ASSIGNMENT ON

DRUGS USED FOR

NEWBORN

SUBMITTED TO:Mrs. SOMIBALA THOKCHOM

TUTOR
R.C.O.N
SUBMITTED BY:VARSHA SHARMA
MSC NURSING FIRST YEAR
RUFAIDA COLLEGE OF NURSING

INDEX
SNO

TOPIC

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TEACHERS
SIGNATUR

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Introduction
Drugs used for the
neworn
Drugs used in
resuscitation
Summary
Conclusion
Bibliography

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DRUGS USED FOR THE NEWBORN

INTRODUCTION
Drugs used for the newborn immediately after birth to prevent complications, and to
reduce the infant mortality and morbidity rate. Essential medications and immunization
given for the prophylaxis purpose to reduce the chances of occurrences of highly
prevalent dieses e.g. - Hepatitis, Tetanus etc.
Vitamin- K (PHYTOMENADIONE)

Dose and Administration

Prophylaxis
1. Term infant
1. Intramuscular injection 0.5-1mg IM at birth (preferred route)
2. Oral administration
2mg oral soon after birth, then
2mg oral at 3-7 days, then
2mg oral at 6 weeks.
Note:
1. If the oral dose is vomited or regurgitated within one hour, a
repeat dose should be given.
2. When this preparation is prescribed orally the second and third
doses may need to be administered after the baby has been
discharged from hospital.
3. It is the responsibility of the LMC and parents to ensure that
subsequent doses are administered.
Drug Preparation, Dosage and Administration
1. Vitamin K1: The recommended preparation for use is Vitamin K1 (Phytonadione
injectable emulsion), which possesses the same degree of activity as the naturally
occurring Vitamin K. The pharmacological action of Vitamin K is to promote the
synthesis of Vitamin K-dependent clotting factors (factor II, VII, IX and X) in the liver.
2. Preparation: There are two commonly available preparations in the market:
a. 1 mg/1 ml
b. 1 mg/0.5 ml
3. States may go for any of the two preparations depending on the availability. Under
no circumstances should the state procure the preparation of Injection Vitamin K
containing 10 mg/ml.
4. Storage: Injection Vitamin K does not require refrigeration and can be stored at
room temperature. As it is thermo stable, no additional expenditure on
cold chain maintenance is needed.
All facilities will ensure regular supplies of Vitamin K preparation, syringes, etc.
Bleeding in a newborn is a danger sign and may also occur due to causes other
than Vitamin K deficiency. In case the newborn has any bleeding manifestation,
appropriate referral and management should be instituted promptly as such cases
may require blood products and supportive care.6
5. Dosage: Injection Vitamin K 1 mg per 1 ml or 0.5 ml aqueous preparation.
6. Site of injection: Antero-lateral aspect of the thigh. In case any vaccination being
given at birth such as Hep B then they should be given in separate thighs.
Preterm infant <1.5kg
1. 0.5mg IM at birth
Treatment of Vitamin K Deficiency Bleeding
1. Intravenous 1 mg, repeated 8 hourly if necessary. Administer slowly.
Indications
1. 1. Prophylaxis of Vitamin K Deficiency Bleeding (VKDB).
2. Treatment of VKDB or neonatal hypoprothrombinaemia.
Contraindications
1. Lack of parental consent (see Vitamin K guideline).

Precautions
1. Delay IM administration in infants at risk of HIV and haemophilia as per guidelines.
2. Severe hepatic dysfunction.
3. Bleeding disorders that are not vitamin K dependent.
4. Parenteral administration may increase risk of kernicterus.
Abstract-1
Can prenatal vitamin K1 (phylloquinone) supplementation replace prophylaxis at birth?
OBJECTIVE:To assess the effect of prenatal vitamin K1 on the coagulation status of
newborns.METHODS:We measured noncarboxylated prothrombin and performed the
Normotest in two groups of 5-day-old infants whose mothers were given oral vitamin K1,
10 mg/day for 2 weeks at least 10 days before delivery, or were
untreated.RESULTS:Noncarboxylated prothrombin was found in one of 74 treated women
and 13 of 186 controls, a nonsignificant difference. The mean (+/- standard deviation)
Normotest value was 59.6 +/- 10.1% (range 38.9-84.4) for the treated group and 53.4 +/9.9% (range 16.3-89.9) for the controls, a statistically significant difference (P < .
001).CONCLUSION:Based on the Normotest results, we suggest that vitamin K crosses the
placenta and persists to activate the vitamin K-dependent coagulant factors until at least
the fifth day of life. Thus, prenatal vitamin K1 administration may replace prophylaxis at
birth.

