University of Iowa
Department of Family Medicine

FPInfo: Resources to support patient care

Disease Specific Resources - Neonatology


 Neonatal Rususcitation

Apgar Score

 

 

Score

Sign

0

1

2

Heart rate

Respirations

Absent

Absent

Slow (<100 beats/min)

Slow, irregular

>100 beats/min

Good, crying

Muscle tone

Limp

Some flexion

Active motion

Reflex irritability

(catheter in nares, tactile stimulation)

No response

Grimace

Cough, sneeze, cry

Color

Blue or pale

Pink body, blue extremities

Completely pink


 

Select the appropriate-sized tube.

Tube Size (mm)
(inside diameter)

 

Weight

(g)

Gestational Age

(wks)

2.5

Below 1,000

Below 28

3.0

1,000-2,000

28-34

3.5

2,000-3,000

34-38

3.5-4.0

Above 3,000

Above 38

 

 

 Medications for Neonatal Resuscitation

Medication

Concentration to Administer

Preparation

Dosage/
Route*

Total Does/Infant

Rate/Precautions

 

Epinephrine

 

1:10 000

 

1 ml

 

0.1-0.3 mL/kg

 

IV or ET

Weight

1 kg

2 kg

3kg

4kg

Total mL

0.1-0.3 mL

0.2-0.6 mL

0.3-0.9 mL

0.4-1.2 mL

 

Give rapidly
May dilute with normal

Saline to 1-2 mL if giving ET

 

Volume Expanders

Whole blood 5% Albumin-saline

Normal saline

Ringers lactate

40 mL

10 mL/kg

 

IV

Weight

1 kg

2 kg

3 kg

4 kg

Total mL

10 mL

20 mL

30 mL

40 mL

 

Give over 5-10 minutes

 

Sodium

Bicarbonate

 

0.5 mEq/mL

(4.2% solution)

 

20 mL or two 10 mL prefilled syringes

 

2 mEq/kg

IV

Weight

1 kg

2 kg

3 kg

4 kg

Total Dose

2 mEq

4 mEq

6 mEq

8 mEq

Total mL

4 mL

8 mL

12 mL

16 mL

 

Give slowly, over at least 2 minutes

Give only if infant is being effectively ventilated

 

Naloxone

Hydrochloride

 

0.4 mg/mL

 

1 mL

 

0.1 mg/kg (0.25 mL/kg)

IV, ET

IM, SQ

Weight

1 kg

2 kg

3 kg

4 kg

Total Dose

0.1 mg

0.2 mg

0.3 mg

0.4 mg

Total mL

0.25 mL

0.50 mL

0.75 mL

1.00 mL

 

 

Give rapidly

IV, ET preferred

IM, SQ acceptable

 

1.0 mg/mL

 

1 mL

0.1 mg/kg (0.1 mL/kg)

IV, ET

IM, SQ

1 kg

2 kg

3 kg

4 kg

0.1 mg

0.2 mg

0.3 mg

0.4 mg

0.1 mL

0.2 mL

0.3 mL

0.4 mL

 

Dopamine

 

Weight           Desired dose       mg of dopamine

6  x   (kg)    x    (g/kg/min)   =    per 100 mL of                                                          solution

       Desired fluid (mL/h)

 

Begin at 5 g/kg/min (may increase to 20 g/kg/min if necessary)

IV

Weight

 

1 kg

2 kg

3 kg

4 kg

Total g/min

 

5-20 g/min

10-40 g/min

15-60 g/min

20-80 g/min

Give as a continuous infusion using an infusion pump

Monitor heart rate and blood pressure closely

Seek consultation

*IM, intramuscular; ET, endotracheal; IV, intravenous; SQ, subcutaneous