Section 4: Subspecialty Management
Chapter 58: Resuscitation of the Newborn

RESUSCITATION DRUGS

Table 58–5 lists drugs and the usual starting doses used during resuscitation of the newborn. Birchfield et al 93  have reviewed the use of drugs in neonatal resuscitation. 93  Severe acidosis (pH <7.0) may decrease the effectiveness of these drugs. Therefore, the pH should be raised above 7.20 as soon as possible. All drugs should be infused in the smallest volume of fluid possible to reduce the risk of inducing hypervolemia. To do so, drugs such as isoproterenol must be administered in high concentrations (16 mg/mL). However, it should be remembered that the dead space of the catheter is filled with the same concentration of the drug. If the contents of the catheter are flushed into the patient by infusing fluid or another drug, serious cardiac arrhythmias or cardiac arrest may occur. To avoid these complications, the dead space of the catheter and stopcock should be cleared by withdrawing 1.5 mL of blood and fluid. It is preferable to infuse potent cardiac and vasoactive drugs into a separate intravenous line.

TABLE 58–5. Drugs Used During Resuscitation

Hyperglycemia can significantly augment the effects of hypoxia on ischemia. 94  It increases the extent of CNS damage and reduces the survival of patients who can be resuscitated from cardiac arrest. 95, 96  Consequently, glucose should be given only to neonates who are hypoglycemic. The blood glucose concentration should be measured by a glucometer. If the blood glucose concentration is low, one should give a bolus of glucose (0.5–1.0 mL/kg of 10% dextrose) and begin a constant infusion of 5 to 7 mg/kg/min of glucose. Repeat the glucose measurement in 10 minutes and then as necessary.