Abstract-2 Improving the vitamin K status of breastfeeding infants with maternal vitamin K
supplements.OBJECTIVE:To increase the phylloquinone (vitamin K1) concentration of
human milk with maternal oral phylloquinone supplements such that both the
phylloquinone intake of breastfed infants and their serum concentrations of phylloquinone
would approach those of formula-fed infants who are known to be at much less risk for
hemorrhagic disease of the newborn.DESIGN: Two stages: stage I, longitudinal,
randomized study of 6 weeks' duration; and stage II, longitudinal, randomized, doubleblind, placebo-controlled study of 12 weeks' duration.SETTING:Patients from a private
pediatric practice in Madison, WI.PATIENTS:Stage I: sequential sampling of 20 lactating
mothers to determine the level of maternal supplementation needed in stage II. Ten
mothers received 2.5 mg/d oral phylloquinone, and 10 mothers received 5.0 mg/d oral
phylloquinone. Stage II: sequential sampling of 22 human milk-fed infants and lactating
mothers. All infants received 1 mg of phylloquinone at birth. Eleven mothers received a
placebo; 11 mothers received 5 mg/d phylloquinone.MEASUREMENTS AND RESULTS:In
stage I, both 2.5 and 5.0 mg/d phylloquinone significantly increased the phylloquinone
content of human milk at both 2 and 6 weeks. As expected, 5.0 mg had a greater effect
(mean +/- SD, 58.96 +/- 25.39 vs 27.12 +/- 12.18 ng/mL at 2 weeks). In stage II, the
vitamin K-supplemented group had significantly higher maternal serum phylloquinone
concentrations, higher phylloquinone milk concentrations, and higher infant plasma
phylloquinone concentrations at 2, 6, and 12 weeks compared with the placebo group. At
12 weeks infant phylloquinone intakes were significantly higher for the vitamin K group
than the placebo group (9.37 +/- 4.55 vs 0.15 +/- 0.07 microgram/kg per day). This
corresponded to a plasma phylloquinone concentration in the vitamin K group of 2.84 +/3.09 vs 0.34 +/- 0.57 ng/mL in the placebo group. At 12 weeks, the prothrombin times did
not differ between the groups, but the des-gamma-carboxy-prothrombin (partially
carboxylated prothrombin thought to be a measure of vitamin K deficiency) was
significantly elevated in the placebo group compared with the vitamin K group (1.48 +/1.19 vs 0.42 +/- 0.55 ng/mL).CONCLUSION:In exclusively breastfed infants who receive
intramuscular phylloquinone at birth, the vitamin K status as measured by plasma

phylloquinone and des-gamma-carboxy-prothrombin concentrations is improved by

maternal oral supplements of 5 mg/d phylloquinone through the first 12 weeks of life.

Hepatitis B vaccination
Neonates whose mothers are HBsAg-positive should be given 1 dose of HBIG 0.5 mL IM
within 12 h of birth. Recombinant HBV vaccine should be given IM in a series of 3 doses,
as is recommended for all infants in the US. (N OTE: Doses vary among proprietary
vaccines.) The first dose is given concurrently with HBIG but at a different site. The 2nd
dose is given at 1 to 2 mo, and the 3rd dose is given 6 mo after the first. If the infant
weighs < 2 kg, the first dose of vaccine may be less effective. Subsequent vaccine doses
are given at age 30 days (or when discharged from the hospital), and then 2 other doses
are given at 1 to 2 mo and 6 mo after the 30-day dose. Infants born to mothers with
unknown HBsAg status at the time of delivery should receive their first dose of vaccine
within 12 h of birth and receive HBIG 0.5 mL IM as soon as possible (up to 7 days) after
delivery if maternal testing is positive for HBsAg. Testing for HBsAg and anti-HBs at 9 to
15 mo is recommended for all infants born to HBsAg-positive mothers.
Separating a neonate from its HBsAg-positive mother is not recommended, and
breastfeeding does not seem to increase the risk of postpartum HBV transmission,
particularly if HBIG and HBV vaccine have been given. However, if a mother has cracked
nipples, abscesses, or other breast pathology, breastfeeding could potentially transmit
HBV.

