This document provides treatment guidelines for several neonatal conditions including sepsis, persistent pulmonary hypertension of the newborn (PPHN), meconium aspiration syndrome, and cardiac dysfunction. For sepsis, it recommends starting epinephrine or norepinephrine infusions and adding a second vasopressor if needed. For PPHN, it suggests milrinone, dopamine, or dobutamin infusions. Meconium aspiration syndrome can be treated with milrinone, dopamine, or epinephrine. And cardiac dysfunction may respond to milrinone, dobutamin, or dopamine infusions starting at low doses.

1. Neonatal Sepsis
• Epinephrine infusions (starting dose 0.05 to 0.1 mcg/kg/min, titrate
to response up to 1.5 mcg/kg/min)
• 2nd vasopressor if not responded to dose of 1.5 mcg/kg/min
• In warm shock (Eg, bounding pulses, pink extremities, and "flash"
capillary refill),
• Norepinephrine infusion 0.03 to 0.05 mcg/kg/min as the 1st drug

2. PPHN
• Milrinone has inotropic and vasodilator effects
• Dopamine or Dobutamin,
• Used either in isolation or in combination.
• Both starting at 5-10 mcg/kg/min
• Adrenaline infusions in severe myocardial dysfunction

3. Meconium Aspiration Syndrome
• Milrinone
• Dopamine /+- Dobutamin,
• Adrenaline.

4. Cardiac Dysfunction
• Milrinone - 0.5 μg/kg/min
• Dobutamin
• Dopamine

5. References
1. NZ Starship Guidelines
2.Up to date- Rapid recognition and initial resuscitation septic shock
3.AHA Guidelines - Cardiopulmonary Resuscitation in Infants and
Children With Cardiac Disease A Scientific Statement From the
American Heart Association
4. Wales Neonatal Network Guideline on Management of Persistent
Pulmonary Hypertension of Newborn (PPHN) in Near Term & Term
Infants