1. MEDICATIONS

2. Medications Epinephrine Volume expanders Sodium bicarbonate Naloxone Dopamine

3. Neonatal Resuscitation No role of Atropine Calcium Dexamethasone Dextrose

4. Epinephrine Indications HR < 60 per minute despite 30 seconds of BMV plus chest compressions

5. Epinephrine Formulation 1:1000 Dilution 1:10000 (Ten times) 0.2 ml in 1.8 ml Load 1 ml (in 1ml syringe) Dose 0.1-0.3 ml/kg Route IV (preferable) Rate Rapid bolus IT * - use only if IV access is not available; dose of up to1ml/kg to be used; Efficacy ?

6. Epinephrine Effect : Inotropic, chronotropic, peripheral vasoconstriction Expect: HR > 60 within 30 seconds

7. Epinephrine Follow up: if HR < 60 Repeat epinephrine q 3-5 minutes Ensure: effective ventilation effective chest compressions endotracheal intubation (if not done already) Consider using volume expander Consider using sodium bicarbonate

8. Volume expanders Consider Pallor persisting after oxygenation Weak pulses, good heart Tachy / bradycardia No improvement despite effective ventilation, chest compressions & Epinephrine

9. Volume expanders Normal saline Ringer’s lactate Whole blood (O Neg cross matched with mother’s blood)

10. Normal saline Indications Evidence or suspicion of acute blood loss with signs of hypovolemia and/or baby responding poorly to resuscitation

11. Normal saline Dosage 10 ml/kg 40 ml in syringe or infusion set Route IV- umbilical is best Rate over 5-10 minute

12. Volume expanders Effect: Volume expansion, correction of metabolic acidosis Expectation: Better BP & pulses, less pallor Follow up: If signs of hypoperfusion persist, repeat volume expander, consider sodium bicarbonate or dopamine

13. Sodium bicarbonate Indications Prolonged arrest that does not respond to other therapy if ABG shows metabolic acidosis with normal PaCO 2

14. Sodium bicarbonate Preparation 0.9 mEq (approx. 1mEq)/ml Dilution 1:1 dilution Load 10 ml of diluted solution Dose 2 mEq/kg of diluted solution Route IV; Never through ET tube Rate Slow over 2 minutes or more @ not >1 mEq/kg/min

15. Sodium bicarbonate Effect : Control of metabolic acidosis; volume expansion Expectation : HR > 100 within 30 seconds Follow up: If persistent metabolic acidosis Use epinephrine and volume expansion, consider dopamine

16. Naloxone hydrochloride Indications Severe respiratory depression after BMV has restored a normal heart rate & color And A history of maternal narcotic administration within the past 4 hours

17. Naloxone Preparation 0.4 mg/ml Load 1 ml in syringe Dose 0.1 mg/kg (0.25 ml/kg) Route IV, IM; No intratracheal Rate Rapidly

18. Naloxone Effect : Narcotic antagonist Expectation: Spontaneous respiration Follow up : If no response, repeat dose

19. Dopamine Indication: Persisting evidence of shock Effects: Increases cardiac output Expectation: Better perfusion, better pulses

20. Dopamine Preparation : 40 mg/ml Dose : 5 mcg/kg/min to 20 mcg/kg/min Route : IV Rate : Constant infusion for hours to days

21. - Medications Begin Epinephrine HR below 60/min after 30 seconds of Volume Expander PPV and chest compressions Sodium Bicarbonate Dopamine Give epinephrineMay be repeated every 3-5 minutes if required HR above 60 Discontinue medications Prolonged arrest that does not Evidence or suspicion of acute May be repeated respond to other therapy blood loss with signs of if signs of hypovolvemia hypovolemia persist Give sodium bicarbondte Give volume expander Evidence of continuing depression

22. Consider other causes, eg: - Pneumothorax - Diaphragmatic hemia - Persistant pulmonary hypertension Consider starting dopamine Obtain consultation Naloxone Respiratory depression and history of narcotics administered in the mother within past 4 hours after 30 seconds of BMV