BNF for Children
The UK has one of the highest rates of teenage pregnancy in western Europe. BNFC now provides information on the use of all forms of contraception including hormonal methods, devices, and emergency contraception in section 7.3.
The rising incidence of sexually transmitted infections in young people is of great concern. Guidance on the treatment of sexually transmitted infections has been expanded in this edition with the introduction of a section on pelvic inflammatory disease in Table 1, section 5.1.
From September 2008, immunisation with human papilloma virus vaccine will be offered routinely to all girls aged 12–13 years in order to protect them against human papilloma virus types 16 and 18, which cause over 70% of cervical cancers. The Immunisation Schedule in BNFC (section 14.1) has been updated to reflect these changes. BNFC also includes details of ‘catch-up’ programmes for the vaccine in England, Wales, Scotland, and Northern Ireland (section 14.4).
Guidance on the management of urinary-tract infections has been updated in BNFC (Table 1, section 5.1 and section 5.1.13) to take into account the recommendations of the NICE guideline: Urinary-tract Infections in Children (August 2007). This guideline emphasises that antibacterial prophylaxis should not be given routinely to children following their first urinary-tract infection. However, BNFC recommends that antibacterial prophylaxis can be considered for children with recurrent infection, significant urinary-tract anomalies, or significant kidney damage.
Administration of ceftriaxone- and calcium-containing solutions to neonates has been associated with several deaths following precipitation in the lungs and urine (Drug Safety Update 2007; 1(4): 2–11). BNFC (section 5.1.2) reflects these safety concerns and contra-indicates the use of ceftriaxone in children who require concomitant treatment with calcium.
BNFC (section 3.4.3) continues to reflect advice from the Resuscitation Council (UK) on the emergency treatment of anaphylactic reactions. We have worked closely with the working group to reflect the updated guideline (http://www.resus.org.uk) in BNFC. Changes have been made to the intramuscular and intravenous doses of adrenaline. BNFC continues to emphasise that adrenaline should usually be given by intramuscular injection; it also provides advice on when it is appropriate to consider intravenous adrenaline.
Shock is a medical emergency associated with a high mortality. Guidance on the management of shock has been updated in BNFC (section 2.7.1) to provide advice on the treatment of different types of shock including septic, cardiogenic, and hypovolaemic shock.
The Paediatric Formulary Committee and the Dental Advisory Group have reviewed the NICE guidelines on Antimicrobial Prophylaxis Against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures (March 2008). BNFC (Table 2, section 5.1) reflects these radical guidelines and advises that antimicrobial prophylaxis is no longer recommended for the prevention of endocarditis in children undergoing dental and non-dental procedures. Prophylaxis may expose children to the adverse effects of antimicrobials when the evidence of benefit has not been proven.
Overcorrection of the haemoglobin concentration with erythropoietins may increase the risk of serious cardiovascular events and death in adults with chronic kidney disease (Drug Safety Update 2007; 1(5): 2–5). When children are treated with erythropoietins, BNFC (section 9.1.3) advises that the haemoglobin concentration should not be increased beyond that which provides adequate control of anaemic symptoms; haemoglobin concentrations higher than 12 g/100 mL should be avoided.
More space has been devoted in this edition to the administration of continuous intravenous infusions in neonatal intensive care. This information can be found for key drugs in the Administration section of the monographs.
We encourage you to complete a BNFC online learning module which is available free at http://bnfc.org/bnfc/bnfcextra/current/450048.htm. This popular module reviews the assessment and management of constipation in children. It also addresses other issues such as the implications of using medicines off-label, reporting adverse drug reactions in children to the regulatory authorities, and navigating the digital version of BNFC to achieve most of the module objectives.
BNF publications launched a free e-newsletter service in March 2008. Newsletters are designed to alert you to significant changes in the clinical content of the BNF and BNFC and to the way that this information is delivered. Newsletters will review clinical case studies to help you put this therapeutic advice into practice and provide you with tips on using these publications effectively. If you would like to be kept informed of the latest changes that are influencing clinical practice, please sign up at the following URL: http://bnf.org/newsletter
As part of our commitment to make the knowledge within BNFC more accessible, we have made a change to the way preparation records are displayed online. These preparation records are now displayed along with the relevant monograph above so that monograph-level information (e.g. warnings, side-effects, and doses) are displayed without additional navigation.
A new dimension has been added to the means of accessing BNFC information with the development of an interface to the NHS Dictionary of Medicines and Devices. The NHS dm+d provides a standard way of representing medicines to clinicians within prescribing and dispensing systems. The new interface on bnfc.org allows system suppliers to provide their healthcare professional users with a robust and secure means of accessing BNFC knowledge directly from their clinical software applications.
Numerous changes are made for each edition of the BNFC. The most significant changes that have been made for BNF for Children 2008 can be reviewed by following the links below:
