Anemia of Prematurity - Portal Neonatal

Drug Name
Pediatric Dose
Contraindications
Interactions
Dobutamine (Dobutrex) -- Second inotropic DOC, preferred by some as
first choice in severe cardiogenic shock.
Produces vasodilation and increases inotropic state. At higher dosages
may cause increased heart rate, exacerbating myocardial ischemia.
2-25 mcg/kg/min IV continuous infusion; begin at lower doses, increase
as needed on basis of BP and heart rate; wean on basis of BP response
Documented hypersensitivity; idiopathic hypertrophic subaortic stenosis
and atrial fibrillation or flutter
Beta-adrenergic blockers antagonize effects of dobutamine; general
anesthetics may increase toxicity
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions
May cause arrhythmias, hypertension, tachycardia, and vasodilation of
cutaneous microcirculation; assess volume status before administering,
since may cause hypotension, especially in infants with clear evidence of
hypovolemia; may cause tissue sloughing at IV site, particularly when
the drug infiltrates soft tissue
FOLLOW-UP Section 8 of 10
Further Inpatient Care:
• Close physical therapy and developmental evaluation are needed before discharge.
Further Outpatient Care:
• As noted before, most infants do not need specific outpatient care. However, they should be
monitored in a regular pediatric clinic. Severely disabled children may need to be monitored in
multispecialty clinics and by a developmental neurologist.
In/Out Patient Meds:
• Continuation of seizure medications should depend on evolving CNS symptoms and EEG
findings.
Transfer:
o In most infants who are developing normally and have a normal EEG before hospital
discharge, phenobarbital is discontinued within 3-4 weeks of birth.
o In those with significant CNS disability with or without persistent episodes of seizures,
phenobarbital is continued for 3-6 months; the decision to wean off the drug depends
on later changes in EEG and clinical course.
• Infants delivered in a level I or II center may require transfer to a tertiary neonatal intensive
care unit for definitive neurodiagnostic studies (EEG and neuroimaging) and consultation with
a pediatric neurologist.
Deterrence/Prevention:
• The era of neuroprotection may be near. Most of the treatments discussed here are
experimental. With the exception of hypothermia, which is still being examined in clinical trials,
none of the therapies cited below has been consistently shown to have efficacy in human
infants.