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EMERGENCY MEDICATIONS AND THERAPY FOR NEONATESa
MEDICATION INDICATIONS DOSING RANGE NOTES UMBILICAL CATHETER DOSINGb
UAC UVC
Furosemide Volume overload, pulmonary edema 1 mg/kg/dose, IM, IV     Yes
Lorazepam Anticonvulsant 0.05 mg/kg/dose IV, infuse over 3–5 minutes May cause respiratory depression and hypotension, may repeat in 10–15 minutes   Yes
Naloxone Narcotic reversal 0.1 mg/kg IM/IV (IV preferred; IM acceptable but delayed onset of action). ETT route: no studies in neonates Not recommended as part of initial resuscitation of newborns with respiratory depression in delivery room. If respiratory depression continues, naloxone may be given if mother had narcotics within 4 hours of delivery.   Yes
Phenobarbital Anticonvulsant 15–20 mg/kg IV load over 15–30 minutes Respiratory depression possible if diazepam used first. Follow with maintenance dose.   Yes
Phenytoin Anticonvulsant 15–20 mg/kg IV load IV rate 0.5 mg/kg/min maximum; mix only with NS.   Yes
Sodium bicarbonate Documented metabolic acidosis with adequate ventilation, hyperkalemia 1–2 mEq/kg IV over at least 30 minutes or more Use 0.5 mEq/mL; infuse over 30 minutes or more.   Yes
Volume Expansion
Normal saline (preferred) or lactated Ringer’s solution Volume expansion 10 mL/kg IV over 5–10 minutes; may repeat Check Hct and serum glucose before and after dose. Yes Yes
O Rh-negative packed RBCs Volume expansion (severe anemia/blood loss) 10 mL/kg IV over 5–10 minutes; may repeat If time permits, blood should be cross-matched to the mother. Yes (not preferred) Yes
Atropine Bradycardia 0.01–0.03 mg/kg/dose IV, IM, ETT; repeat every 10–15 minutes For ETT use, dilute with NS.   Yes
Calcium gluconate (10%) (100 mg/mL)

Hyperkalemia

Hypocalcemia

Ca gluconate 100–200 mg/kg slow IV over 10–30 minutes (1.0–2.0 mL/kg) Infuse slowly; caution with digitalized patient; tissue necrosis if extravasation. Can also use CaCl 20–30 mg/kg.   Yes
Dextrose

Hypoglycemia

Hyperkalemia (used with insulin)

100–500 mg/kg/dose IV (1–5 mL/kg/ dose D10W) D10 = 100 mg/mL; D12.5 = 125 mg/mL; D25 = 250 mg/mL (D25 only in central line). Yes Yes
Dobutamine Cardiogenic shock, hypotension due to refractory CHF 2–15 mcg/kg/min, increase every 10 minutes to maximum 40 mcg/kg/min Mix in D5W, NS, LR.   Yes
Dopamine Hypotension, agonal heart 5 mcg/kg/min, increase to a maximum of 40 mcg/kg/min Mix in D5W, NS, LR.   Yes
Cardioversion/defibrillation VT, VF, SVT, atrial fib/flutter 1–4 joules/kg, increase 50–100% each time Synch switch off for VF.  
Epinephrine (1:10,000) Asystole, bradycardia, hypotension (acute) 0.1–0.3 mL/kg/dose of 1:10,000 IV; ETT only 0.5–1 mL/kg/dose of 1:10,000 (dilute with NS) Do not use 1:1000; for ETT use, dilute in 1–2 mL NS; NRP, AHA, AAP suggests higher dose if by ETT.   Yes
Endotracheal tube (uncuffed)

2.5 mm internal diameter (ID)

3.0 mm ID

3.5 mm ID

3.5–4.0 mm ID

<1000 g or <28 weeks

1000–2000 g or 28–34 weeks

2000–3000 g or 34–38 weeks

>3000 g or >38 weeks

   

aFor abbreviations, see Appendix A.

bAvoid infusion of catecholamines into UAC. UVC in good position preferred to administer medications.

In emergency situations, a UVC inserted only to the point where blood can be aspirated (at least 2–4 cm; less in preterm infants), but whose position is not verified by radiograph, can be used for volume expanders, epinephrine, glucose (not >12.5%), and bicarbonate that is diluted. Intraosseous access can be used as an alternative route. Note: No hypertonic solutions should be used in a catheter that is not confirmed by x-ray.

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