TY  - CHAP
M1  - Book, Section
TI  - Emergency Medications and Therapy for the Neonates
A1  - Gomella, Tricia Lacy
A1  - Cunningham, M. Douglas
A1  - Eyal, Fabien G.
A1  - Tuttle, Deborah J.
Y1  - 2013
N1  - 
T2  - Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 7e
AB  - Table  Graphic  Jump  Location|Download  (.pdf)|PrintEMERGENCY  MEDICATIONS  AND  THERAPY  FOR  NEONATESaMEDICATIONINDICATIONSDOSING  RANGENOTESUMBILICAL  CATHETER  DOSINGbUACUVCFurosemideVolume  overload,  pulmonary  edema1  mg/kg/dose,  IM,  IV  YesLorazepamAnticonvulsant0.05  mg/kg/dose  IV,  infuse  over  3–5  minutesMay  cause  respiratory  depression  and  hypotension,  may  repeat  in  10–15  minutes  YesNaloxoneNarcotic  reversal0.1  mg/kg  IM/IV  (IV  preferred;  IM  acceptable  but  delayed  onset  of  action).  ETT  route:  no  studies  in  neonatesNot  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.  YesPhenobarbitalAnticonvulsant15–20  mg/kg  IV  load  over  15–30  minutesRespiratory  depression  possible  if  diazepam  used  first.  Follow  with  maintenance  dose.  YesPhenytoinAnticonvulsant15–20  mg/kg  IV  loadIV  rate  0.5  mg/kg/min  maximum;  mix  only  with  NS.  YesSodium  bicarbonateDocumented  metabolic  acidosis  with  adequate  ventilation,  hyperkalemia1–2  mEq/kg  IV  over  at  least  30  minutes  or  moreUse  0.5  mEq/mL;  infuse  over  30  minutes  or  more.  YesVolume  ExpansionNormal  saline  (preferred)  or  lactated  Ringer’s  solutionVolume  expansion10  mL/kg  IV  over  5–10  minutes;  may  repeatCheck  Hct  and  serum  glucose  before  and  after  dose.YesYesO  Rh-negative  packed  RBCsVolume  expansion  (severe  anemia/blood  loss)10  mL/kg  IV  over  5–10  minutes;  may  repeatIf  time  permits,  blood  should  be  cross-matched  to  the  mother.Yes  (not  preferred)YesAtropineBradycardia0.01–0.03  mg/kg/dose  IV,  IM,  ETT;  repeat  every  10–15  minutesFor  ETT  use,  dilute  with  NS.  YesCalcium  gluconate  (10%)  (100  mg/mL)HyperkalemiaHypocalcemiaCa  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.  YesDextroseHypoglycemiaHyperkalemia  (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).YesYesDobutamineCardiogenic  shock,  hypotension  due  to  refractory  CHF2–15  mcg/kg/min,  increase  every  10  minutes  to  maximum  40  mcg/kg/minMix  in  D5W,  NS,  LR.  YesDopamineHypotension,  agonal  heart5  mcg/kg/min,  increase  to  a  maximum  of  40  mcg/kg/minMix  in  D5W,  NS,  LR.  YesCardioversion/defibrillationVT,  VF,  SVT,  atrial  fib/flutter1–4  joules/kg,  increase  50–100%  each  timeSynch  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.  YesEndotracheal  tube  (uncuffed)2.5  mm  internal  diameter  (ID)3.0  mm  ID3.5  mm  ID3.5–4.0  mm  ID3000  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.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1107523003
ER  -