Drugs Used for Emergency and Cardiac Indications in Newborns





Jacquelyn McClary






































































































Agent Dosage Comments
Adenosine (Adenocard) 50 μg/kg rapid IV (over 1-2 sec) followed immediately by NS flush Increase dose every 2 min by 50-μg/kg increments if no response; max dose 250 μg/kg Facial flushing, irritability, and transient arrhythmias (asystole) may occur. Apnea in a premature infant has been reported. Monitor ECG and blood pressure continuously during administration.
Alprostadil (prostaglandin E 1 ) Starting dose: 0.05-0.1 μg/kg/min continuous IV infusion
Maintenance dose: after response observed titrate down to lowest effective dose, which may be as low as 0.01 μg/kg/min
May cause apnea, fever, hypotension, and flushing.
Amiodarone Loading dose: 5 mg/kg IV over 30-60 min
Maintenance dose: 7-15 μg/kg/min continuous IV infusion
Monitor ECG and blood pressure continuously for bradycardia and hypotension. Administration into central line preferred to minimize risk of extravasation.
Atropine 0.01-0.03 mg/kg IV push or IM
Repeat every 10-15 min to max 0.04 mg/kg
May be given via endotracheal tube
Low dosages may result in paradoxical bradycardia.
Calcium chloride 10% (27 mg elemental Ca 2+ per mL) 35-70 mg/kg (0.35-0.7 mL/kg), 10-20 mg/kg elemental calcium IV over 10-30 min Dilute with NS to a final concentration of 20 mg/mL. Stop infusion if HR <100. Extravasation may lead to tissue necrosis.
Calcium gluconate 10% (9.3 mg Ca 2+ per mL) Emergency dose: 100-200 mg/kg (1-2 mL/kg), 10-20 mg/kg elemental calcium IV over 10-30 min
Maintenance dose in IV fluids: 200-800 mg/kg/day (20-80 mg/kg/day elemental calcium)
Dilute with NS to a final concentration of 50 mg/mL. Stop infusion if HR <100. Extravasation may lead to tissue necrosis.
Digoxin Loading dose (digitalization): divided into 3 doses over 24 hr given by slow IV push or PO


  • PMA ≤29 wk: 15 μg/kg IV or 20 μg/kg PO



  • PMA 30-36 wk: 20 μg/kg IV or 25 μg/kg PO



  • PMA 37-48 wk: 30 μg/kg IV or 40 μg/kg PO



  • PMA ≥49 wk: 40 μg/kg IV or 50 μg/kg PO

Maintenance dose:


  • PMA ≤29 wk: 4 μg/kg IV or 5 μg/kg PO q24h



  • PMA 30-36 wk: 5 μg/kg IV or 6 μg/kg PO q24h



  • PMA 37-48 wk: 4 μg/kg IV or 5 μg/kg PO q12h



  • PMA ≥49 wk: 5 μg/kg IV or 6 μg/kg PO q12h

Avoid hypokalemia, hypomagnesemia, hypocalcemia, and hypercalcemia. Assess renal function. Monitor HR rate and heart rhythm. Follow serum drug concentrations with a target range of 1-2 ng/mL.
Dobutamine 2-25 μg/kg/min continuous IV infusion Tachycardia may occur at high dosages. Hypotension risk increases in hypovolemic patients.Tissue ischemia with extravasation; inject phentolamine into affected area as soon as possible.
Dopamine 2-20 μg/kg/min continuous IV infusion
“Renal dose”: 2-5 μg/kg/min
Cardiac stimulation: 5-15 μg/kg/min
Vasoconstriction: >5 μg/kg/min
Pharmacologic effect is dose dependent. Extravasation may lead to necrosis; inject phentolamine into affected area as soon as possible.
Epinephrine Emergency dose: 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 concentration) IV push; 0.1 mg/kg ET followed by 1 mL NS
Continuous IV infusion: 0.02-1 μg/kg/min
Monitor HR and blood pressure continuously. Infiltration may cause tissue necrosis; inject phentolamine into affected area as soon as possible.
Esmolol (Brevibloc) Supraventricular tachycardia: 100 μg/kg/min continuous IV infusion; increase by 50-100 μg/kg/min every 5 min; usual max 200 μg/kg/min
Postoperative hypertension: 50 μg/kg/min continuous IV infusion; increase by 25-50 μg/kg/min every 5 min; usual max 200 μg/kg/min
Monitor ECG continuously.May cause hypotension at high dosages.
Hydralazine (Apresoline) 0.1-0.5 mg/kg/dose IV or IM q6-8h; increase gradually to max 2 mg/kg/dose q6h
0.25-1 mg/kg/dose PO q6-8h, or twice the IV dose
Administration with a β-blocker may increase antihypertensive effect and decrease the hydralazine dose required.
Ibuprofen lysine (NeoProfen) First dose: 10 mg/kg IV over 15 min
Second and third doses (starting 24 hr after first dose): 5 mg/kg IV over 15 min q24h
Monitor urine output and signs of bleeding.
Indomethacin (Indocin) 3 doses given IV over 30 min q12-24h
Age at first dose determines dosing regimen:


