Chloral Hydrate in Infants

Available strength of syrup: 100mg/ml  and 40mg/ml

Availability	Justification
Chloral Hydrate 100mg/ml	In more recent studies, higher single doses of up to 100 mg/kg have been  used with increased success in children and infants over 1 month of age. Not to exceed 120 mg/kg or 1 g/dose in infants It can be used in adults and children
Chloral Hydrate 40mg/ml	When adhering to strict protocols and with adequate monitoring, chloral hydrate sedation for MRI scanning can be safely performed for both preterm and term infants. Chloral hydrate cannot be given as a tablet as it can cause mucosal membrane damage in the alimentary canal. The most frequent adverse effect of chloral hydrate is gastrointestinal irritation and gastric irritation, manifested by nausea, vomiting, diarrhea and stomach pain, besides unpleasant taste and flatulence may also occur. These effects can be minimized by taking chloral hydrate with a full glass of fluid because ileus in an infant has been reported.  Ileus a painful obstruction of the ileum or other part of the intestine. Or it should be administered with feeds, diluted 1:3 with water or other liquid such as fruit juice or ginger. Lower concentration would help to minimize the adverse effect in infants.

Monitoring needed:

1. Repeat doses should be used with great caution as drug and metabolites accumulate with repeated use; toxicity has been reported after 3 days in a preterm neonate and after 7 days in a term neonate receiving chloral hydrate 40 to 50 mg/kg every 6 hours.
2. Neonates should be monitored for increased bilirubin concentrations as hyperbilirubinemia may occur due to competition of chloral hydrate metabolites with bilirubin for hepatic glucuronidation. 

References:

http://www.medscape.com/viewarticle/513402

http://www.nature.com/pr/journal/v70/n5s/abs/pr2011871a.html

http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20C)/CHLORAL%20HYDRATE.html

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