NETS logo Clinical Calculator
Version 5.2.9 (10 Feb 2021)

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Disclaimer

The Clinical Calculator was designed to meet the particular needs of NETS teams. However, it is available online to aid clinicians providing critical care of newborns, infants and children with the guidance of NETS and prior to the arrival of a retrieval team. Although NETS uses this tool and has sought to verify the contents and calculations in good faith, it is provided "as-is", without support or warranty of any kind and no responsibility is accepted for its use by others. Clinicians must use their own judgement as to the appropriateness of a drug or intervention when using the NETS Clinical Calculator tools. The drug doses provided by the included tools are not a substitute carefully checked prescriptions and should be used in conjunction with an appropriate formulary which contains information on drug interactions, compatibilities, precautions, side effects, rates of delivery, minimum/maximum doses and drug monitoring.

Further Information

Drug names are consistent with the Therapeutic Goods Administration and 'tall man lettering' (mixed case names suggested by the Australian Commission on Safety and Quality in Health Care) are used to reduce the likelihood of errors where there is possible confusion between drugs with similar names. Generic drug names are not ini-capped where as the few brand names included are ini-capped and have a ® symbol where appropriate.

When a dose range given for a drug in the calculators, the recommended calculated dose is also provided. Doses and volumes are rounded with precision depending on the magnitude of the dose or volume. Doses for the paediatric calculator are generally capped at adult doses.

The infusion calculations give a dose to be added to the syringe, but not a volume of the drug. Final infusion volumes are almost all 50 mL. To make up smaller volumes, reduce the dose of drug added into the syringe proportionately. In a fluid restricted child it may be necessary to make certain infusions as double-strength solutions and adjust the infusion rate accordingly.

Endotracheal tube sizes and lengths presented are for general guidance, and will not be appropriate for all patients. The aim should be careful positioning guided by direct visualisation at the cords.

Acute care of the newborn infant may require a range of procedures for which selection of appropriate equipment and correct placement of lines and tubes can be vital. The Resuscitation at Birth guide does not replace clinical expertise and procedural experience. The referring hospital's most senior and experienced practitioner should be available for any very sick patient; prior to the arrival of a NETS team and until the baby's departure for another hospital.

Weight ranges:

Resuscitation at Birth up to 5000 g Paediatric 4 kg to 150 kg
Neonatal 0.4 kg to 6 kg Burns 4 kg to 150 kg

Estimated ETT sizes and lengths:
(Age is in completed years. Weight is rounded to the nearest kg.)

 Neonates up to 4 kg:Children between 28 days
and 1 year:*
Children at least 1 year old and not older than 16 years:
Internal diameter (mm) ±0.5 =from table in ANZCOR 2016size 4.0age/4 + 4 (APLS 2017)
Oral depth of insertion (cm) = weight-based (Kempley 2008)weight/2 + 8 (Lau 2006)age/2 + 13 (Lau 2006)
Nasal depth of insertion (cm) = weight-based (Kempley 2008)weight/2 + 9 (Lau 2006)age/2 + 15 (Lau 2006)

* weights within this age range are capped at minimum 4 kg and maximum 12 kg

Estimated paediatric patient weights:
(Uses Best Guess formula extrapolated for ages 15-16 years. Age is in completed years)

Age between 1 and 5 years:weight = (age + 5) x 2
Age between 5 and 16 years:weight = 4 x age

Maintenance Fluid Rate:
Based on the original Holliday & Segar formula for daily maintenance total:
100 mL/kg for the first 10 kg + 50 mL/kg for the second 10 kg + 20 mL/kg for each subsequent kg.
For example, maintenance for a 25 kg child = (100 x 10) + (50 x 10) + (20 x 5) = 1600 mL/day or 67 mL/hr.

Customised Concentrations of Glucose & Saline:
If a bag of the desired concentration is not available use the Adhoc Fluid Concentrations Calculator to guide preparation.
** Warning - hypertonic saline solutions should be used with extreme caution and under expert guidance **

Acknowledgements:

This web version authored by Adrian Bonsall, NETS CMO. Original concept by Dr Andrew Berry, NETS State Director, with further development by Dr Janil Puthucheary & Ian Braithwaite. Many thanks to all the staff at NETS for their contributions. If there are any queries or suggestions, please contact: Technical Support.

References

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Resuscitation At Birth

  1. ANZCOR Newborn Life Support Flowchart, January 2016. Accessed from Australian Resuscitation Council Website: https://resus.org.au/guidelines/.
  2. ANZCOR Neonatal Guidelines - Guideline 13, January 2016. Last updated August 2018. Accessed from Australian Resuscitation Council Website: https://resus.org.au/guidelines/.
  3. American Academy of Pediatrics. Textbook of Neonatal Resuscitation, 7th Ed, Weiner GM (Ed), American Academy of Pediatrics, 2016.
  4. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Pediatric Anesthesia 2006;16(12):1238-1243.
  5. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation 2008;77:369-73.
  6. Appendix F - Resuscitation of the baby at birth. Advanced Paediatric Life Support: A Practical Approach to Emergencies, 6th Ed, Australia & New Zealand, Advanced Life Support Group 2017.