Oral polio vaccination

OPV consists of a mixture of live attenuated poliovirus strains of each of the three
serotypes, selected by their ability to mimic the immune response following infection with
wild polioviruses, but with a significantly reduced incidence of spreading to the central
nervous system. Three or more spaced doses of OPV are required to generate adequate
levels of seroconversion. The action of oral polio vaccine (OPV) is two-pronged. OPV
produces antibodies in the blood ('humoral' or serum immunity) to all three types of
poliovirus, and in the event of infection, this protects the individual against polio paralysis
by preventing the spread of poliovirus to the nervous system. OPV strains also produce a
local immune response in the lining ('mucous membrane') of the intestines - the primary
site for poliovirus multiplication. The antibodies produced there inhibit the multiplication
of subsequent infections of 'wild' (naturally occurring) virus. This intestinal immune
response to OPV is probably a reason why mass campaigns with OPV have been shown to
stop person-to-person transmission of wild poliovirus. In very rare cases, the
administration of OPV results in vaccine-associated paralysis associated with a reversion
of the vaccine strains to the more neurovirulent profile of wild poliovirus. In a few
instances, such vaccine strains have become both neurovirulent and transmissible and
have resulted in infectious poliomyelitis.
BCG (Bacillus Calmette-Guerin)
Infants under 12 months of age:
A dose of 0.05 ml of the reconstituted vaccine is injected strictly by
the intradermal route.

Method of Administration:
The injection site should be clean and dry. If antiseptics (such as alcohol) are applied to
swab the skin, they should be allowed to evaporate completely before the injection is
made.
BCG Vaccine should be administered by personnel trained in the intradermal technique.
The vaccine should be injected strictly intradermally in the arm, over the distal insertion of
the deltoid muscle onto the humerus (approx. one third down the upper arm), as follows:
The skin is stretched between thumb and forefinger.
The needle should be almost parallel with the skin surface and slowly inserted
(bevel upwards), approximately 2 mm into the superficial layers of the dermis.
The needle should be visible through the epidermis during insertion.
The injection is given slowly.
A raised, blanched bleb is a sign of correct injection.
The injection site is best left uncovered to facilitate healing.

Contraindications
BCG Vaccine SSI should not be administered to individuals known to be hypersensitive to
any component of the vaccine.
Normally, the vaccination should be postponed in persons with pyrexia or generalised
infected skin conditions. Eczema is not a contraindication, but the vaccine site should be
lesion free.
BCG Vaccine SSI should not be given to persons receiving systemic corticosteroids or
immunosuppressive treatment including radiotherapy, to those suffering from malignant
conditions (e.g., lymphoma, leukaemia, Hodgkins disease or other tumours of the
reticulo-endothelial system), those with primary or secondary immunodeficiencies, those
with HIV-infection, including infants born to HIV-positive mothers. The reaction to BCG
vaccination may be exaggerated in these patients, and a generalised BCG-infection is
possible.
BCG Vaccine SSI should not be given to patients who are receiving anti-tuberculosis drugs.

Naloxone Hydrochloride
Dose and Administration
0.1-0.2 mg/kg/dose IM (0.25-0.5ml/kg of 0.4 mg/ml concentration) 1.
May also be given IV, intratracheally or subcutaneously.
May repeat in 3-5 minutes if no response during resuscitation.
Indications
1. Narcotic induced respiratory and CNS depression.
2. Narcotic overdose.
Contraindications and Precautions
1. Known or suspected naloxone hypersensitivity.
2. Newborns of mothers who are known or suspected to be physically dependent on
opioids. In such cases an abrupt and complete reversal of narcotic effects may
precipitate an acute abstinence syndrome.
3. Not indicated if infant shows no sign of respiratory depression.
4. Has no effect on non-narcotic induced respiratory and CNS depression.

