unknown mechanism
likely competes with calcium to reduce myometrial contractility
continuous IV infusion
monitor
blood pressure
RR
presence of deep tendon reflexes
arrhythmias
serum levels
magnesium sulfate
12mg IM q 12 h X 2
betamethasone course
6 mg IM q12h X 4
dexamethasone course
4 guidlelines for intrapartum antibiotic prophylaxis (IAP)
positive screening culture from vagina or rectum
given birth to an infant with early-onset GBS disease
GBS bacteriuria during current pregnancy
culture status unknown + other risk factors (fever, preterm labor, prolonged rupture of membranes)
what if mother has UTI and comes in for delivery
give ampicillin or penicillin at least 4 hours prior to delivery
2 mainstays of maternal antibiotic regimen for GBS
penicillin
ampicillin
alternative regimens for penicillin allergic pts in maternal antibiotic regimen for GBS
cefazolin - most evidence
clindamycin - increase GBS resistance to
vancomycin
3 surfactant options for RDS
curosurf - poractant
infasurf - calfactant
survanta - beractant
3 treatment options for RDS
surfactant therapy
antimicrobial therapy
supportive therapies
oxygen
assisted ventilation
management of acidosis
fluid & electrolyte management
analgesia & sedation
what 3 things are you looking to cover with antimicrobial therapy
GBS
listeria
gram (-) enteric organisms
what does ampicillin cover
GBS
listeria
what does gentamicin cover
GBS
gram (-) enteric organisms
what antimicrobial could be added for late onset RDS to cover staphlococci
vancomycin
what could be added for RDS if herpes simplex virus (HSV) is suspectd
acyclovir
2 meds used for supportive therapy with analgesia & sedation
fentanyl
lorazepam or midazolam
supportive therapy for RDS
boluses should be injected slowly over 3-5 minutes
continuous infusion may be used
fentanyl
supportive therapy for RDS
analgesia and sedation
PRN doses
continuous infusion may be used