Anemia of Prematurity - Portal Neonatal

Drug Name
Pediatric Dose
Vecuronium (Norcuron) -- Has few to no adverse hemodynamic adverse
effects and may be preferred over pancuronium as a muscle relaxant in
the infant with PPHN; however, it is more expensive than pancuronium.
Intermediate-acting nondepolarizing muscle relaxant. Onset of action is
1-2 min, and duration of action is 45-90 min. Primary route of excretion is
hepatic.
0.05-0.15 mg/kg/dose IV q1-2h; alternatively, may be used as a
continuous infusion
Contraindications Documented hypersensitivity; myasthenia gravis or related syndromes
Interactions
Increased effect with magnesium sulfate, furosemide, aminoglycosides,
amphotericin, ketamine, cyclosporine, inhalation anesthetics, or
antiarrhythmics; decreased effect with calcium, carbamazepine,
phenytoin, corticosteroids, theophylline, or caffeine
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
In myasthenia gravis or myasthenic syndrome, small doses of
vecuronium may have profound effects; caution with conditions that may
potentiate neuromuscular blockade (eg, electrolyte abnormalities,
neuromuscular disease, acidosis, hepatic failure)
Drug Category: Pulmonary vasodilating agents -- Recently approved as a therapeutic modality for
infants with PPHN, nitric oxide is an important mediator of vascular tone. It is delivered as an inhaled
gas. At least 2 multicenter studies did not show that inhaled nitric oxide decreases mortality or the
need for extracorporeal support in infants with CDH; however, it may be useful in stabilizing an infant
while evaluating or transferring for ECMO.
Drug Name
Pediatric Dose
Nitric oxide (INOmax) -- The FDA approved nitric oxide for the treatment
of PPHN in December 1999. Produced endogenously from action of
enzyme nitric oxide (NO) synthetase on arginine. Relaxes vascular
smooth muscle by binding to heme moiety of cytosolic guanylate
cyclase, activating guanylate cyclase and increasing intracellular levels
of cGMP, which then leads to vasodilation. When inhaled, NO decreases
pulmonary vascular resistance and improves lung blood flow.
Optimal dose is unknown, although most investigators agree that doses
>20 ppm are not beneficial and may be harmful. Administration should
occur under controlled conditions with access to ECMO if needed. NO2
and methemoglobin levels should be monitored frequently, and weaning
should occur gradually. Abrupt discontinuation may be associated with
severe rebound pulmonary hypertension.
1-20 ppm inhalation
Deliver by system that measures concentrations of NO in breathing gas,
with constant concentration throughout respiratory cycle, and that does
not cause generation of excessive inhaled nitrogen dioxide
Contraindications Right-to-left shunting of blood; methemoglobin reductase deficiency
Interactions
Concomitant administration with NO donor compounds (eg,
nitroprusside, nitroglycerin) may have additive effects and increase risk
of methemoglobinemia
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Methemoglobinemia and pulmonary inflammation resulting from reactive
nitrogen intermediates; abrupt discontinuation of NO may lead to
worsening oxygenation and increasing PAP; toxic effects include
methemoglobinemia and pulmonary inflammation resulting from reactive
nitrogen intermediates; caution in thrombocytopenia, anemia,
leukopenia, or bleeding disorders; monitor for PaO2, methemoglobin,
and NO2; abrupt withdrawal causes rebound pulmonary hypertension