BNF for Children (BNFC) 2018-2019

DOSE EQUIVALENCE AND CONVERSION

▶Phospholipid 100 mg/kg is equivalent to a volume of

4 mL/kg.

lCAUTIONSConsult product literature

lSIDE-EFFECTS

▶UncommonEndotracheal tube obstruction

▶Frequency not knownBradycardia.hypoxia

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Liquid

▶Survanta(AbbVie Ltd)

Phospholipids (as Beractant) 25 mg per 1 mlSurvanta 200 mg/ 8 ml

endotracheopulmonary suspension bottles| 1 bottleP£ 306. 43

Poractant alfa

lINDICATIONS AND DOSE

Treatment of respiratory distress syndrome in neonates,

birth weight over 700 g (specialist use only)

▶BY ENDOTRACHEAL TUBE

▶Neonate: 100 – 200 mg/kg, then 100 mg/kg every 12 hours

if required, maximum 300 – 400 mg/kg per course.

Prophylaxis of respiratory distress syndrome (specialist

use only)

▶BY ENDOTRACHEAL TUBE

▶Neonate 24 weeks to 31 weeks corrected gestational

age: 100 – 200 mg/kg, administer soon after birth,

preferably within 15 minutes, then 100 mg/kg after

6 – 12 hours if required, then 100 mg/kg after 12 hours if

required, and if neonate still intubated. Max

300 – 400 mg/kg per course.

lCAUTIONSConsult product literature

lSIDE-EFFECTS

▶Rare or very rareBradycardia.hypotension

▶Frequency not knownHyperoxia

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Liquid

▶Curosurf(Chiesi Ltd)

Phospholipids (as Poractant alfa) 80 mg per 1 mlCurosurf

240 mg/ 3 ml endotracheopulmonary suspension vials| 1 vialP

£ 547. 40 (Hospital only)

Curosurf 120 mg/ 1. 5 ml endotracheopulmonary suspension vials|

1 vialP£ 281. 64 (Hospital only)

5.1 Neonatal apnoea

XANTHINES

Caffeine citrate 24-Feb-2016

lINDICATIONS AND DOSE

Neonatal apnoea (specialist supervision in hospital)

▶BY MOUTH, OR BY INTRAVENOUS INFUSION

▶Neonate:Initially 20 mg/kg, administered over

30 minutes if given by intravenous infusion, then

5 mg/kg once daily, administered over 10 minutes if

given by intravenous infusion, started 24 hours after

initial dose; increased if necessary to 10 mg/kg daily.

DOSE EQUIVALENCE AND CONVERSION

▶Caffeine citrate 2 mg:caffeine base 1 mg

PHARMACOKINETICS

▶Caffeine citrate is well absorbed when given orally.

lUNLICENSED USEgCaffeine citrate loading doses in

the BNFfor childrenmay differ to those in product

literaturel.

IMPORTANT SAFETY INFORMATION

MHRA/CHM ADVICE: SAFE PRACTICE

From August 2013 , all licensed preparations of caffeine

are required to be labelled as caffeine citrate. To

minimise the risk of dosing errors,always state dose in

terms of caffeine citrate when prescribing caffeine.

Some stock packaged as caffeine base.

lCAUTIONSCardiovascular disease.gastro-oesophageal

reflux.rhythm disorder.seizure disorders

lINTERACTIONS→Appendix 1 : caffeine citrate

lSIDE-EFFECTS

▶Common or very commonArrhythmias.hyperglycaemia

▶UncommonSeizure

▶Frequency not knownBrain injury.deafness.failure to

thrive.feeding intolerance.feeling jittery.

gastrointestinal disorders.hypoglycaemia.increased

cardiac output.irritability.regurgitation.restlessness

lHEPATIC IMPAIRMENTManufacturer advises caution with

impaired hepatic function.

lRENAL IMPAIRMENTManufacturer advises caution with

impaired renal function—potential for accumulation of

caffeine.

Dose adjustmentsReduced daily maintenance dose

required—consult product literature.

lMONITORING REQUIREMENTS

▶gThe therapeutic range for plasma-caffeine

concentration is usually 10 – 20 mg/litre

( 50 – 100 micromol/litre), but a concentration of

25 – 35 mg/litre ( 130 – 180 micromol/litre) may be required.

Signs of toxicity only normally occur at concentrations

greater than 50 mg/litre ( 260 micromol/litre).k

▶Monitor for recurrence of apnoea for 1 week after stopping

treatment.

lDIRECTIONS FOR ADMINISTRATIONCaffeine citrate

injection may be administeredby mouthorby intravenous

infusion.

lNATIONAL FUNDING/ACCESS DECISIONS

Scottish Medicines Consortium (SMC) Decisions

TheScottish Medicines Consortiumhas advised (September

2013 ) thatPeyona®is accepted for use within NHS

Scotland for the treatment of primary apnoea of premature

newborns only whilstPeyona®is available at the price

agreed in the patient access scheme.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: oral suspension, oral solution

Solution for injection

▶Caffeine citrate (Non-proprietary)

Caffeine citrate 10 mg per 1 mlCaffeine citrate 10 mg/ 1 ml solution

for injection ampoules| 10 ampouleP£ 48. 82

Solution for infusion

▶Peyona(Chiesi Ltd)

Caffeine citrate 20 mg per 1 mlPeyona 20 mg/ml solution for

infusion ampoules| 10 ampouleP£ 172. 50 (Hospital only)

Oral solution

▶Caffeine citrate (Non-proprietary)

Caffeine citrate 10 mg per 1 mlCaffeine citrate 50 mg/ 5 ml oral

solution| 5 mlP£ 25. 22 DT = £ 25. 22

190 Respiratory depression, respiratory distress syndrome and apnoea BNFC 2018 – 2019

Respiratory system

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