Anemia of Prematurity - Portal Neonatal

Drug Name
Sotalol (Betapace) -- Recent use in fetal arrhythmias has been
promising; however, data are scarce, and definitive pharmacokinetic
studies have not been performed.
Adult Dose 80-160 mg PO q12h
Pediatric Dose Fetal or preterm: Not established
Contraindications
Interactions
Documented hypersensitivity; sinus bradycardia, second-degree and
third-degree AV block
Aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, and
rifampin may decrease bioavailability and plasma levels, possibly
resulting in decreased pharmacologic effect; cardiotoxicity may increase
when administered concurrently with calcium channel blockers,
quinidine, and flecainide; toxicity increases when coadministered with
digoxin, flecainide, acetaminophen, clonidine, epinephrine, nifedipine,
phenothiazines, and catecholamine-depleting agents
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Drug Name
Accumulation of drug with renal failure is worrisome, since renal
perfusion is poor in hydropic fetus
Flecainide (Tambocor) -- Limited data from infants suggest that half-life
at birth may be prolonged. These data have not been extended
backward to fetal life. Maternal (transplacental) use, in conjunction with
digoxin, has been promising anecdotally.
Adult Dose 50-100 mg PO q12h, may be increased prn, not to exceed 300-400 mg/d
Pediatric Dose Fetal or preterm: Not established
Contraindications
Interactions
Documented hypersensitivity; third-degree AV block and myocardial
depression; uncertain in premature fetus
Amiodarone, cimetidine, and digoxin may increase plasma
concentrations; beta-adrenergic blockers, verapamil, and disopyramide
may have additive inotropic effects with coadministration; ritonavir may
increase cardiotoxicity; uncertain in premature fetus
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Lack of data still limits widespread use
FOLLOW-UP Section 8 of 10
Further Inpatient Care:
• No unique features exist to the follow-up care necessary for a perinatal patient who survives
hydrops fetalis.
• If the precipitating cause was profound anemia, red cell survival may remain reduced in
patients with isoimmune hemolytic anemia, and red cell production may be impaired in the
fetus or newborn who has received multiple red cell transfusions.
• If the cause of hydrops fetalis was a treatable infection, assurance of total eradication of the
offending agent is obviously necessary.
• In situations in which multiple anomalies and/or chromosomal abnormalities are present,
family counseling is recommended.
• Follow-up measures targeted toward the specific pathophysiologic disturbances present in
individual cases may be required (eg, any baby who has experienced a compromised
perinatal period).
• Despite the profound compromise in perfusion and fetal function of multiple organ systems in
the fetus with hydrops, the limited follow-up data that are currently available provide an
unexpectedly optimistic outlook for babies who survive fetal hydrops.