BNF for Children
BNF Publications is delighted to announce that SGS, one of the world leaders in quality management assessment, has confirmed that the BNF quality management system is ISO 9001:2008 certified.
ISO 9001:2008 certification demonstrates that the procedures that underpin the production of BNF and BNFC products are robust and carried out to the highest of standards; that we engage with and respond to our users; that we train our staff to promote excellence in performance; and that we are committed to ongoing innovation to meet the needs of healthcare professionals in the future.
The table showing equivalent doses of morphine sulphate and diamorphine hydrochloride in Prescribing in Palliative Care has been revised to improve the clarity of the table. The updated version shows equivalent doses of morphine sulphate and diamorphine hydrochloride over 24 hours.
Guidance on the management of constipation in children has been updated in BNFC (section 1.6) to take into account the recommendations of the NICE guideline: Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care (May 2010). In children over 1 year of age with constipation, BNFC recommends the use of laxatives alongside a review of the diet to ensure that it includes an adequate intake of fluid and fibre; an oral preparation containing macrogols is the first-line treatment for constipation and faecal impaction. While the doses of some laxatives have been modified in BNFC (see Dose Changes), parents and carers of children should be advised to adjust the dose of laxatives in order to establish a regular pattern of bowel movements in which stools are soft, well-formed, and passed without discomfort.
Melatonin (section 4.1.1) is often prescribed under a shared-care arrangement between primary and secondary care. Furthermore, unlicensed preparations of melatonin, which can vary in clinical effect, are used commonly in children. BNFC now advises that the shared-care protocol should specify the manufacturer for the melatonin to be dispensed in the community.
We have received a number of helpful comments on the dose of paracetamol in BNFC, both on the details of the dose and on the format. Taking into account these comments, and with input from our expert advisers and the Paediatric Formulary Committee, the dose of paracetamol has been amended for this edition (section 4.7.1). We hope you agree that the dose is now simpler, clearer, and more consistent.
BNFC (section 5.1) provides guidance on the treatment of syphilis and pelvic inflammatory disease in children under 12 years of age to reflect the recommendations of the BASHH guideline: Management of Sexually Transmitted Infections and Related Conditions in Children and Young People (2010). Children under 12 years of age with syphilis should be treated with either benzylpenicillin or procaine benzylpenicillin for 10 days. Those under 12 years with pelvic inflammatory disease should receive a single dose of ceftriaxone and a 14-day course of erythromycin and metronidazole.
Babies born preterm should receive all routine immunisations based on their actual date of birth. The risk of apnoea following vaccination is increased in preterm babies, particularly in those born at or before 28 weeks postmenstrual age. BNFC (section 14.1) recommends that if babies at risk of apnoea are in hospital at the time of their first immunisation, they should be monitored for 48 hours after immunisation. If a baby develops apnoea, bradycardia, or desaturation after the first immunisation, the second immunisation should also be given in hospital with similar monitoring.
Neonates are at greater risk of calcium-ceftriaxone precipitation than older children, particularly if they were born preterm or have impaired bilirubin binding (Drug Safety Update 2009; 3 (3): 2–3). BNFC (section 5.1.2.1) contra-indicates ceftriaxone in neonates less than 41 weeks postmenstrual age. Ceftriaxone is also contra-indicated in neonates over 41 weeks postmenstrual age with jaundice, hypoalbuminaemia, or acidosis, or in those who require concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium). In older children, ceftriaxone must not be administered simultaneously with parenteral nutrition or infusion fluids containing calcium, even by different infusion lines; however, they may be administered sequentially, so long as the infusion line is flushed between infusions or if the infusions are given by different infusion lines at different sites.
Tacrolimus is now also available as Modigraf® granules, which are used to prepare an immediate-release oral suspension, taken twice daily. The BNFC advice in section 8.2.2 alerting healthcare professionals to the danger of switching between tacrolimus preparations without adequate monitoring, has been updated following the launch of Modigraf®. Switching between different formulations of tacrolimus (Prograf®, Modigraf®, and Advagraf®) should not occur, except under the supervision of a transplant specialist.
Section A2.6 in the appendix on Borderline substances (Appendix 2) has been revised. Gluten-free and low-protein food products are now listed under separate subheadings, such as bread (including bread rolls and baguettes), flour mixes, and pasta.
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The UK health departments distribute BNFCs to NHS hospitals, doctors, and community pharmacies. For information on the supply of copies of the BNFC to NHS organisations, see the DH website . Alternatively, copies may be obtained through any bookseller or direct from www.pharmpress.com.
Numerous changes are made for each edition of the BNFC. The most significant changes that have been made for BNFC 2010―2011 can be reviewed by following the links below:
