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This study aims to assess the need for modification of the current vancomycin dosing protocol at a single institution by conducting a comparison of dosing per protocol versus off protocol and the resulting first troughs in neonates. Secondary outcomes include comparison of time to first therapeutic steady-state trough, dose at first therapeutic steady-state trough, and success of the consult-to-pharmacy service.This single center retrospective chart review analyzed patients at a level-IIIb neonatal intensive care unit who received vancomycin and had at least one appropriately drawn trough level documented from 2013 to 2014. Effectiveness of each dosing strategy was evaluated by assessing troughs.Approximately 30% of first vancomycin trough levels obtained are within the desired range of 15 to 20 μg/mL and patients achieve therapeutic steady-state trough levels after 3.6 days, regardless of the initial dosing strategy. The current protocol reflects the therapeutic steady state dosing only 22% of the time. The vancomycin consult-to-pharmacy service improves the achievement of goal trough ranges.An assessment of doses that achieved a goal vancomycin trough of 15 to 20 μg/mL revealed that a dose of 12.5 mg/kg at the same intervals and age ranges specified in the current protocol would enable the achievement of this higher goal trough.