NEONATAL RESUSCITATION DRUGS MEDICATIONS
Category: Child Health
Abstract : neonatal resuscitation drugs medications : Medications : Neonatal
resuscitation drugs should be stocked in any area in which neonates may be
resuscitated, including each delivery and stabilization area, as well as the
emergency room. Personnel should be familiar with neonatal medications,
concentrations, dosages, and routes of administration. Drugs currently
recommended include epi
neonatal resuscitation drugs medications :
Medications :
Neonatal
resuscitation drugs should be stocked in any area in which neonates may be
resuscitated, including each delivery and stabilization area, as well as the
emergency room. Personnel should be familiar with neonatal medications,
concentrations, dosages, and routes of administration. Drugs currently
recommended include epinephrine (1:10,000), sodium bicarbonate (0.
5 mEq/mL), and
isotonic sodium chloride solution (0.9%) as a volume expansion
agent.
Epinephrine use should be considered only when ventilation has
been established and provided for at least 30 seconds. The only exception to
this rule may be in infants who are born without a detectable pulse or heart
rate. The current recommended dose for epinephrine is 0.01-0.03 mg/kg (0.1-0.3
mL of the 1:10,000 solution) via IV or endotracheal route.
No studies are
currently available that assess the use of higher dosages or repeated dosing in
neonates. Epinephrine administered via the ETT either should be diluted into 1
mL of saline or should be followed immediately by 1-2 mL of saline to ensure the
distribution and absorption of the small volume of drug. If an umbilical venous
catheter is used for medication administration, the catheter should be inserted
only until blood flow is obtained, usually 3-5 cm. Because the dosing
recommendations for epinephrine have included the endotracheal route of
administration, the need for emergent placement of umbilical venous catheters
has been reduced markedly in the delivery room.
In an editor's note
commenting on an article entitled Cardiopulmonary Resuscitation in the Delivery
Room, Catherine DeAngelis writes, "....check the airway (optimize respiratory
support) one more time before compressing the chest. More often than not, you
and the infant can then take deep breaths, and you can beat your own chest
instead of the infant's."
The article reported that approximately one
third of infants in their study with neonatal depression at birth had associated
fetal acidemia. However, in the remaining infants without fetal acidemia, chest
compressions were initiated as a consequence of improper or inadequate
ventilatory support at birth. In this population of infants without the initial
acidemia, chest compressions and/or epinephrine therapy was ineffective. The
heart rate only improved after either effective tracheal intubation established
a patent airway and/or after incremental increases in positive-pressure
ventilation exceeded the opening pressure of the lungs, establishing
ventilation. This study and others continue to reinforce the primary importance
of the establishment of effective ventilation—for without ventilation, other
therapies, including medications, will not be effective in establishing adequate
heart rate and perfusion.
Sodium bicarbonate has been recommended in the
delivery room to reverse the effects of metabolic acidosis related to hypoxia
and asphyxia. However, recent studies show that 0.9% saline provides better
cardiac and blood pressure support to correct both the acidosis and the
underlying etiology of the metabolic acidosis. Sodium bicarbonate should not be
used until adequate ventilation is obtained because of the concomitant
production of carbon dioxide following the use of this drug. If sodium
bicarbonate is used in the face of a persistent respiratory acidosis and
elevated pCO2, the acidosis will not be corrected.
To correct a
documented or presumed metabolic acidosis following the establishment of
adequate ventilation, a dose of 2 mEq/kg IV may be administered. If the base
deficit is known, then a more precise dose can be administered. Use of sodium
bicarbonate in the delivery room has been associated with an increased incidence
of intraventricular hemorrhage in very low birthweight infants; thus, caution is
advised.
Volume expansion may be used in neonates with evidence of acute
blood loss or with evidence of shock of any etiology. In general, the neonatal
heart responds well to the increase in preload at the atrial level caused by the
volume expansion. Hypovolemia may be masked in a newborn infant because of the
significant peripheral vasoconstriction caused by the elevated catecholamines
following delivery. Systolic blood pressure also may be elevated falsely with
pain.
The current recommendations for volume expansion during
resuscitation include isotonic sodium chloride solution or lactated ringers, 5%
albumin, Plasmanate, or O-negative blood that has been cross matched with the
mother. However, because of the advantages of long shelf life, low cost, ready
availability, and the lack of evidence of the superiority of other agents,
isotonic sodium chloride solution is the most frequently used agent for volume
expansion. The currently recommended dosage for volume expansion is 10 mL/kg IV
over 5-10 minutes, and it may be infused more cautiously in extremely preterm
infants. Naloxone is an opioid antagonist and should be used only in neonates
exhibiting respiratory depression in the setting of a laboring mother who has
received iatrogenically administered opioids within 4 hours of
delivery.
Naloxone should not be administered to neonates who are not in
distress or to neonates with another predisposing perinatal complication to
explain the distress.
The great majority of neonates born to mothers who
receive opioids do not receive and do not require naloxone administration. The
intramuscular administration of naloxone should not be used as a substitute for
other forms of vigorous stimulation. Additionally, the administration of
naloxone to a neonate who is born to a mother with long-term use of opiates or
opioids (eg, heroin, methadone) may induce seizures secondary to acute
withdrawal. Remember that some opioid agents have a longer half-life in the
neonate than naloxone, which may lead to a later recurrence of respiratory
depression in the nursery. Therefore, any infant who has received naloxone
should be monitored for the recurrence of respiratory depression for 12 hours.
Naloxone dosage is 0.1 mg/kg of the 0.4-mg/mL parenteral solution administered
intravenously, endotracheally, or intramuscularly.
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