Yenidoğan Canlandırma Programı 5-1 6. Lesson Drugs

Yenidoğan Canlandırma Programı 5-1

6. Lesson

Drugs


Course contents

• Neonatal drug indications in newborn resuscitation• The drugs used in resuscitating a newborn• Routes of administration of drugs during the

resuscitation of a newborn • Umbilical venous catheter insertion• Adrenaline use• The use of volume expanders during the

rescuscitation of a newborn


If the heart rate, in spite of ventilation and chest compression is below 60

beats / min, be sure that the ventilation and compression are

applied effectively .!


Newborn drug delivery routes

• Umbilical

• Endotracheal tube

• Intraosseous


Umbilical vessels


Performing umbilical catheterization

• Clean with iodine

• Do a flat incision just leaving 1-2

cm on the cord

• Insert the catheter into the

umbilical vein through the skin

• Control by 0.5 ml saline


Place of umbilical catheter


Endotracheal tube

• The fastest way to apply

• However, absorption is not reliable

• Higher doses should be used ,n comparison to intravenous route


Intraosseous

• Limited data on its use in newborns

• May be an alternative


Adrenaline indication Effective positive pressure ventilation for 30

seconds

Effective ventilation for 60 sec + compression

Heart rate below 60 beats / min


As a result of effective ventilation and compression for a period of 60

seconds, if heart rate is below 60 beats / min adrenaline should be

administered through the umbilical way .

!


Adrenaline

• Increases both the rate and strength of heart contractions

• Leads to peripheral vasoconstriction

• May increase blood flow to the brain and coronary arteries


If adrenaline is given early

• Time for appropriate ventilation is consumed for the drug administration

• If adrenaline is given without ensuring adequate ventilation, increased oxygen demand may cause myocardial damage


Adrenaline useRecommended concentration= 1/10 000

The recommended route= intravenous (endotracheal route should be considered until you open intravenous access )

The recommended dose =1/10 000 solution, 0.1 - 0.3 ml / kg (for endotracheal route, consider 0.5 to 1ml / kg)

Recommended preparation = 1/10 000 solution in a 1 mL syringe ( Use a larger syringe in case of endotracheal route)

Recommended delivery speed = Fast- as possible


Dilution of adrenaline

1 mg=1 mL (1/1 000) Adrenaline + 9 mL distilled water =1/10 000

0,5 mg=1 mL (1/2 000) Adrenaline + 4 mL distilled water =1/10 000

0,25 mg=1 mL (1/4 000) Adrenaline + 1.5 mL distilled water= 1/10 000


REVISION


The expected effect of adrenaline

• Continue ventilation with 100% oxygen and heart compression

• Heart rate increases above 60 beats/min in 60 secs.


If no improvement • Control the efficacy of ventilation and compression

• Insert endotracheal tube/check

• Dose may be repeated in every 3-5 min

• If low dose is used in beginning, increase to highest doses during the repeat doses.

• Apply repeated doses via intravenous route, if possible


If the baby seems to be in shock and does not respond to

resuscitation, consider to give volume expander.

!


Signs of shock

• Paleness

• Prolonged capillary filling time

• Weak pulse

• Low or "0" blood pressure


Volume expanders

• 0.9% NaCl (normal saline)

• Ringer's lactate

• O Rh (-) erythrocyte suspension (in case of severe fetal anemia)


Volume expanders

Recommended solution = saline solution

Recommended dose = 10 ml / kg

Recommended route = umbilical vein

Recommended speed = 5 to 10 min


REVISION


Key points

Documents

Yenidoğan Canlandırma Programı 5-1 6. Lesson Drugs