NICU Medications

This anti-viral agent is used to treat congenital CMV (cytomegalovirus), although the benefits of its use are controversial. It must be administered intravenously, and treatment typically lasts 6 weeks or more. Liver function and enzymes should be monitored, although both the disease and the medication can affect the results.

An antibiotic commonly used intravenously in conjunction with ampicillin to treat the class of bacteria identified as Gram negative (a microbiological classification), or at other times when infection is suspected. At high doses, gentamycin can damage the kidney and can cause hearing loss that develops later on. If your baby is treated with gentamycin for more than 2 days, your doctors will measure the level of medicine in his/her blood to be sure it is within an acceptable range.

This is a steroid that is normally produced by your adrenal gland in response to physiologic stress. It is essential to life and is controlled by a complex feedback loop between the adrenal gland and the brain (pituitary gland). Premature infants, as well as sick older infants, may have adrenal insufficiency, and benefit from exogenous administration. It is typically given intravenously to increase blood pressure and improve overall condition in critically ill infants. It must be weaned slowly, as rapid discontinuance can lead to adrenal crisis.

Yep, the same medicine known as Advil® or Motrin® is used in neonates. Belonging to the class of non-steroidal anti-inflammatory medications, or “NSAIDs,” these medications also constrict blood vessels, reducing the flow of blood through them. Indomethacin given intravenously has been available longer in the United States than intravenous ibuprofen, and is used more commonly, but the two medications have been shown in research studies to do the same things and have the same side effects. Because of its constrictive effect on blood vessels, indomethacin is used to do one of two things: to close a patent ductus arteriosus (PDA) and to decrease the risk of a brain hemorrhage in very small babies. Like most therapies, it doesn’t work 100% of the time, and, because it constricts blood flow in all of the blood vessels in the body, it has side effects. Because its benefits cannot be predicted with certainty, exposing a baby to the side effects requires thoughtful consideration before prescribing it.

This is the same nutritional supplement that is recommended for pregnant women and others to help prevent anemia – low levels of red blood cells. Your body’s red blood cells live only about 3-4 months and your bone marrow, signaled by a substance produced by the kidney (erythropoietin), uses iron to make new ones. All babies get anemic after birth, and, for term babies, this signals their kidneys to start the production process. Premature babies are also anemic (anemia of prematurity), and iron may be prescribed. How much iron is needed by a premature baby, when it should be started, and the impact of blood transfusions on this need are areas of controversy, and a wide variation in practice exists. The American Academy of Pediatrics issued a guideline regarding iron supplementation in infants that can be accessed at http:/​/​pediatrics.aappublications.org/​cgi/​content/​abstract/​peds.2010-2576v1. Nonetheless, iron deficiency and iron deficiency anemia may have long-term effects on behavior and neurodevelopment.

This is an anti-seizure medication that is slowly replacing phenobarbital as the drug of choice to control seizures from any cause. It is administered orally.

A diuretic (“water pill”) that can be used intravenously to stimulate urine production and excretion, or intermittently in babies with breathing problems that may be caused by excess fluid in the lungs (heart problems or chronic lung disease). Furosemide works by changing the composition of urine made by the kidneys, including increasing the excretion of calcium and other minerals and electrolytes. This can require supplementation to replace what is being lost. This excess mineral excretion can jeopardize bone formation and can lead to kidney stones.

This is a type of vasodilator (medication that makes the blood vessels dilate) that is used in the treatment of pulmonary hypertension. When the blood pressure in the lungs is high, the heart has to work extra hard to pump against the higher pressures, which can lead to heart failure. Milrinone inhibits an enzyme resulting in an easiertime for the hearto pump blood into the body. It is only administered intravenously.

This is a narcotic pain reliever that is used frequently and is very safe, with no recognized long term effects. It can be administered both intravenously and orally. The main side effect of morphine is respiratory depression. Because babies in the NICU are on continuous monitoring for both breathing and heart rate, this is not a major concern, and any effects on breathing can be immediately detected and reversed. Babies who receive morphine for very long times may become habituated and the dose will need to be slowly decreased to avoid symptoms of narcotic withdrawal (see “Narcotic Abstinence Syndrome” under Diagnoses/conditions).

Many premature infants are prescribed multi-vitamins and/or multi-vitamins with iron. Regardless of whether your infant is breast or formula fed, the evidence indicates that these supplements are unnecessary. Infant formulas have adequate vitamin contents, and the thriving breastfed infant is not in need of supplementation. Unless your infant has an intestinal abnormality that prevents normal feeding, the evidence indicates that vitamin supplements are not indicated.

This medication is an antagonist to narcotic analgesics like morphine and fentanyl and will immediately reverse their action. Sometimes, narcotic pain relievers given to mothers during labor, like Nubain®, can pass through the placenta to the baby and depress breathing after birth. A dose of naloxone, given intramuscularly in the delivery room, can restore spontaneous breathing. However, if naloxone is given to a narcotic addict, it can cause life-threatening seizures. Therefore, it is dangerous to give naloxone in the delivery room if the mother is not extremely well known to the delivery team, as the baby may be narcotic-habituated.

This is another option in the group of paralytic drugs, with a longer duration of action than vecuronium. It is typically used as a one-time administration for a procedure, such as intravenous line placement.

This medication is added to the fluid infusing through a peripheral arterial catheter to make it last longer. Arteries have a layer of muscle in them that allows them to constrict (eg, get smaller) or dilate (eg get bigger) which helps regulate their blood flow. Papaverine is a vasodilator, which means it makes the vessel get bigger. This increases the blood flowing through the vessel and, when there’s a catheter sitting in it, makes the catheter work for a longer period of time. Not all NICUs use papaverine in their peripheral arterial lines, although there is objective evidence to indicate that it helps. Papaverine may not be readily available in all hospitals.

This is a medication given intravenously to maintain blood flow through a fetal blood vessel after birth when your baby is born with a specific type of anatomic abnormality in his/her heart. During fetal life, your baby doesn’t breathe. Because there’s no reason for blood to flow to his/her lungs, there is a blood vessel called the ductus arteriosus that acts as a bypass around the lung and moves the blood from the right to the left side of the heart and out to the body without going through the lungs. After birth, that vessel is programmed to close within the first few days of life. If your baby is born with one of a small group of abnormalities known collectively as “cyanotic congenital heart disease” (see diagnoses/conditions for more information), the ductus arteriosus is the only way blood can get into your baby’s lung – which is essential for life after birth. PGE keeps that vessel open (“patent”) until your baby can undergo life-saving cardiac surgery.

This is an anti-seizure medication that also has sedating effects. It has been used in neonates for quite a long time, but there is controversy as to whether, long term, it is good or bad. Until very recently it has been the first drug used to treat neonatal seizures, or in anticipation of possible seizures. It is also used to help stimulate the gall bladder to process bilirubin, the substance responsible for jaundice. It can be given orally or intravenously, and is generally considered safe.