Neonatal Drug Dosing Guidelines

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fentaNYL Dose Adjustment in Renal Impairment


Reserved/Restricted : Outside of NICU/PICU/OR/PACU/ED, the use of continuous infusion is restricted to Pediatric Acute Pain Service (APS) and Pediatric Advanced Care Team (PACT). Transdermal patch- prescribing and management is restricted to prescribers with Pediatric Acute Pain Service (APS) or Pediatric Advanced Care Team (PACT).

  • These dosing guidelines are intended for opioid-naive, acute pain situations. 
  • Practitioners should consider whether the patient is opioid naive and other underlying medical conditions when choosing an initial dose.
  • The Children’s Health Program is supported by an Acute Pain Service which is available for medical consultation in complex dosing situations.
  • Patients already receiving regular opioids or with cancer or chronic pain may require significantly higher or more frequent doses.

Go to NICU Parenteral Administration Information for fentaNYL

Analgesia/Sedation- Continuous Infusion

Ordered as: ____microgram/kg/hour

Loading Dose
1-2 microgram/kg IV x 1 PRN

Initial Dosing
1-2 microgram/kg/hour IV continuous

Suggested Titration
0.5-1 microgram/kg/hour every 1 to 4 hours PRN (titrated to effect)

Usual Range
1-4 microgram/kg/hour IV continuous

Maximum: 5 microgram/kg/hour

Sedation - Continuous Infusion in Congenital Diaphragmatic Hernia (CDH)
Ordered as: ____microgram/kg/hour

Initial Dosing
2 microgram/kg/hour IV continuous

Suggested Titration
0.5-1 microgram/kg/hour every 1 to 4 hours PRN (titrated to effect).  
If inadequate sedation at 4 micrograms/kg/hour, add midazolam as second line agent.

Analgesia/Sedation- Intermittent
Ordered as : micrograms

0.5-3 microgram/kg/dose IV every 2 to 4 hours PRN . Note: Usually equal either to 1) the hourly rate or 2) half of the hourly rate if on continuous infusion


Go to clinical order set IWK NEINT Non-Emergent Intubation in NICU Pre-Medication Orders


Go to Neonatal Resuscitation/Pre-Intubation Medications Calculator


Weaning Guidelines
Neonates treated with continuous infusion for 5 days or longer are more likely to develop narcotic withdrawal symptoms.  Wean as below if on fentaNYL for:

  • 5 days or less:  wean by 30-50% every 12 to 24 hours
  • 6 to 10 days:  wean by 20% every 12 to 24 hours
  • Greater than 10 days: wean by 10% every 24 hours

Guidelines for conversion of IV fentaNYL to oral morphine in neonates
Go to calculator for conversion of IV fentaNYL to oral morphine in neonates
Note: this provides a rough estimate for converting IV FentaNYL to PO morphine. There is significant individual response to various opioids as well as unpredictable or incomplete tolerance between opioids; clinical judgement must always be used when converting opioids.  Neonates can be more susceptible to adverse effects of opioids therefore consider starting at a lower dose than what the conversion suggests. 

  • Calculate total micrograms/day of IV fentaNYL
  • Divide by 1000 (converts micrograms to mg) *This is the mg/day of IV fentaNYL*
  • Multiply by 50 (converts IV fentaNYL to PO morphine AND incorporates drug cross tolerance) *This is the mg/day of PO morphine*
  • Divide mg/day of PO morphine by:
    • 8 for q3h dosing *This is the mg/dose at q3h dosing*
    • 6 for q4h dosing *This is the mg/dose at q4h dosing*
  • Divide the mg/dose by the patient's weight (to obtain mg/kg/dose), then consider:
    • Does the dose make sense? How does it compare to the Neonatal and/or Pediatric morphine drug dosing guideline?
    • If concerned about treating pain in addition to withdrawal, a higher dose is usually required.  If withdrawal is the only concern, consider starting at a lower dose.
  • Consider ordering a PO morphine breakthrough dose (one half of the calculated maintenance dose)

Go to Pediatric Drug Dosing Guideline for fentaNYL

Injection: 50 micrograms/mL, 10 micrograms/mL IWK Compounded, 2 micrograms/mL IWK Compounded
Transdermal Patch: 25 micrograms/hour, 50 micrograms/hour, 75 micrograms/hour, 100 micrograms/hour

For more detailed information, go to Micromedex

Created on February 11, 2019 12:15 PM
Updated on January 21, 2022 03:41 PM

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