(1)If advanced into the liver, may cause irreversible damage (2)If advanced into the heart, may cause dysrhythmias v.Flush the catheter with 0.5 mL of normal saline and tape into place. c.A peripheral IV or IO line can be used, but a smaller needle should be used in newborns. IV. Pharmacologic Interventions A.Medications are rarely needed in newborn resuscitation because they can usually be resuscitated with ventilator support. 1.Medication dosages are based on weight. a.A full-term newborn usually weighs 6½ to 9 lb and is 20 inches long. b.A newborn at 28 weeks of gestation usually weighs 2½ lb and is 14¾ inches long. B.Bradycardia 1.Often the result of inadequate ventilation and will respond to effective PPV 2.Epinephrine administration is indicated when a newborn still has a pulse rate of less than 60 beats/min after effective ventilation and chest compressions. a.Recommended concentration: 1:10,000 b.Recommended dose: 0.1 to 0.3 mL/kg of 1:10,000 epinephrine IV, administered rapidly i.Followed by 0.5- to 1-mL saline flush c.The preferred method during resuscitation is through a low umbilical vein catheter. d.Epinephrine can also be administered via ET tube while IV access is being established. i.Recommended dose: 0.5 to 1 mL/kg of 10,000 epinephrine e.Check pulse rate 1 minute after administering epinephrine (longer if by ET tube). i.May repeat dose every 3 to 5 minutes for persistent bradycardia, ensuring that: (a)Ventilation is adequate and effective (b)ET tube is not dislodged (c)Chest compressions are given to adequate depth C.Low blood volume 1.If there is significant intravascular volume depletion, fluid resuscitation may be needed. 2.Causes may include: a.Placenta abruptio b.Twin-to-twin transfusion c.Placenta previa d.Septic shock
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3.Signs of hypovolemia include: a.Pallor b.Persistently low pulse rate c.Weak pulses d.No improvement in circulatory status after adequate resuscitation efforts. 4.Place a low umbilical vein line in a newborn. a.If more than a few days old, place a peripheral IV or IO line. 5.Fluid bolus in a newborn is 10 mL/kg given IV every 5 to 10 minutes of: a.Saline b.Lactated Ringer’s c.O Rh-negative blood 6.Multiple boluses may be given if needed. D.Acidosis 1.Suspected metabolic acidosis if bradycardia persists after: a.Adequate ventilation b.Chest compressions c.Volume expansion 2.A saline bolus of 10-mL/kg normal saline may improve perfusion and clear acid. E.Respiratory depression secondary to narcotics 1.If the mother is a drug addict, administration of naloxone (Narcan) to the newborn may cause potentially fatal seizures. 2.If a newborn has respiratory suppression from the mother’s chronic use of narcotics: a.Provide ventilator support. b.Transport immediately. 3.If respiratory depression is from the mother being treated acutely with narcotics: a.0.1 mg/kg of naloxone may be administered via IV or intramuscularly F.Hypoglycemia 1.Most often seen in newborns: a.Who are small for gestational age b.Who are large for gestational age c.Whose mothers were diabetic during pregnancy 2.Neurologic symptoms include:
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