Anemia of Prematurity - Portal Neonatal

MEDICATION Section 7 of 11
In addition to the treatments listed below, surfactant replacement therapy is prescribed frequently.
Natural bovine lung extract is administered to replace the surfactant that has been stripped. Surfactant
also acts as a detergent to break up residual meconium, thereby decreasing the severity of lung
disease. Although 4 different commercial surfactant preparations are available, the FDA has not yet
approved surfactant for this indication. However, surfactant commonly is used in patients with MAS,
even though its efficacy, dosage regimen, and most effective product still are not established clinically.
Drug Category: Pulmonary vasodilating agents -- Decreases pulmonary vascular resistance.
Administer directly into the main pulmonary artery because the major complication is systemic
hypotension without significant effects on pulmonary hypertension. Because of the severe systemic
hypotensive effects of tolazoline and nitroprusside, inhaled nitric oxide is used more commonly.
Drug Name
Pediatric Dose
Tolazoline (Priscoline) -- Competitively blocks alpha-adrenergic receptors
to antagonize circulating epinephrine and norepinephrine. Produces
direct smooth muscle relaxation. Results in decreased blood pressure,
peripheral vasodilation, and decreased peripheral resistance.
1-2 mg/kg IV infused over 10 min into a vein that drains via the superior
vena cava; if arterial pO2 increases, follow with continuous IV infusion of
1-2 mg/kg/h
Contraindications Documented hypersensitivity (rare in neonates); hypotension
Interactions
Incompatible with indomethacin (forms precipitant); disulfiramlike
reaction with concomitant alcohol administration (avoid IV diluents with
alcohol); H2-antagonists (eg, ranitidine) may decrease effects
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Drug Name
Major adverse effect is systemic hypotension without significant effect on
pulmonary pressure; gastric bleeding; ulceration, and gastric perforation
has been reported; acidosis may decrease response
Nitroprusside (Nitropress) -- Causes peripheral vasodilatation by direct
action on venous and arteriolar smooth muscle. Increases inotropic
activity of the heart. At higher dosages, it may exacerbate myocardial
ischemia by increasing the heart rate.
Pediatric Dose 0.25-0.5 mcg/kg/min continuous IV infusion; titrate to effect
Contraindications
Interactions
Documented hypersensitivity (rare in neonates); arteriovenous shunt;
coarctation of the aorta
Produces vasodilation and increases inotropic activity of the heart. At
higher dosages, it may exacerbate myocardial ischemia by increasing
the heart rate
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Major adverse effects include severe systemic hypotension and
tachycardia; thiocyanate and cyanide toxicity with long-term therapy;
exercise caution in patients with elevated ICP and/or severe renal and
hepatic failure; use only in 5% dextrose-containing solutions; wrap the
solution in opaque material to protect it from light
Caution in increased intracranial pressure, hepatic failure, severe renal
impairment, and hypothyroidism; caution in renal or hepatic insufficiency
Drug Category: Respiratory gases -- Inhaled nitric oxide (NO) has the direct effect of pulmonary
vasodilatation without the adverse effect of systemic hypotension. Approved for use if concomitant
hypoxemic respiratory failure occurs.