Depression in the Newborn Infant
by Clinical Practice Committee
- This is manifest either at
delivery when a baby needs resuscitation, or following delivery with
behavioural changes in the infant.
- Narcotics given to the mother
in labour can contribute to depression in an asphyxiated infant, or can
result in depression without asphyxia. In this latter case, the baby usually
has a normal heart rate initially, but depressed respiration.
of Narcotic Depression
- When indicated, resuscitation
must be instituted without delay, usually before naloxone administration.
- Treat narcotic depression
with naloxone (Narcan) intramuscularly.
- Dose 0.1-0.2mg/kg
per dose, IM.
- Naloxone comes in
ampoules containing 0.4mg/ml.
administration is preferable. The onset of action is almost as rapid as
with IV administration, but the duration of action is much longer.
See Naloxone Drug Protocol
for more details.
- DO NOT GIVE NALOXONE TO
INFANTS AT RISK OF DRUG WITHDRAWAL, WHOSE MOTHERS HAVE BEEN TAKING OPIOID
- The half life of intravenous
naloxone is very short, and there is the potential its action will wear off
before that of the opioid causing the depression. This appears not to be a
problem with large intramuscular doses of naloxone (as recommended here).
- There appears to be a depot
effect of the IM injection. Measurable effects of naloxone have been seen up
to 48 hours after the dose.
- Babies needing resuscitation
and/or naloxone at birth need observation afterwards. This need not
necessarily be on NICU but can be with the mother in the delivery unit or
post natal ward.
- When administered in the
delivery room, naloxone will often be given on the verbal order of the
doctor or NS-ANP. This order should be written on the ‘blue card’ by the
doctor/NS-ANP after the resuscitation.
|Committee on Drugs. American
Academy of Pediatrics. Pediatrics 1989;83:803.
|Wiener PC et al. Br Med J
|Brice JEH et al. Arch Dis Child.
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