Text IV. Pharmacological Therapy

1. Catheterization of the umbilical vein with a № 5 French catheter often provides the quickest vascular route for administering drugs and volume expanders.

2. If the heart rate does not respond promptly to resuscitation efforts, administer epinephrine 1:10,000 (0.1 ml/kg). May be given via endotracheal tube or umbilical vein catheter.

3. The endotracheal tube is often the most accessible route for administering epinephrine and is clearly a preferred alternative to intracardiac injection. Dilute the epinephrine in 1-2 ml of saline to facilitate delivery by this route.

4. If hypovolemia is suspected, administer 10 to 20 ml/kg of 0.9% saline, type 0 rh negative blood cross-matched against the mother, heparinized placental blood, plasmanate or albumin (1 gm/kg) diluted to a 5% solution with saline.

5. If the infant remains pale and/or bradycardiac for four to five minutes after beginning ventilation, he or she probably has metabolic acidosis and will benefit from the administration of sodium bicarbonate so long as ventilation is adequate. Use a 0.5 mEq/ml concentration and infuse 2-3 mEq/kg at a rate of 1 to 2 mEq/kg/min or less. Subsequent doses of sodium bicarbonate should be based on blood gas analysis. In general, metabolic acidosis with a base deficit of 10 mEq/L or greater should be corrected if the infant’s condition remains unstable after resuscitation.

6. Other drugs such as atropine (0.01 mg/kg) or 10 % calcium gluconate (0.5 ml/kg) are seldom used in the delivery room at this time.

7. Drug depression:

a) Narcotic antagonists, such as naloxone, 0.1 mg/kg (new dose, see formulary), should be administered for suspected drug depression only after appropriate initial resuscitation has taken place and the infant continues to hypoventilate. Too often, a narcotic antagonist is administered in lieu of assisting ventilation, and a wait-and-see attitude prevails to the detriment of the patient.

b) Knowledge of maternal heroin use is essential to avoid precipitation of seizures secondary to acute narcotic withdrawal.

c) Maternal general anesthesia may result in an anesthetized newborn who requires 10 to 15 minutes (occasionally longer) of manual ventilation to recover from the anesthetic.

27. Read text V and write out key-sentences from each passage: