title: Special Comments - Neonatal Intensive Care Drug Manual
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  Neonatal Intensive Care Drug Manual
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  bet | 384/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Special Comments
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  Always establish and maintain adequate respiration before administration of naloxone to a newborn infant. The majority of infants born following intrapartum maternal opioid administration do not require administration of an opioid antagonist.
  Opioid antagonists should not be used as a substitute for provision of usual methods of clinical care and resuscitation of the newly born infant.
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  Evidence summary
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  Efficacy: Pediatric Advanced Life Support Guidelines [1] and Cardiac arrest in special circumstances Guidelines [2]: Naloxone reverses the respiratory depression of opioid overdose, but in persons with long-term addictions or cardiovascular disease, naloxone may markedly increase heart rate and blood pressure and cause acute pulmonary oedema, cardiac arrhythmias (including asystole) and seizures. Ventilation before administration of naloxone appears to reduce these adverse effects. Intramuscular administration of naloxone may lower the risk by slowing the onset of drug effect. The use of naloxone can prevent the need for intubation. Titrate dose until the patient is breathing adequately and has protective airway reflexes. All patients treated with naloxone must be monitored. Opioid-exposed newborn infants with respiratory maladaptation to birth: Systematic review [3] reported 9 trials (316 infants) that compared the effects of naloxone versus placebo. The dose of naloxone used ranged from 0.01 to 0.07 mg/kg with the exception of one study [4] in which a total dose of 0.2 mg IMI was given. None of these trials specifically recruited infants with cardiorespiratory or neurological depression. The main outcomes reported were measures of respiratory function in the first six hours of life. There is some evidence that naloxone increases alveolar ventilation. The trials did not assess the effect on admission to a neonatal unit and failure to establish breastfeeding. The existing evidence from randomised controlled trials is insufficient to determine whether naloxone confers any important benefits to newborn infants with cardiorespiratory or neurological depression that may be due to intrauterine exposure to opioid. (LOE I GOR D)
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