Anemia of Prematurity - Portal Neonatal

Drug Name
Doxapram (Dopram) -- Stimulates respiratory drive by activating
peripheral carotid chemoreceptors; increases tidal volume and slightly
increases respiratory rate; stimulates medullary respiratory center with
increasing doses; induces pressor response due to improved cardiac
output (greater in hypovolemic patients).
Pediatric Dose 0.5-2.5 mg/kg/h continuous IV infusion
Contraindications
Interactions
Documented hypersensitivity; epilepsy; mechanical obstruction; muscle
paresis; flail chest, pneumothorax, other restrictive lung diseases; head
injury; stroke; significant cardiovascular impairment; severe
hypertension; intraventricular hemorrhage and kernicterus reported
when used in a neonate's first week of life or when the bilirubin level is
high.
Delay infusion for at least 10 min after discontinuation of anesthetics
known to cause myocardium sensitivity to catecholamines; may
temporarily mask residual effects of muscle relaxants; additive pressor
effect may occur if coadministered with MAOIs
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions
Caution in neonates; contains benzyl alcohol, which has been
associated with a fatal gasping syndrome in premature neonates;
incidence of hypertension and CNS symptoms increase at infusion rates
>1.5 mg/kg/h
FOLLOW-UP Section 8 of 11
Further Inpatient Care:
• Most neonatologists agree that babies should be apnea-free for 2-10 days before discharge.
The minimum length of this apnea-free period has been subject to debate among clinicians.
Darnall et al concluded that otherwise healthy preterm neonates continue to have periods of
apnea separated by as many as 8 days before the last one before discharge. Infants with
longer apnea intervals often have risk factors other than AOP.
• Home monitoring after discharge is necessary for an infant whose apneic episodes continue
despite methylxanthine administration. Infants undergoing methylxanthine therapy rarely are
sent home without a monitor because apnea may recur once they outgrow their therapeutic
level. Without a monitor, caregivers may not know when apnea reappears.
• Some families, however, cannot manage a monitor in the home, and, in these cases, caffeine
administration may be the only possible therapy. Seriously consider frequent follow-up for
such infants, and readmit them for further study when blood levels approach the
subtherapeutic range.
Further Outpatient Care:
• Home monitors
o Among the several types of monitors now available for home use in the United States, the
most common combines impedance pneumography with assessment of the average heart
rate to provide cardiorespiratory monitoring. The most significant drawback of impedance
monitors is their inability to detect obstructive apnea.
o Standard home monitors detect respiratory signals and heart rates. Electrodes are placed
directly on the infant's chest or inside an adjustable belt secured around his or her chest.
o Recently developed units store records of events, which help the physician to evaluate
home events. These devices also provide a record of compliance to show monitor use.
The event recorder has a computer chip that continuously records respiratory and cardiac
signals. Normal signals are erased, but any event that violates preset alarm parameters
activates the monitor to save records of that event, as well as records of activities 15-75