Neonatal Drug Therapy Manual

MethylPREDNISolone sodium succinate

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated January 26, 2022 - 6:00pm

Alternate Name(s): 
Solu-Medrol
Classification: 
Glucocorticoid, anti-inflammatory
Original Date: 
December 2008
Revised Date: 
February 2018
Indications: 
  • As an anti-inflammatory in infants with BPD, to shorten weaning from respirator; and prior to extubation, to reduce laryngeal edema and stridor
  • Treatment of hypoglycemia
  • In patients undergoing cardiac surgery with cardiopulmonary bypass to decrease inflammatory response and reduce myocardial injury
Administration: 
  • IV intermittent infusion: over 15 minutes (over 60 minutes for 30 mg/kg/dose)
Dosage: 
  • Neonates:
    • 0.16 - 0.8 mg/kg/day divided every 6 - 12 hours
  • Infant: (corrected GA > 42 weeks and PNA > 4 weeks)
    • 0.5 - 1.7 mg/kg/day divided every 6 - 12 hours

For patients undergoing cardiopulmonary bypass:

  • 2 doses of 30 mg/kg/dose:
    • 1st dose: 6 hours prior to scheduled OR time (correlates to 8 hours prior to incision)
    • 2nd dose: given in the OR at time of incision

NOTE: Use 62.5 mg/mL concentration to prepare doses for this specific indication

Side Effects: 
  • CVS: hypertension, edema
  • Endocrine and metabolic: hyperglycemia, hypokalemia, alkalosis
Parameters to Monitor: 
  • BP
  • Electrolytes
  • Serum glucose

 

Reconstitution and Stability: 

IV intermittent infusion:

  • Methylprednisolone 125 mg/vial (Act-O-Vial)
    • Reconstitute Act-O-Vial by pressing down on plastic activator to force diluent into the lower compartment.  Gently agitate.  Remove plastic tab covering center of stopper prior to inserting needle to withdraw dose.  Reconstituted solution is 62.5 mg/mL
    • Take 0.8 mL (50 mg) and add to 19.2 mL D5W
    • Final concentration: 2.5 mg/mL
  • Methylprednisolone 125 mg/vial (Act-O-Vial)  (prior to cardiac surgery ONLY)
    • Reconstitute Act-O-Vial by pressing down on plastic activator to force diluent into the lower compartment.  Gently agitate.  Remove plastic tab covering center of stopper prior to inserting needle to withdraw dose.  Reconstituted solution is 62.5 mg/mL
    • Withdraw patient's dose
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: amiodarone, dopamine, heparin, KCl (up to 40 mmol/L), midazolam, milrinone, morphine, TPN

Incompatible: penicillin, propofol

References: 

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

-Schroeder VA, Pearl JM, Schwartz SM, Shanley TP, Manning PB, Nelson DP. Combined steroid treatment for congenital heart surgery improves oxygen delivery post bypass inflammatory mediator expression. Circulation. 2003; 107: 2823-2828

-Varan B, Tokel K, Mecan S, Donmer A, Aslamaci S. Systemic inflammatory response related to cardio pulmonary bypass and its modification by methylpredisolone: High dose versus low dose. Pediatric cardiology 2002; 23(4): 437-441

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