MEDICATIONS

Medications Epinephrine

Volume expanders

Sodium bicarbonate

Naloxone

Dopamine

Neonatal Resuscitation

No role of Atropine Calcium Dexamethasone Dextrose

Epinephrine

Indications HR < 60 per minute despite 30 seconds of

BMV plus chest compressions

Epinephrine

Formulation 1:1000 Dilution 1:10000 (Ten times)

0.2 ml in 1.8 ml Load 1 ml (in 1ml syringe) Dose 0.1-0.3 ml/kg Route IV (preferable) Rate Rapid bolus

IT * - use only if IV access is not available; dose of up to1ml/kg to be used; Efficacy ?

Epinephrine

Effect : Inotropic, chronotropic, peripheral vasoconstriction

Expect : HR > 60 within 30 seconds

Epinephrine

Follow up: if HR < 60 Repeat epinephrine q 3-5 minutes Ensure:

effective ventilation

effective chest compressions

endotracheal intubation (if not done already)

Consider using volume expander

Consider using sodium bicarbonate

Volume expanders

Consider Pallor persisting after oxygenation Weak pulses, good heart Tachy / bradycardia No improvement despite effective

ventilation, chest compressions & Epinephrine

Volume expanders

Normal saline

Ringer’s lactate

Whole blood (O Neg cross matched with mother’s blood)

Normal saline

Indications Evidence or suspicion of acute blood loss

with signs of hypovolemia and/or baby responding poorly to resuscitation

Normal saline

Dosage 10 ml/kg

40 ml in syringe or infusion set

Route IV- umbilical is best

Rate over 5-10 minute

Volume expanders

Effect : Volume expansion, correction of metabolic acidosis

Expectation : Better BP & pulses, less pallor

Follow up : If signs of hypoperfusion persist, repeat volume

expander, consider sodium bicarbonate or dopamine

Sodium bicarbonate

Indications

Prolonged arrest that does not respond to other therapy

if ABG shows metabolic acidosis with normal PaCO2

Sodium bicarbonate

Preparation 0.9 mEq (approx. 1mEq)/ml

Dilution 1:1 dilution

Load 10 ml of diluted solution

Dose 2 mEq/kg of diluted solution

Route IV; Never through ET tube

Rate Slow over 2 minutes or more @ not >1 mEq/kg/min

Sodium bicarbonate

Effect : Control of metabolic acidosis; volume expansion

Expectation : HR > 100 within 30 seconds

Follow up : If persistent metabolic acidosis

Use epinephrine and volume expansion, consider

dopamine

Naloxone hydrochloride

Indications Severe respiratory depression after BMV has

restored a normal heart rate & color

And

A history of maternal narcotic administration within the past 4 hours

Naloxone

Preparation 0.4 mg/ml

Load 1 ml in syringe

Dose 0.1 mg/kg (0.25 ml/kg)

Route IV, IM; No intratracheal

Rate Rapidly

Naloxone

Effect : Narcotic antagonist

Expectation : Spontaneous respiration

Follow up : If no response, repeat dose

Dopamine

Indication : Persisting evidence of shock

Effects : Increases cardiac output

Expectation : Better perfusion, better pulses

Dopamine

Preparation : 40 mg/ml

Dose : 5 mcg/kg/min to

20 mcg/kg/min

Route : IV

Rate : Constant infusion for

hours to days

-Medications Begin Epinephrine • HR below 60/min after 30 seconds ofVolume Expander PPV and chest compressions Sodium Bicarbonate Dopamine Give epinephrine May be repeated every 3-5

minutes if required

HR above 60 Discontinue medications

Prolonged arrest that does not Evidence or suspicion of acute May be repeated respond to other therapy blood loss with signs of if signs of hypovolvemia hypovolemia

persist

Give sodium bicarbondte Give volume expander

Evidence of continuing depression

Evidence of continuing depression

• Consider other causes, eg: - Pneumothorax - Diaphragmatic hemia

- Persistant pulmonary hypertension

• Consider starting dopamine

• Obtain consultation

Naloxone Respiratory depression and historyof narcotics administered in the mother within past 4 hours after

30 seconds of BMV