INTERNSHIP

MONTHLY REVIEW
th
20 MARCH TO 19th

APRIL
PRESENTED BY,
SILPA JOSE
PHARM D INTERN
THE ERODE COLLEGE
OF PHARMACY
WARD AND POSTING PERIOD
*PAEDIATRIC EMERGENCY : 20.3.2019 to 4.4.2019
*NICU : 5.4.2019 to 19.4.2019
ACTIVITIES

Medication history interview form : 37

Drug information query collected : 32
Patient counselling done : 37
ADR monitored : 0
Drug interaction : 3
Cost effective analysis form : 25
Medication Error monitoring form : 36
Dosage adjustment form : 35
Intervention form : 29
Medication reconciliation form : 37
DISEASE WISE CLASSIFICATION

ACUTE PHARINGITIS
BRONCHIOLITIS
ASTHMA
SHORT PYREXIA
LRI
VIRAL FEVER
URTI
HERPANGINA
IMPETIGO
FEBRILE SEIZURE
TONSILITIS
HEPATITIS
URTICARIA
SEPTIC ARTHRITIS
ACUTE GASTROENTERITIS
AGE WISE CLASSIFICATION

MALE

FEMALE
DRUG WISE CLASSIFICATION

AMPICILLIN

NEB.SALBUTA
MOL
PARACETAMOL

RANITIDINE
DISEASE WISE CLASSIFICATION

NEONATAL
JAUNDICE
RESPIRATORY
DISTRESS
HYPERTHERMIA

PERINATAL
ASPHYXIA
BABY OF DIABETIC
MOTHER
NEONATAL
CONVULSION
 PATIENT DETAILS

Name : B/O Seethalakshmi

IP No : 11587
Age/Sex : NB /Mch
Weight : 3.180 kg (term baby)
DOA :7-4-19
Patient complaints : Yellow colour discoloration of skin and eye for 2
days.(after 24 hour of delivery)
Type of delivery : NVD
 ABNORMAL LAB PARAMETERS
Bilirubin T : 17.69 mg/dl
Bilirubin D : 0.54 mg/dl

Diagnosis : NEONATAL JAUNDICE

 TREATMENT GIVEN

Drug name Dose Route Frequency

INJ: CIPROFLOXACIN 45 mg IV BD

INJ : GENTAMICIN 16 mg IV BD

PHOTOTHERAPY GIVEN
PHARMACIST INTERVENTION
* The gentamicin ( Aminoglycoside ) should be given an OD dose but in this
patient they given as BD dose.
* Ciprofloxacin doesn’t have any role in neonatal jaundice and also not
licensed for use in children under 1 year (not a labeled indication)
NEONATAL JAUNDICE
Neonatal jaundice is a yellowish discoloration of the white
part of the eyes and skin in a newborn baby due to high
bilirubin levels.

The term jaundice is derived from the French word jaune, which
means yellow.
Jaundice is not technically a disease, but rather it is a visible sign of
an underlying condition causing increased levels of bilirubin in the
blood.
CLASSIFICATION
What causes jaundice in newborns!!
* Jaundice is caused by the accumulation of bilirubin in the
blood, typically from an increased production of bilirubin or
a decreased ability to metabolize and excrete it.
* Bilirubin is formed when red blood cells break down and is
normally metabolized in the liver and excreted in urine and
feces.
*Internal bleeding (hemorrhage)
*An infection in your baby's blood (sepsis)
*Other viral or bacterial infections.(syphilis and
rubella)
*An incompatibility between the mother's blood
and the baby's blood.
*A liver malfunction.
*Hypoxia - low oxygen levels
*Blocked bile duct or bowel
SIGN AND SYMPTOMS

*Yellow discoloration of the skin, mucous

membranes and the whites of the eyes
*Light-colored stool
*Poor feeding
*Lethargy/excessive sleepiness
*Changes in muscle tone (either listless or stiff
with arching of the back)
*High-pitched crying
*Seizures
RISK FACTORS

* Prematurity
* Low birth weight
* Jaundice in the first 24 hrs of life
* Sepsis
* Lactation failure in exclusive breastfeeding
* Babies of diabetic mother
* Family history of severe NNJ in siblings
* G6PD deficiency
* Kernicterus
*Diagnostic test
STANDARD TREATMENT GUIDELINES

* According to standardtreatment guidelines health and welfare department

government of tamilnadu said, Treatment of hyperbilirubinemia :

* Hydration : continued and frequent breast feeding 8 to 12 times/day.

* Phototherapy:
Special blue lights to be used, 45 cm distance between baby and phototherapy
unit, Eyes and genitalia should be covered ,Watch for side effects ( diarrhea,
skin rash, hyperthermia or hypothermia)
* Exchange transfusion:
Always cross match donors blood with mothers and babies blood.
* Drugs to increase conjugation
Standard treatment guidelines
for infant below 2 months age (more than 2
kg)
ANTIBIOTIC EACH DOSE FREQUENCY ROUTE DURATION

< 7 days > 7 days

1st line therapy
INJ:
CEFOTAXIME + 50 mg/kg/dose 12 hrly 8 hrly IV
INJ: 2-3 weeks
GENTAMICIN 5 mg/kg/dose 24 hrly 24 hrly IV
2 nd line therapy
MEROPENEM + 2Omg/kg/dose 12 hrly 8 hrly IV 2-3 weeks
VANCOMYCIN 15mg/kg/dose 12 hrly 8 hrly
Phototherapy
* If the bilirubinlevel >18mg/dl the phototherapy
should be given 24-48 hours
* >18mg/dl - 49-72 hours
* >20mg/dl - >72 hours
PATIENT COUNSELING

* Ciprofloxacin may become more sensitive to sunlight than they are

normally. Exposure to sunlight, even for brief periods of time, may
cause severe sunburn, skin rash, redness, itching, or discoloration.
 PATIENT COUNSELING
* Look closely at baby skin 2 times a day to make sure that the colour is returning to
normal. If your baby has dark skin, look at the white part of the eyes.
* Neonates should be nursed naked apart from a nappy under phototherapy and will
need to be nursed in an Isolette to maintain an appropriate neutral thermal
environment
* Cover the eyes with appropriate opaque eye covers
* Feed your baby about 8 to 12 times every 24 hrs.
* Check the blue lights functions ,45 cm distance between baby and phototherapy unit,
Eyes and genitalia should be covered .
* When blue tube lights are not available, four pairs of white tube lights may be used
instead.
* Babies can be taken out of phototherapy for breastfeeding.
* Monitoring baby temperature 2 hourly.
* Monitoring fluid balance – daily weight, urine output. Increases fluid as necessary.
* Monitoring bilirubin level.