Neonatal Calculator

  1. American Academy of Pediatrics. Textbook of Neonatal Resuscitation, 7th Ed, Weiner GM (Ed), American Academy of Pediatrics, 2016.
  2. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Pediatric Anesthesia 2006;16(12):1238-1243.
  3. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation 2008;77:369-73.
  4. ANZCOR Neonatal Guideline 13.5 (August 2016). Accessed Dec 2019 via Australian Resuscitation Council Website: https://www.nzrc.org.nz/assets/Guidelines/Neonatal-Resus/ANZCOR-Guideline-13.5-Aug16.pdf.
  5. Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am. J. Dis. Child. 1986 Aug;140(8):786-8.
  6. Wright IM, Owers M, Wagner M. The umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant. Pediatr Crit Care Med. 2008 Sep;9(5):498-501.
  7. Australasian Neonatal Medicines Formulary. Accessed Dec 2019 via https://www.anmfonline.org/clinical-resources/.
  8. Clinical Excellence Commission, 2018, Newborn Antibiotic Guideline for early and late onset sepsis during birth episode of care. Revised June 2018. Sydney: Clinical Excellence Commission.

Paediatric Calculator

  1. Tinning K, Acworth J. Make your Best Guess: an updated method for paediatric weight estimation in emergencies. Emergency Medicine Australasia. 2007 Dec 1;19(6):528-34.
  2. Advanced Paediatric Life Support: A Practical Approach to Emergencies, 6th Ed, Australia & New Zealand, Advanced Life Support Group 2017. [Including updated Status Epilepticus algorithm Nov 2019.]
  3. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Pediatric Anesthesia 2006;16(12):1238-1243.
  4. BNF for Children. Accessed Dec 2019 via https://www.medicinescomplete.com.
  5. Australian Medicines Handbook: Children's Dosing Companion July 2018. Accessed Dec 2019 via https://childrens.amh.net.au.
  6. Drug Doses, Frank Shann 17th Ed, 2017.
  7. Paediatric Pharmacopoeia 13th Ed (2002) Royal Children's Hospital, Melbourne.
  8. Clinical Excellence Commission, 2018, Paediatric Antibiotic Guidelines for Severe Sepsis & Septic Shock & Unwell Neonates. Revised July 2018. Sydney: Clinical Excellence Commission
  9. SCHN Guideline 2014-9103 v2: Seizures - Acute Management in Infants and Children Apr 2017, Sydney Children's Hospitals Network
  10. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19(5):823-32.
  11. The Children's Hospital Westmead Meds4Kids Dosing Guide. Accessed Dec 2019 via Sydney Children's Hospital Network (SCHN) & The Children's Hospital at Westmead intranet sites.
  12. Australian Injectable Drug Handbook 7th Ed. Accessed Dec 2019 via Clinical Information Access Portal (CIAP).
  13. Children's Hospital Westmead Paediatric Injectable Medicines Handbook. Accessed Dec 2019 via Clinical Information Access Portal (CIAP).
  14. Royal Children's Hospital, Melbourne, Paediatric Injectable Guidelines 4th Edition January 2013 Adapted for Sydney Children's Hospital, Randwick.

Initial Burns Fluid Calculator

  1. Baxter CR. Fluid volume and electrolyte changes in the early post-burn period. Clin Plast Surg. 1974;1:693-703.
  2. Statewide Burn Injury Service. NSW Burns transfer guidelines 4th edition. Agency for Clinical Innovation Jul 2017.
  3. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19(5):823-32.
  4. Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet. 1944;79:352-8.
  5. Sakson JA. Simplified chart for estimating burn areas. Am J Surg 1959;98:693-4.
  6. Mercer NS, Price RJ, Maude S, Hiles RW, Pigott RW. The Frenchay Burns Chart. Burns Incl Therm Inj. 1988 Feb;14(1):58-9.
  7. Greenhalgh DG. Burn resuscitation. J Burn Care Res, 2007;28(4):555-65.

Severe Asthma Song Sheet

  1. Severe Asthma Management - NETS Practice Guideline.
  2. NSW Health Guideline for the Acute Management of Infants and Children with Asthma.

Diabetic Ketoacidosis Song Sheet

  1. Sydney Children's Hospitals Network Practice Guideline: Diabetic Ketoacidosis (DKA), published June 2018.

Status Epilepticus/Seizures Song Sheet

  1. Seizure Management for Children >1 Month of Age - NETS Practice Guideline.
  2. Sydney Children's Hospitals Network Practice Guideline: Seizures - Acute Management in Infants and Children.

Neonatal Bilirubin Therapy Calculator

  1. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004 Jul;114(1):297-316.

Neonatal Therapeutic Cooling Criteria

  1. NETS Practice Guideline - Therapeutic Hypothermia in the Newborn Sep 2014.
  2. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electrographic study. Arch neurol 1976;33(10):696-705
  3. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan ER, et al. Whole-Body Hypothermia for Neonates with Hypoxic–Ischemic Encephalopathy. N Engl J Med 2005 Oct 13;353(15):1574-84

All rights reserved. NETS Version 5.2.9
Email: Technical Support