1. Yenidoğan Canlandırma Programı 5-1 6. Lesson Drugs

2. Yenidoğan Canlandırma Programı 5-2 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

3. Yenidoğan Canlandırma Programı 5-3 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. !

4. Yenidoğan Canlandırma Programı 5-4 Newborn drug delivery routes Umbilical Endotracheal tube Intraosseous

5. Yenidoğan Canlandırma Programı 5-5 Umbilical vessels

6. Yenidoğan Canlandırma Programı 5-6 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

7. Yenidoğan Canlandırma Programı 5-7 Place of umbilical catheter

8. Yenidoğan Canlandırma Programı 5-8 Endotracheal tube The fastest way to apply However, absorption is not reliable Higher doses should be used,n comparison to intravenous route

9. Yenidoğan Canlandırma Programı 5-9 Intraosseous Limited data on its use in newborns May be an alternative

10. Yenidoğan Canlandırma Programı 5-10 Adrenaline indication Effective positive pressure ventilation for 30 seconds Effective ventilation for 60 sec + compression Heart rate below 60 beats / min

11. Yenidoğan Canlandırma Programı 5-11 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. !

12. Yenidoğan Canlandırma Programı 5-12 Adrenaline Increases both the rate and strength of heart contractions Leads to peripheral vasoconstriction May increase blood flow to the brain and coronary arteries

13. Yenidoğan Canlandırma Programı 5-13 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

14. Yenidoğan Canlandırma Programı 5-14 Adrenaline use Recommended 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

15. Yenidoğan Canlandırma Programı 5-15 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

16. Yenidoğan Canlandırma Programı 5-16 REVISION

17. Yenidoğan Canlandırma Programı 5-17 The expected effect of adrenaline Continue ventilation with 100% oxygen and heart compression Heart rate increases above 60 beats/min in 60 secs.

18. Yenidoğan Canlandırma Programı 5-18 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

19. Yenidoğan Canlandırma Programı 5-19 If the baby seems to be in shock and does not respond to resuscitation, consider to give volume expander. !

20. Yenidoğan Canlandırma Programı 5-20 Signs of shock Paleness Prolonged capillary filling time Weak pulse Low or "0" blood pressure

21. Yenidoğan Canlandırma Programı 5-21 Volume expanders 0.9% NaCl (normal saline) Ringer's lactate O Rh (-) erythrocyte suspension (in case of severe fetal anemia)

22. Yenidoğan Canlandırma Programı 5-22 Volume expanders Recommended solution = saline solution Recommended dose = 10 ml / kg Recommended route = umbilical vein Recommended speed = 5 to 10 min

23. Yenidoğan Canlandırma Programı 5-23 REVISION

24. Yenidoğan Canlandırma Programı 5-24 Key points