5. Naloxone is an adjuvant therapy to customary resuscitation efforts for narcotic

induced respiratory depression. Other resuscitative measures such as maintenance
of a free airway, artificial ventilation, cardiac massage and vasopressor agents
should be employed as necessary.
6. Caution in infants with tachycardia, congenital heart defects.
Possible Adverse Effects
1. Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating,
tachycardia, increased blood pressure and tremulousness.
2. Gastrointestinal disturbances (nausea, vomiting).
3. Lethargy, tremors.
Abstract-3
Naloxone for opiate-exposed newborn infants.BACKGROUND:Naloxone, a specific opiate
antagonist, is available for the treatment of newborn infants with cardiorespiratory or
neurological depression that may be due to intrauterine exposure to opiate. It is unclear
whether newborn infants may benefit from this therapy and whethernaloxone has any
harmful effects.OBJECTIVES:To determine the effect of naloxone as a treatment
for newborn infants who have been exposed in utero to opiate.SEARCH METHOD
SELECTION CRITERIA:Randomised controlled trials comparing the administration
of naloxone versus placebo, or no drug, or another dose ofnaloxone to newborn infants
with suspected or confirmed in utero exposure to opiate.DATA COLLECTION AND
ANALYSIS:We extracted data using the standard methods of the Cochrane Neonatal
Review Group with separate evaluation of trial quality and data extraction by two review
authors and synthesis of data using risk ratio, risk difference and weighted mean
difference.MAIN RESULTS:We included nine trials that compared the effects
of naloxone versus placebo or no drug in newborn infants exposed to maternal opiate
analgesia prior to delivery. 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 the
primary outcomes of this review (admission to a neonatal unit and failure to establish
breastfeeding).AUTHORS CONCLUSIONS: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 opiate. Given concerns about the safety of naloxone in this
context it may be appropriate to limit its use to randomised controlled trials that aim
resolve these uncertainties.
Zidovudine (if mother is HIV positive)
Dose and Administration
Dose for the first 4 weeks following delivery
1. Oral
Gestation

Dose
Term
4mg/kg/dose every 12 hours, or
2mg/kg/dose every 6 hour
Preterm 30-36 weeks 2mg/kg/dose every 12 hours for 2
weeks, then 2mg/kg/dose every 8
hours.
Preterm <30 weeks
2mg/kg/dose ever 12 hours for 4
weeks, then 2mg/kg/dose every 8
hours.
2. Intravenous

Gestation

Dose
1.5mg/kg/dose every 6 hours.
1.5mg/kg/dose every 12 hours.

Term
Preterm
Over 1 Month to 3 months
Route
Dose
Oral
4mg/kg/dose every 12 hours.
IV
1.5mg/kg/dose every 6 hours.
Indications
1. Maternal HIV status positive as part of the antepartum, intrapartum and 4 weeks
newborn regimen of anti retroviral treatment to reduce perinatal transmission of HIV
virus.
2. May also be used in conjunction with other drugs as part of treatment in infants
identified as being HIV-infected during the first few weeks of life.
Contraindications
1. Jaundice requiring phototherapy (relative contraindication)
2. Neutrophil count <0.75 x 109/L
3. Haemoglobin <80g/L
4. Platelet count <50 x 109 /L
Precautions
1. Renal impairment - consider reducing dose according to clinical response.
Possible Adverse Effects
Adverse effects tend to be dose-related and reversible. With more advanced disease the
toxicity is greater.
1. Anaemia, leucopenia (mainly neutropenia). Less common: thrombocytopenia,
pancytopenia.
2. Vomiting, diarrhoea, abdominal pain.
3. Increase in liver function tests and bilirubin.
4. Rash.
5. Myopathy.
6. Lactic acidosis, with or without hepatic failure.
7. Persistent mitochondrial dysfunction.
8. Cardiomyopathy (rare).
9. Discolouration of nails & skin.
10.
Possible increased risk of sepsis.
Special Considerations
1. Monitor:
o
Full blood count, platelets, bilirubin, liver function, and renal function.
o Hepatic function: If there is hepatic impairment, consider dose reduction,
especially if adverse effects suggest toxicity.
o Renal function. For renal impairment, use doses at the lower end of the dose
range and adjust according to clinical response.
2. Zidovudine for babies being discharged
o Currently zidovudine oral liquid is available with a Special Authority
application.

