Sandbox: Difference between revisions

Revision as of 15:51, 20 April 2022

Suspected Infection Source	8-21 Days Olds	22-28 Days Olds	29-60 Days Olds
UTI	Ampicillin IV or IM (150 mg/kg per day divided q8) and either [[ceftazidime IV or IM (150 mg/kg per day divided q8) or *gentamicin IV or IM (4 mg/kg per dose q24)	*Ceftriaxone IV or IM (50 mg/kg per dose q24)	Ceftriaxone IV or IM (50 mg/kg per dose q24) Oral options: Cephalexin 50-100 mg/kg per day QID or cefixime 8 mg/kg QD
No source identfied	Ampicillin IV or IM (150 mg/kg per day divided q8) and either [[ceftazidime IV or IM (150 mg/kg per day divided q8) or *gentamicin IV or IM (4 mg/kg per dose q24)	*Ceftriaxone IV or IM (50 mg/kg per dose q24)	*Ceftriaxone IV or IM (50 mg/kg per dose q24)
Bacterial meningitis	Ampicillin IV or IM (300 mg/kg per day divided q6) and[[ceftazidime IV or IM (150 mg/kg per day divided q8)	Ampicillin IV or IM (300 mg/kg per day divided q6) and[[ceftazidime IV or IM (150 mg/kg per day divided q8)	Cephalosporin Ceftriaxone IV (100 mg/kg QD) or Ceftazidime IV (150 mg/kg QD) AND vancomycin IV (60 mg/kg QD)

Authors:

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 {| {{table}}
-| align="center" style="background:#f0f0f0;"|'''Initiation of calories'''
+| align="center" style="background:#f0f0f0;"|'''Suspected Infection Source'''
-| align="center" style="background:#f0f0f0;"|'''Initiate with 100–150 g of dextrose or 10–20 kcal/kg for the first 24 hours; advance by 33% of goal every 1 to 2 days. This includes enteral as well as parenteral glucose.'''
+| align="center" style="background:#f0f0f0;"|'''8-21 Days Olds'''
+| align="center" style="background:#f0f0f0;"|'''22-28 Days Olds'''
+| align="center" style="background:#f0f0f0;"|'''29-60 Days Olds'''
 |-
-| ||In patients with moderate to high risk of RS with low electrolyte levels, holding the initiation or increase of calories until electrolytes are supplemented and/or normalized should be considered.
+| [[UTI]]||*[[Ampicillin]] IV or IM (150 mg/kg per day divided q8) and either **[[ceftazidime IV or IM (150 mg/kg per day divided q8) or **[[gentamicin]] IV or IM (4 mg/kg per dose q24)||*[[Ceftriaxone]] IV or IM (50 mg/kg per dose q24)||*[[Ceftriaxone]] IV or IM (50 mg/kg per dose q24) *Oral options: **[[Cephalexin]] 50-100 mg/kg per day QID or **[[cefixime]] 8 mg/kg QD
 |-
-| ||Initiation of or increasing calories should be delayed in patients with severely low phosphorus, potassium, or magnesium levels until corrected.
+| No source identfied||*[[Ampicillin]] IV or IM (150 mg/kg per day divided q8) and either **[[ceftazidime IV or IM (150 mg/kg per day divided q8) or **[[gentamicin]] IV or IM (4 mg/kg per dose q24)||*[[Ceftriaxone]] IV or IM (50 mg/kg per dose q24)||*[[Ceftriaxone]] IV or IM (50 mg/kg per dose q24)
 |-
-| ||Calories from IV dextrose solutions and medications being infused in dextrose should be considered in the limits above and/or initiated with caution in patients at moderate to severe risk for RS. If a patient has received significant amounts of dextrose for several days, from maintenance IV fluids and/or medications in dextrose, and has been asymptomatic with stable electrolytes, calories from nutrition may be reintroduced at a higher amount than recommended above.
+| Bacterial [[meningitis]]||*[[Ampicillin]] IV or IM (300 mg/kg per day divided q6) and*[[ceftazidime IV or IM (150 mg/kg per day divided q8)||*[[Ampicillin]] IV or IM (300 mg/kg per day divided q6) and*[[ceftazidime IV or IM (150 mg/kg per day divided q8)||*Cephalosporin **[[Ceftriaxone]] IV (100 mg/kg QD) or **[[Ceftazidime]] IV (150 mg/kg QD) *AND [[vancomycin]] IV (60 mg/kg QD)
-|-
-| Fluid restriction||No recommendation.
-|-
-| Sodium restriction||No recommendation.
-|-
-| Protein restriction||No recommendation.
-|-
-| Electrolytes||Check serum potassium, magnesium, and phosphorus before initiation of nutrition.
-|-
-| ||Monitor every 12 hours for the first 3 days in high-risk patients. May be more frequent based on clinical picture.
-|-
-| ||Replete low electrolytes based on established standards of care.
-|-
-| ||No recommendation can be made for whether prophylactic dosing of electrolytes should be given if prefeeding levels are normal.
-|-
-| ||If electrolytes become difficult to correct or drop precipitously during the initiation of nutrition, decrease calories/grams of dextrose by 50% and advance the dextrose/calories by approximately 33% of goal every 1–2 days based on clinical presentation. Recommendations may be changed based on practitioner judgment and clinical presentation, and cessation of nutrition support may be considered when electrolyte levels are severely and/or life-threateningly low or dropping precipitously.
-|-
-| Thiamin and multivitamins||Supplement thiamin 100 mg before feeding or before initiating dextrose-containing IV fluids in patients at risk.
-|-
-| ||Supplement thiamin 100 mg/d for 5–7 days or longer in patients with severe starvation, chronic alcoholism, or other high risk for deficiency and/or signs of thiamin deficiency.
-|-
-| ||Routine thiamin levels are unlikely to be of value.
-|-
-| ||MVI is added to PN daily, unless contraindicated, as long as PN is continued. For patients receiving oral/enteral nourishment, add complete oral/enteral multivitamin once daily for 10 days or greater based on clinical status and mode of therapy.
-|-
-| Monitoring and long-term care||Recommend vital signs every 4 hours for the first 24 hours after initiation of calories in patients at risk.
-|-
-| ||Cardiorespiratory monitoring is recommended for unstable patients or those with severe deficiencies, based on established standards of care.
-|-
-| ||Daily weights with monitored intake and output.
-|-
-| ||Evaluate short- and long-term goals for nutrition care daily during the first several days until the patient is deemed stabilized (eg, no requirement for electrolyte supplementation for 2 days) and then based on institutional standards of care.
 |}