Question

A delivery mother received morphine sulfate IV 30 minutes ago. Describe what interventions you would be prepared for immediately after delivery of the infant. Describe all of the pharmacological interventions that accompany newborn care and which intervention has the highest priority for an infant of a diabetic mother.

Answer 1

1.Interventions immediately after delivery of the infant:

• Neonatal respiratory depression is possible when morphine is used in labour ,so everything should be kept ready for neonatal resuscitation and intubation if needed.
• Opiod antagonist such as Naloxone must be available for reversal of opiod induced respitatory depression in neonate.

2.Pharmacological interventions in newborn care :

• Obtain toxicology screen as soon as possible after birth using available method.
• Pharmacologic treatment-a) first line treatment : MORPHINE initial dose 0.05mg/kg. b)Titration: increase by 0.025 mg / kg ,if same /increases scores after 2 doses . c) suggested maximum dose 0.2 mg/ kg.
• Adjunctive pharmacologic treatment- drug of choice - Phenobarbitol starting dose -10-15 mg/ kg PO load,then 5mg/kg/day Bid
• Treatment of opiod withdrawl seizure- drug of choice : Morphine 0.1 to 0.2 mg/ kg iv or im.
• Refer all drug exposed neonates to early intervention programes.

3.The intervention that has highest priority for an infant of a diabetic mother is Neonatal hypoglycemia screening and management.