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): 
Beta-Agonist, Bronchodilator
Original Date: 
March 1996
Revised Date: 
June 2018
  • Bronchospasm in infants with brochopulmonary dysplasia (BPD)
  • Adjunctive therapy for Neonatal Hyperkalemia
  • For Bronchospasm in infants with BPD:
    • Inhalation solution via nebulizer: dilute with 2 - 3 mL of 0.9%NaCl
    • Metered-dose inhaler (MDI): use with aerochamber


  • For Neonatal Hyperkalemia:
    • Inhalation solution via nebulizer
    • IV intermittent infusion
  • For Bronchospasm in infants with BPD:
    • Nebulization:   1.25 mg - 2.5 mg/dose q8h prn.  Dilute to 3 mL with 0.9%NaCl
    • Inhalation: 1 - 2 puffs (100 - 200 micrograms) Q4-6H prn


  • For Neonatal Hyperkalemia:
    • Nebulization (possible if conventionally/Jet ventilated, not possible for HFOV)
      • 0.4 mg in 2 mL of 0.9%NaCl every 2 hours to a maximum of 12 doses
    • IV Intermittent Infusion:
      • 4 micrograms/kg iv over 20 minutes q4h
Side Effects: 
  • CNS: twitching, tremors, abnormal motor activity
  • CVS: tachycardia, palpitations
  • Endocrine and metabolic: hyperglycemia, lactic acidosis
Parameters to Monitor: 
  • HR
  • Serum glucose
  • Serum potassium
Reconstitution and Stability: 
  • Salbutamol 1 mg/mL (NOT available at TOH)
    • Take 0.2 mL (200 mcg = 0.2 mg) and add to 9.8 mL D5W or 0.9% NaCl
    • Final concentration: 20 mcg/mL



- Solutions compatible: D5W, 0.9% NaCl

- Y-site compatible: hydromorphone, morphine


- American Society of Health-System Pharmacists (ASHP). Handbook on Injectable Drugs 19th Edition. Bethesda: ASHP 2017

- Mhanna MJ, Patel JS, Patel S, et al, "The Effects of Racemic Albuterol Versus Levalbuterol in Very Low Birth Weight Infants," Pediatr Pulmonol, 2009, 44(8):778-83

- Vemgal P, Ohlsson Interventions for non-oliguric hyperkalaemia in preterm neonates. A. Cochrane Database Syst Rev. 2012 May 16;5:CD005257.

- Yaseen H Darwich M. Salbutamol Versus Cation-Exchange resin (Kayexalate) for the Treatment of Nonoliguric Hyperkalemia in Preterm Infants. Am J Perinatol. 2008 Mar;25(3):193-7.


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