Medicine in resuscitation of the newborn

Abstract

Most medications used in newborn resuscitation are based on studies done in children and adults. Because of the different physiological and anatomical factors in neonates, drugs cannot be assumed to have the same indications, dosages, response and safety. The umblical vein is most commonly used for intravenous (IV) infusion of medications. However when venous excess is not readily accessible the endotracheal (ET) route may be used to deliver drugs. As optimal drug dosages for ET administration in neonates has not been determined, the recommended ET dosage of drugs is the same as the IV dose. Medications commonly used in neonatal resuscitation are adrenaline, volume expanders, sodium bicarbonate, dopamine and naloxone hydrochloride; and are only needed in neonates who do not respond to adequate ventilation with 100 % oxygen and chest compressions. In children and adults a higher IV dosage of adrenaline (0.1 mg/kg) has been shown to improve long term survival. However, as such high dosages of adrenaline may cause systemic hypertension and intracranial haemorrhage in newborn infants, the dose of adrenaline should be 0.01 - 0.03 mg/kg for the first and subsequent doses. A higher dosage of naloxone (0.1 mg/kg) has been recommended so as to provide optimal opiate reversal in most newborns. In small neonates, the use of Neonatal naloxone (Narcan 0.02 mg/ml) may result in infusion of unacceptable fluid volumes; and preparations containing 0.4 mg/ml or 1 mg/ml may be more appropriate. Sodium bicarbonate has not been shown to improve successful resuscitation rates or intramyocardial acidosis, and should be used only when there is documented or assumed metabolic acidosis or if resuscitation is prolonged and the infant remains unresponsive to other measures. There is no evidence that other medications such as atropine or calcium is useful in the acute phase of neonatal resuscitation in the delivery room.