o Availability: Pharmac
o Special Authority forms: ADHB Intranet/Medicines Information/Special
Authority Forms or Pharmac
o The Ministry of Health can be contacted for approval via freephone 0800 243
666
If the Special Authority is granted, the medicine can be obtained from most
community pharmacies.
Abstract-4
Maternal ability to take care of children exposed to HIV.OBJECTIVE:to assess the ability of
mothers to take care of children exposed to HIV, using the Assessment Scale of Care Skills
for Children Exposed to HIV at Birth and to check the association between the scale
dimensions and maternal characteristics.METHOD:this cross-sectional study involved 62
HIV+ mothers whose children of up to one year old had been exposed to the virus at birth.
The Assessment Scale of Care Skills for Children Exposed to HIV at Birth consists of 52
items and five dimensions, indicating high, moderate or low care ability.RESULTS:72.7% of
the mothers appropriately offered zidovudine syrup; 86.0% were highly skilled to prepare
and administer milk formula; 44.4% were moderately able to prepare and administer
complementary feeding; 76.5% revealed high ability to administer prophylactic treatment
against pneumonia and 95.3% demonstrated high abilities for clinical monitoring and
immunization. Significant associations were found between some maternal variables and
the scale dimensions.CONCLUSION:
the scale permits the assessment of maternal care delivery to these children and the
accomplishment of specific child health interventions.
MEDICATIONS USED FOR NEONATAL RESUSCITATION
Route of delivery
Routes of delivery for medications include:

umbilical venous catheter preferred route

ET for adrenaline only
peripheral intravenous line difficult to cannulate in the collapsed infant
intraosseous needle for failed or unsuccessful umbilical venous catheterisation
umbilical arterial catheter should not be used for drug administration during
resuscitation

ADRENALINE
For HR < 60 for > 30 sec despite compressions and positive pressure ventilation.
Dosage:

0.3 ml/kg of 1:10,000 as a quick push IV repeated at 3-5 minute intervals. It

should be followed by a small saline flush.
0.5 - 1.0ml/kg of 1:10,000 ET (if no IV access).

Volume (preload)
10 - 15 ml/kg normal saline repeated 2 or 3 times.
This may need to be followed with O negative red blood cells in the setting of massive
blood loss, especially in babies who are not responding to resuscitation interventions.

NALOXONE
Naloxone does not form part of the initial resuscitation of newborns with respiratory
depression in the delivery room.
Dosage - 0.1mg/kg of 0.4mg/ml solution
Contra-indication Naloxone may result in rapid withdrawal with seizures if given to infants
of narcotic dependent women.
BICARBONATE
Bicarbonate is not indicated for routine use:

Argument for correction of acidosis includes theoretical concerns about hypoxia and
elevated pulmonary vascular bed pressure and poor cardiac contractility with
acidosis.
Argument against correction includes concerns regarding hyperosmolarity and CO2
generation with intracellular acidosis from alkali infusion.

SUMMARY:-

Drugs used for the newborn immediately after birth to prevent complications, and to
reduce the infant mortality and morbidity rate. Essential medications and immunization
given for the prophylaxis purpose to reduce the chances of occurrences of highly
prevalent dieses e.g. - Hepatitis, Tetanus etc.
CONCLUSION:some of the are very essential for newborn eg:immunization, vitamine k injection for the
prevention of complications and accurance of diseases among the newborn.to revive the
newborn baby in case of the newborn born with the fetalbirth asphyxia,or born to the hiv
hepatitis positive mothers.so we can prevent transmission by doing correct treatment on
time.
BIBLIOGRAPY
1. http://en.wikipedia.org
2.http://www.ssi.dk/English/Vaccines/BCG%20Vaccine%20Danish%20Strain
%201331/Discription%20of%20BCG%20Vaccine%20SSI.aspx
3. http://www.health.vic.gov.au/neonatalhandbook/procedures/resuscitation.htm
4.http://www.ncbi.nlm.nih.gov/pubmed/8423960
5.http://www.ncbi.nlm.nih.gov/pubmed/8423960
6.http://www.ncbi.nlm.nih.gov/pubmed/23970235
7.Thirimon Moe-Byrne1, Jennifer VE Brown1,William McGuire2, Naloxone for opiateexposednewborninfants*CochraneNeonatalGroupDOI: 10.1002/14651858.CD003483.p
ub2
8.Freitas JG, Barroso LM, Galvo MT.Maternal ability to take care of children exposed to
HIV, Universidade de Fortaleza, Fortaleza, CE, Brazi 2013 Jul-Aug;21(4):964-72. doi:
10.1590/S0104-11692013000400019.