Medications used in Resuscitation

Figure. Neonatal Flow Algorithm.

et al. Circulation 2005;112:IV-188-IV-195

Copyright American Heart Association

 Drugs are very much a last line measure in resuscitation of the newborn, and should only be used after ensuring that the baby is well oxygenated. Drugs are rarely indicated in resuscitation of the newly born But if the heart rate remains <60 bpm despite adequate ventilation with 100% oxygen and chest compressions. Rarely, buffers, a narcotic antagonist, or vasopressors may be useful after resuscitation.

Drugs are seldom needed to:

1. Stimulate the heart. 2. Increase tissue perfusion 3. Restore acid-base balance.

Medications

Epinephrine Volume expanders Naloxone Sodium Bicarbonate Calcium gluconate Sterile water

Routes of administration
1. Umbilical vein

UVC Most rapid route for adrenaline. Can also be used for fluids.

3.5Fr or 5Fr umbilical catheter is inserted just inside skin surface

2. Endotracheal tube

Only adrenaline should be given through this route

3. Peripheral vien

4. Intraosseous lines

Epinephrine

Epinephrine should be considered only when the heart rate is below 60 beats/min and ventilation has been established and provided for at least 30 seconds. The only exception to this rule may be in infants born without a detectable pulse or heart rate.

Route and Dose of Epinephrine Administration The recommended IV dose is 0.01 to 0.03 mg/kg per dose. If the endotracheal route is used,, administration of a higher dose (up to 0.1 mg/kg) The concentration of epinephrine for either route should be 1:10 000 (0.1 mg/mL).

Volume Expansion

Consider volume expansion when blood loss is suspected or the infant appears to be in shock and has not responded adequately to other resuscitative measures. An isotonic crystalloid rather than albumin is the solution of choice for volume expansion in the delivery room The recommended dose is 10 mL/kg over 5-10 minutes , which may need to be repeated.

Naloxone Administration of naloxone is not recommended as part of initial resuscitative efforts in the delivery room for newborns with respiratory depression. If administration of naloxone is considered, heart rate and color must first be restored by supporting ventilation. The preferred route is IV or intramuscular. The recommended dose is 0.1 mg/kg, but no studies have examined the efficacy of this dose in newborns.

SODIUM BICARBONATE Dosage range for bicarbonate 1-2mmol/kg. Give slowly over at least 2 minutes (preferably longer) However, studies show that 0.9% saline provides better cardiac and blood pressure support to correct both the metabolic acidosis itself and the underlying cause of the acidosis.

Calcium Gluconate Calcium is not a routine resuscitation drug. It is used for the treatment of symptomatic hyperkalaemia or hypocalcaemia. Dosage range for calcium is 0.5-2.0ml/kg. Give slowly over 30 minutes. Observe for bradycardia.

Glucose Glucose: administration should be considered after prolonged resuscitation, as glycogen stores may be depleted. Give 5ml/kg of 10% dextrose.

MEDICATION CONCENTRATION DOSE ROUTE WEIGHT (G) 500 750 1000 1250 1500 1750 2000 2500 3000 3500 4000 4500 5000

ADRENALINE 1:10,000 0.1ml/kg IV 0.3ml/kg ETT

NALOXONE 0.4mg/ml 0.1mg/kg IM/IV

SODIUM BICARBONATE 8.4% 2mmol/kg IV

CALCIUM GLUCONATE 10% 0.5ml/kg IV

0.05ml 0.08ml 0.10ml 0.13ml 0.15ml 0.18ml 0.20ml 0.25ml 0.30ml 0.35ml 0.40ml 0.45ml 0.50ml

0.15ml 0.23ml 0.30ml 0.38ml 0.45ml 0.53ml 0.60ml 0.75ml 0.90ml 1.05ml 1.20ml 1.35ml 1.50ml

0.13ml 0.19ml 0.25ml 0.31ml 0.38ml 0.44ml 0.50ml 0.63ml 0.75ml 0.88ml 1.0ml 1.0ml 1.0ml

1.0ml 1.5ml 2.0ml 2.5ml 3.0ml 3.5ml 4.0ml 5.0ml 6.0ml 7.0ml 8.0ml 9.0ml 10.0ml

0.25ml 0.38ml 0.50ml 0.63ml 0.75ml 0.88ml 1.00ml 1.25ml 1.50ml 1.75ml 2.00ml 2.25ml 2.50ml

Thank you