and had a color change, when mixed with neonatal TPN solutions.

Levels of Serum HDL-cholesterol and Total Cholestetol in Kawasaki Disease and Their Significance

BACKGROUND: The value of serum lipid in children after recovery of Kawasaki disease may be important bacause of the predilection of this disease for the coronary artery. METHODS: To determine the alterations in serum total cholesterol(TC) and high density lipoprotein(HDL)-cholesterol levels in Kawasaki disease(KD), we measured serum HDL-cholesterol and TC in 35 patients(mean age 36.8+/-22.0 months, range 6 to 93 months) with Kawasaki disease(KD) during 10 days or less after the onset(group A) and 2 months later after recovery. TC and HDL-cholesterol were also measured in an acute febrile respiratory illness group(group B) and a nonfebrile respiratory illness group(group C) to compare with those of KD. RESULTS: HDL-cholesterol levels in group A were depressed(29.6+/-11.0mg/dl) compared with group B and C(47.3+/-13.3mg/dl and 45.1+/-12.4mg.dl, respectively, p<0.01). TC levels in group A(145.1+/-33.1mg/dl) were not significantly different from those of group B(146.8+/-33.4mg/dl) and C(157.1+/-29.6mg/dl). Also the level of serum HDL-cholesterol in the acute phase of KD was significantly lower when compared with that after recovery(30.2+/-13.2mg/dl vs 50.0+/-10.2mg/dl, p<0.05). In KD patients, TC levels were not significantly different between the acute & recovery phase(145.0+/-26.6mg/dl, 153.4+/-32.6mg/dl). Echo-cardiography confirmed coronary artery aneurysms in 11 patients(31.4%) and otherwise, normal findings(n=24) in the KD group. There were no significant difference in TC level(140.7+/-27.6mg/dl vs. 146.9+/-35.4mg/dl, p=NS) and HDL cholesterol level(30.1+/-12.5mg/dl vs. 29.2+/-10.7mg/dl, p=NS) between patients with and without coronary aneurysms. CONCLUSIONS: HDL-cholesterol levels were significantly depressed only in the acute phase of KD but TC levels did not change significantly. Both levels were not related to coronary artery aneurysm.