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
Ringers lactate
Whole blood (O Neg cross matched
with mothers 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
Epinephrine
Begin
HR below 60/min after 30 seconds of
Volume 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 history

of narcotics administered in the
mother within past 4 hours after
30 seconds of BMV