Neonatal Resuscitation / NICU Pre–Intubation Medications – IWK Drug Information Resource

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Neonatal Resuscitation / NICU Pre–Intubation Medications

Date Tuesday, April 29, 2025

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Neonatal Resuscitation (adapted from Neonatal Resuscitation Guidelines 2020)

EPINEPHrine (0.02 mg/kg) UVC/IV/IO UVC is preferred route
Dose
Concentration	0.1 mg/mL
Volume
Notes/Admin Instructions	UVC is preferred route. Draw into a 1 mL syringe and label “For UVC/IV”. IV direct over 1-2 seconds and flush with 3 mL 0.9% NaCl. May repeat every 3-5 minutes if heart rate remains less than 60 beats/min. UVC continues to be the preferred route of emergency vascular access, but Intraosseous (IO) access can be used as an alternative if UVC insertion is not possible. Intra-arterial is NOT recommended.

NICU Pre–Intubation Medications (Preferred sequence of administration is 1, 2 and then 3)

1. atropine (0.02 mg/kg/dose) IV
Dose
Concentration	0.1 mg/mL
Volume
Notes/Admin Instructions	IV direct over 1 minute; anticholinergic (to prevent bradycardia)

2. fentaNYL (2 micrograms/kg/dose) IV
Dose
Concentration	2 micrograms/mL
Volume
Notes/Admin Instructions	Use pharmacy prepared solution from Pyxis. IV direct over 5 seconds if followed immediately by a neuromuscular blocking agent; if not using a neuromuscular block agent, give over 5 minutes. Chest wall rigidity may occur with rapid administration.

3. succinylcholine (2 mg/kg/dose) IV
Dose
Concentration	2 mg/mL
Volume
Notes/Admin Instructions	Use pharmacy prepared solution from Pyxis. IV direct over 10 seconds. Avoid in patients with significant hyperkalemia or family history of malignant hyperthermia.

succinylcholine, repeat dose if needed (1 mg/kg/dose) IV
Dose
Concentration	2 mg/mL
Volume
Notes/Admin Instructions	Use pharmacy prepared solution from Pyxis. IV direct over 10 seconds. Avoid in patients with significant hyperkalemia or family history of malignant hyperthermia.

rocuronium IV
If rocuronium required, please refer to drug dosing guidelines and parenteral monograph for guidance.