TABLE 92 Neonatal Resuscitation Drug Chart

DEXTROSE To provide metabolic substrate and expansion of plasma volume, 10 percent dextrose in water (D10W) at 100 (mL/kg)/day or 6 to 8 (mg/kg)/min should be infused. If the Dextrostix is less than 45 mg/dL, 5 mL/kg of 10 or 15% glucose solution should be infused; 25% dextrose infusions should be avoided because of the risk of rebound hypoglycemia.

EPINEPHRINE To stimulate heart rate if it is under 120 beats per minute, 0.1 mL/kg of a 1:10,000 solution may be given through the endotracheal tube or intravenously. Cardiac massage should continue following epinephrine administration.

NALOXONE Use naloxone only to reverse narcotic respiratory depression, 0.01 mg/kg of a neonatal solution (0.2 mg/mL) may be administered intravenously, subcutaneously, or through the endotracheal tube. The time for peak concentration of transplacentally acquired narcotics in the fetus is 2 h following administration of medication to the mother; thus, delivery of the fetus at that time would predispose the fetus to maximal depression. Naloxone may precipitate withdrawal in infants whose mothers are addicted to narcotics.

ISOPROTERENOL If epinephrine has failed to raise the heart rate to at least 120 beats per minute, 1:10,000 solution or 0.05 to 0.1 pg/min may be infused.

A delay in onset of spontaneous regular respiration of more than 30 min following birth has been associated with a poor prognosis. Attempts at resuscitation after 30 min of no response do not appear to be warranted.

BICARBONATE In the presence of metabolic acidosis, 2 to 3 meq/kg of sodium bicarbonate should be administered as an intravenous infusion. A continuous infusion may be necessary [not to exceed 8 meq/kg/day] if acidosis is protracted.

DOPAMINE Dopamine should be initiated to raise the blood pressure after adequate fluids have been administered. At low doses (2 to 5 pg/kg/min) dopamine preserves renal and mesenteric perfusion; at higher doses (10 to 20 mg/kg/min) it has both inotropic and vasoactive properties through a- and b-adrenergic effects.

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