Neonatal Intensive Care Drug Manual




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Preparation of acetylcysteine 4%: Dilute 20mL of acetylcysteine 20% (200 mg/mL) with 80 mL of glucose 5% or sodium chloride 0.9%* to make a final volume of 100 mL with a concentration of acetylcysteine 4% (40 mg/mL)

*For Acetadote Concentrated Injection – use glucose 5% only.



References

  1. Garza-Cox S, Keeney SE, Angel CA, Thompson LL, Swischuk LE. Meconium obstruction in the very low birth weight premature infant. Pediatrics. 2004;114:285-90.

  2. Mak GZ, Harberg FJ, Hiatt P, Deaton A, Calhoon R, Brandt ML. T-tube ileostomy for meconium ileus: four decades of experience. J Pediatr Surg. 2000;35:349-52.

  3. Nguyen LT, Youssef S, Guttman FM, Laberge JM, Albert D, Doody D. Meconium ileus: is a stoma necessary? J Pediatr Surg. 1986;21:766-8.

  4. Noblett HR. Treatment of uncomplicated meconium ileus by gastrografin enema: a preliminary report. JPediat Surg. 1969;4:190-7.

  5. Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg. 2004;39:731-7.

  6. Kadioglu Simsek G, Arayici S, Buyuktiryaki M, Okur N, Kanmaz Kutman G, Suna Oguz S. Oral N-Acetyl Cysteine for Meconium Ileus of Preterm Infants. Gynecol Obstet Reprod Med. 2019;25:169-73.

  7. Solaz-Garcia AJ, Segovia-Navarro L, Rodriguez de Dios-Benlloch JL, Benavent-Taengua L, Castilla-Rodriguez DY, Company-Morenza MA. Prevention of meconium obstruction in very low birth weight preterm infants. Enferm Intensiva. 2019;30:72-7.

  8. Bajorek S, Basaldua R, McGoogan K, Miller C, Sussman CB. Neonatal gastric lactobezoar: management with N-acetylcysteine. Case Rep Pediatr. 2012;2012:412412.

  9. Savva DA, Crist M, Lardieri A. N-Acetylcysteine for Gastric Lactobezoars in a 1-Month-Old. J. 2019;24:247-50.

  10. De La Llana SA, Hanquinet S, Pfister RE. Gastric lactobezoar in a Zidovudin treated ELBW infant. Swiss Medical Weekly. 2013;197):21S.

  11. Stanger J, Zwicker K, Albersheim S, Murphy IJJ. Human milk fortifier: An occult cause of bowel obstruction in extremely premature neonates. J Pediatr Surg. 2014;49:724-6.

  12. Colombo C, Ellemunter H, Houwen R, Munck A, Taylor C, Wilschanski M. Guidelines for the diagnosis and management of distal intestinal obstruction syndrome in cystic fibrosis patients. Journal of Cystic Fibrosis. 2011;10:S24-S8.

  13. Schauble AL, Bisaccia EK, Lee G, Nasr SZ. N-acetylcysteine for Management of Distal Intestinal Obstruction Syndrome. J. 2019;24:390-7.

  14. Cooke A, Deshpande AV, Wong CK, Cohen R. Hepatic derangement following N-Acetylcysteine enemas in an infant with cystic fibrosis. J Paediatr Child Health. 2008;44:673-5.

  15. Langer JC, Paes BM, Gray S. Hypernatremia associated with N-acetylcysteine therapy for meconium ileus in a premature infant. CMAJ Canadian Medical Association Journal. 1990;143:202-3.

  16. Bailey DJ, Andres JM. Liver injury after oral and rectal administration of N-acetylcysteine for meconium ileus equivalent in a patient with cystic fibrosis. Pediatrics. 1987;79:281-2.

  17. Prescott L. Oral or intravenous N-acetylcysteine for acetaminophen poisoning? Annals of emergency medicine. 2005;45:409-13.

  18. Bateman DN, Dear JW. Acetylcysteine in paracetamol poisoning: A perspective of 45 years of use. Toxicology Research. 2019;8:489-98.

  19. Ahola T, Fellman V, Laaksonen R, Laitila J, Lapatto R, Neuvonen PJ, Raivio KO. Pharmacokinetics of intravenous N-acetylcysteine in pre-term new-born infants. Eur J Clin Pharmacol. 1999;55:645-50.

  20. Olsson B, Johansson M, Gabrielsson J, Bolme P. Pharmacokinetics and bioavailability of reduced and oxidized N-acetylcysteine. European Journal of Clinical Pharmacology. 1988;34:77-82.

  21. Borgstrom L, Kagedal B, Paulsen O. Pharmacokinetics of N-acetylcysteine in man. European Journal of Clinical Pharmacology. 1986;31:217-22.

  22. Burke MS, Ragi JM, Karamanoukian HL, Kotter M, Brisseau GF, Borowitz DS, Ryan ME, Irish MS, Glick PL. New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 2002;37:760-4.

  23. Shaw A. Safety of N-acetylcysteine in treatment of meconium obstruction of the newborn. J Pediatr Surg. 1969;4:119-25.

  24. Fohl AL, Johnson CE, Cober MP. Stability of extemporaneously prepared acetylcysteine 1% and 10% solutions for treatment of meconium ileus. Am J Health-Syst Pharm. 2011;68:69-72.

  25. Society of Hospital Pharmacists of Australia, Australian Injectable Drugs Handbook, 8th Edition 2020. Accessed 26/02/2020.

  26. Product Information. Acetadote Concentrated Injection (Solution for infusion). MIMS online. Accessed 26/02/2020.

  27. Product Information. Acetylcysteine-Link Concentrate for infusion. MIMS online. Accessed 26/02/2020.

  28. Product Information. DBL Acetylcysteine Injection Concentrate. MIMS online. Accessed 26/02/2020.

  29. Cystic fibrosis manual – Children’s Hospital at Westmead practice guideline. Accessed on 6 March 2020.




Original version Date: 26/3/2020

Author: NMF Consensus Group

Current Version number: 1.0

Current Version Date: 26/3/2020

Risk Rating: Low

Due for Review: 26/3/2025

Approval by: DTC

Approval Date: TBA



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Neonatal Intensive Care Drug Manual

Download 1,5 Mb.