Medications Commonly Used in the NICU

NICU babies may need a variety of medications depending on gestational age at birth and day-to-day symptoms or health status. One of the greatest concerns that is closely monitored is infection.

Infection
Sepsis — a bloodstream infection. Risk factors include:

  • Low birth weight
  • Maternal fever or infection
  • Premature or prolonged rupture of membranes
  • Prematurity
  • Resuscitation at birth

Suspected Signs of Infection
Baby shows signs or symptoms of infection but cultures are not positive (no bacteria or fungus grows on laboratory dish), such as:

  • Apnea (lack of breathing)
  • Feeding intolerance
  • Irritability or change in tone
  • Rapid breathing, grunting, retractions
  • Temperature irregularity (too hot or too cold)

Proven Signs of Infection
Bacteria or fungus can be cultured (grown on a dish) in a laboratory from blood, sputum, urine and other body fluids. Or other tests can confirm the presence of bacteria, virus or fungus.

Ruling Out Infection
If baby shows signs or symptoms of what may be infection we treat for 48 to 72 hours. However, these symptoms could be signs of other things, such as:

  • Heart disease
  • Metabolic diseases
  • Nervous system diseases
  • Respiratory distress syndrome

If baby is still with symptoms and/or positive cultures, we extend the treatment for 7 to 10 days.

Antibiotics

  • Ampicillin — Kills group B strep and Listeria, two of the most common organisms that cause sepsis. Its side effects include rash, diarrhea, oral thrush and super-infection.

  • Cefotaxime — Kills H. influenza, N. meningitides, E. coli and other organisms that commonly cause sepsis. Side effects include rash, diarrhea, inflammation at injection site.

 Other Medications

  • Cholecalciferol (vitamin D3) — helps build bones. Its side effects are few. No long term effects are known.

  • Caffeine — helps stimulate breathing. Its side effects include fast heart rate, restlessness. No long term effects are known.

  • Ferrous Sulfate (Iron) — is used to treat anemia. Its side effects if overdosed include toxicity.

  • Erythromycin Ophthalmic Ointment — is an ointment that is placed in the eyes to prevent neonatal conjunctivitis. Its side effects include minor eye irritation. No long term effects are known.

  • Phytonadione (Vitamin K) — is used to prevent hemorrhagic disease. Side effects include pain/redness at injection site. Long term effects are usually none; however occasional brief interruption in breathing may occur.

  • Sucrose — is used for short-term relief of mild pain. Its side effects are usually none.

  • Heparin Flush — is used to prevent IV and IA lines from clotting. The administration route is intravenous (IV) or intra-arterial (IA). Side effects include bleeding if excessive dose.

  • TNA (Total Nutritional Admixture) — is used in the NICU for nutrition. Its route of administration is intravenous (IV) and there are many possible side effects.

  • Hepatitis Vaccine — Is an immunization against hepatitis B infection. Its route of administration is intramuscular (IM). Its side effects include site irritation, redness, pain and rarely allergy.

  • Palivizumab (Synagis) — Is used to prevent lung infection from Respiratory Syncytial Virus (RSV). Its route of administration is intramuscular (IM). Side effects may include pain at site, fever and rarely allergy.

For More Information About the NICU Navigator Program
To learn more or to request support from a NICU Navigator, please call 858-939-4802.