RT Book, Section
A1 Gomella, Tricia Lacy
A1 Cunningham, M. Douglas
A1 Eyal, Fabien G.
A1 Tuttle, Deborah J.
SR Print(0)
ID 1107523003
T1 Emergency Medications and Therapy for the Neonates
T2 Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 7e
YR 2013
FD 2013
PB McGraw-Hill Education
PP New York, NY
SN 9780071768016
LK accesspediatrics.mhmedical.com/content.aspx?aid=1107523003
RD 2024/04/25
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.