  • <48 hr: 0.2/0.1/0.1 mg/kg



  • 2-7 days: 0.2/0.2/0.2 mg/kg



  • >7 days: 0.2/0.25/0.25 mg/kg

Prolonged treatment option: 0.2 mg/kg q24h for 5-7 days
Monitor urine output, electrolytes, blood urea nitrogen, creatinine, and platelet count. Monitor for signs of bleeding.
Isoproterenol (Isuprel) 0.05-0.5 μg/kg/min continuous IV infusion; max dose 2 μg/kg/min May cause arrhythmias and hypoxemia. Correct acidosis prior to starting therapy.
Lidocaine Bolus dose: 0.5-1.0 mg/kg IV push over 5 min; may repeat every 10 min to a max of 5 mg/kg
Continuous IV infusion: 10-50 μg/kg/min
May cause CNS toxicity—monitor for seizures, apnea, respiratory depression. High dosages may cause bradycardia, heart block, hypotension—monitor ECG, HR, and blood pressure continuously.Contraindicated in cardiac failure and heart block.
Milrinone (Primacor) Loading dose: 50-75 μg/kg/min over 15-60 min
Continuous IV infusion: 0.25-0.75 μg/kg/min
Loading dose optional based on status of patient. Correct hypovolemia prior to initiation of therapy. Blood pressure may decrease 5%-9% after loading dose and HR may increase 5%-10%.
Naloxone (Narcan) 0.1 mg/kg IV push repeated every 2-3 min until opioid effect reversed; may need to repeat doses every 20-60 min; may be given IM, SC, or ET, but not recommended due to delayed onset of action Not recommended as part of the initial resuscitation of newborns with respiratory depression.
Neostigmine (Prostigmin) 0.04-0.08 mg/kg slow IV push (IM and SC administration have delayed onset of action) Give in addition to atropine 0.02 mg/kg to reverse neuromuscular blockade.
Nicardipine (Cardene) 0.5 μg/kg/min continuous IV infusion; titrate up to 2 μg/kg/min Monitor blood pressure, HR, and heart rhythm continuously. May take up to 2 days to see final effect of dose.
Procainamide (Pronestyl) Bolus dose: 7-10 mg/kg IV over 1 hr
Continuous IV infusion: 20-80 μg/kg/min
Monitor for hypotension (increased with rapid infusion), bradycardia, arrhythmias. Monitor serum levels, especially in patients with hepatic or renal impairment, or those receiving high dosages.Monitor CBC for neutropenia, thrombocytopenia regularly.
Propranolol (Inderal) 0.01 mg/kg/dose IV push over 10 min q6h; titrate up to max 0.15 mg/kg/dose q6h
0.25 mg/kg/dose PO q6h; titrate up to max 3.5 mg/kg/dose q6h
Monitor ECG continuously during acute treatment of arrhythmias.Monitor blood glucose for hypoglycemia. Monitor blood pressure.
Sodium nitroprusside (Nipride) 0.25-0.5 μg/kg/min continuous IV infusion; titrate up every 20 min. Usual maintenance dose is <2 μg/kg/min
Hypertensive crisis: doses up to 10 μg/kg/min can be used for no longer than 10 min
Monitor HR and intraarterial blood pressure continuously.May produce severe hypotension and cyanide/thiocyanate toxicity; increased risk of toxicity with prolonged treatment, high dosages, and renal or hepatic impairment.Protect drug from light.

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Sep 29, 2019 | Posted by in PEDIATRICS | Comments Off on Drugs Used for Emergency and Cardiac Indications in Newborns
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