Children are Not Just Little Adults ……… Level III
After completing this case study, the reader should be able to:
Determine the role that the rate and extent of organ development plays in the variation of absorption, distribution, metabolism, and elimination of medications in the pediatric population.
Compare and contrast the pharmacokinetic and pharmacodynamic differences between pediatric and adult patients, as well as among various pediatric age groups.
Identify and manage challenges in pediatric pain management.
Identify and manage challenges in pediatric drug formulation and administration.
Nursing reports of new-onset fever and hypotension, increased number of apnea episodes, and “infant acting different”
Alexander Halstrom is a premature 730-g male infant born at 25 4/7 weeks, now day of life 22, who is currently intubated, sedated, on vasopressors and parenteral nutrition with new-onset fever, increased number of apnea episodes, and a 1-day history of “acting different” according to nursing reports.
Prematurity: born at 25 4/7 weeks with APGARs of 1, 4, and 6
Extremely low birth weight (ELBW) = 760 g
Respiratory distress syndrome (RDS)
At risk for retinopathy of prematurity
Grade II intraventricular hemorrhage (IVH)
Microcephaly, head circumference below 10th percentile
NPO, receiving nutritional support
Patent ductus arteriosus (PDA)—small with left-to-right shunt
Infant born to a 24-year-old G2 P0 AB1 mother secondary to polyhydramnios, nonreassuring fetal status, and premature onset of labor.
Maternal labs: HBsAg (–), rubella (–), VDRL (–), and HIV (–) with unknown GBS status who received partial penicillin prophylaxis prior to delivery and indomethacin for tocolysis.
Mother denies drug and alcohol use during pregnancy.
Ampicillin 73 mg IV every 12 hours (200 mg/kg per day)
Gentamicin 1.8 mg IV every 8 hours (7.5 mg/kg per day)
Caffeine 3.7 mg IV every 24 hours (5 mg/kg per day)
Phenobarbital 3.7 mg IV every 24 hours (5 mg/kg per day)
Morphine continuous infusion 10 mcg/kg/h
Midazolam continuous infusion 0.05 mg/kg/h
TPN at total fluid volume of 150 mL/kg per day
Nystatin 100,000 U/g cream one application to affected area PRN
Aquaphor, one application to affected area PRN