Skip to Main Content

++

Children are Not Just Little Adults ……… Level III

++

Learning Objectives

++

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.

++

Patient Presentation

++
Chief Complaint
++

Nursing reports of new-onset fever and hypotension, increased number of apnea episodes, and “infant acting different”

++
HPI
++

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.

++
PMH
++

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)

++

Anemia

++

Apnea of prematurity

++

At risk for retinopathy of prematurity

++

Cholestasis

++

Diaper dermatitis

++

Grade II intraventricular hemorrhage (IVH)

++

Hypotension

++

Microcephaly, head circumference below 10th percentile

++

Newborn sepsis

++

NPO, receiving nutritional support

++

Patent ductus arteriosus (PDA)—small with left-to-right shunt

++

Pulmonary hemorrhage

++

Immunizations up-to-date

++
FH
++

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.

++
SH
++

Noncontributory

++
Current Meds
++

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

++

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.