Pharmacology and Medication Safety in Transport
Dosing discipline
Pediatric transport dosing is always per kilogram from a measured or length-tape weight, recorded on a visible card and confirmed by a second team member for high-alert drugs (opioids, paralytics, vasopressors, insulin, concentrated electrolytes). Use standardized concentrations and an infusion pump for every continuous medication; gravity drips are unacceptable for vasoactive infusions.
Neonatal pharmacology
Neonates have reduced hepatic metabolism and glomerular filtration, higher total body water, and lower albumin, altering volume of distribution and half-life. Renally cleared drugs such as gentamicin need extended intervals; opioids and benzodiazepines require smaller, slower doses; surfactant and caffeine have specific neonatal indications.
Safety practices
The Five Rights are a floor, not a ceiling: verify indication, dose, concentration, rate, and compatibility, and account for line dead space - a small flush through a long neonatal catheter can deliver a meaningful bolus. Perform independent double-checks, avoid error-prone abbreviations (write "mcg" not "µg", "units" not "U", never a trailing zero), and reconcile home and hospital medications at handoff. Document every dose with time and route.
Traps
Ten-fold decimal errors and mg/mcg or per-dose/per-day confusion dominate medication questions. A paralyzed infant who looks comfortable may still be in pain or hypotensive; paralysis never substitutes for analgesia.
Rule of thumb
Label every drawn drug at the bedside with name, concentration, total dose, volume, and time - and if a dose looks unusual, recalculate independently before administering.