Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
March 1993
Revised Date: 
feb 2024
  • Cardiopulmonary resuscitation
  • Hypotension/Shock, Inotropic support

Cardiopulmonary resuscitation:

  • ETT: In emergency situations, when IV access is unavailable.
    • Draw up dose in a 3 or 5 mL syringe and label "for ETT".  Administer rapidly.  Do not follow with a flush.
  • IV direct: Preferred route.
    • Draw up dose in a 1 mL syringe and label "for IV/UVC".  Administer rapidly over 1 minute.  Follow with up to 3 mL 0.9% NaCl flush.

Hypotension/Shock, Inotropic support:

  • IV continuous infusion
  • Cardiopulmonary Resuscitation
    • ETT: 0.1 mg/kg (1 mL/kg of a 1: 10 000 (0.1 mg/mL) solution). 
    • IV/UVC: 0.02* mg/kg (0.2 mL/kg of a 1: 10 000 (0.1 mg/mL) solution) every 3 to 5 minutes PRN. 

* the dosage range is 0.01-0.03 mg/kg (0.1-0.3 mL/kg), however 0.02 mg/kg is the recommended initial dose

  • Hypotension/Shock, Inotropic support
    • IV continuous infusion usual dose: 0.05 to 0.1 mcg/kg/minute for inotrope support; up to 0.3 mcg/kg/minute for vasopressor effect 
    • Recommended max: 1 mcg/kg/minute
Side Effects: 
  • CVS: cardiac arrhythmia, hypertension, tachycardia, vasoconstriction
  • Local: IV infiltration may cause tissue ischemia and necrosis
Parameters to Monitor: 
  • HR
  • BP
  • ECG
  • Site of injection
Reconstitution and Stability: 

For Hypotension/Shock, Inotropic support

  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 1.2 mL (0.12 mg) and add to 18.8 mL D5W
    • Final concentration: 6 mcg/mL
  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 5 mL (0.5 mg) and add to 15 mL D5W
    • Final concentration: 25 mcg/mL
  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 10 mL (1 mg) and add to 10 mL D5W
    • Final concentration: 50 mcg/mL (only with central line)

- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: dobutamine, dopamine, hydrocortisone, midazolam, morphine, potassium chloride (up to 40 mmol/L), SMOF, TPN

- Incompatible: sodium bicarbonate

  • Do not use if solution is brown or a precipitate is present

- Taketomo CK, Hodding JH, Kraus DM.  Pediatric Dosage Handbook 19th Edition. Hudson: Lexi-Comp Inc; 2012

-Trissel LA. Handbook on Injectable Drugs. 16th Editions. Bethesda: American Society of health-System Pharmacists 2011

- Canadian Pediatric Society- updated NRP Guidelines 2022

- Evidence-based Practice for Improving Quality  (EPIQ) Recommendations on Hemodynamics 2023. 

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