• 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.

Treatment of Narcotic Depression

1. When indicated, resuscitation must be instituted without delay, usually before naloxone administration.
2. Treat narcotic depression with naloxone (Narcan) intramuscularly.

1. Dose 0.1-0.2mg/kg per dose, IM.
2. Naloxone comes in ampoules containing 0.4mg/ml.
3. Intramuscular 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 DRUGS.

Observation and Documentation

• 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.

References

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