Therapeutic

Class Medication

Mechanism of

Action Metabolism

Route of

Administration

(neonates) Dose and Frequency Reversal

Agent Comments

More data needed to address safety and

efficacy of midazolam in neonates.

Insufficient evidence to promote routine

use of midazolam as sedative for

neonates.o

Reports of serious neurologic and hemodynamic effects. Reports on effects of

negative cerebral artery blood flow.

Midazolam induces apoptosis and is

concentration dependent via activation of mitochondrial pathway in

neonatal animal models.

Sucrose analgesia Oral sucrose

solution

Activation of

endogenous

opioid system

through tasteo

Carbohydrate

Metabolism:

Undergoes gastric hydrolysis, utilized as a carbohydrate (3.94 kcal/g)

Oral None

Adverse effects

≤1.5%:

Choking, spittingup, vomiting after

dose

Use 12%–24% sucrose or glucose

20%–30%.

Administer 1–2 min prior to procedure.

Concentrated preparations are hyperosmolar (up to 1000 mOsm/L). Use with

caution especially in preterm neonates.

Long-term safety and neurodevelopmental outcomes of repeated oral sucrose

administration is not known.

Coadministration of sucrose with nonnutritive sucking may be additive/

synergistic.

Place on tip of tongue (location of

opioid receptors).

Reduces pain during venipunctures/

heelsticks

Consider limiting total daily doses to

<10 in term infants, safe number of

doses unknown, especially in preterms. Tolerance may develop with

repeated doses.

Use in neonates of opioid-dependent

mothers is controversial.

Topical

anesthetics

Lidocaine 1 mg

with epinephrine

Blocks initiation

and conduction

of nerve impulses

via ↓ sodium permeability

Hepatic/dermal:

CYP-450 and small

amount of dermal

metabolism to

Monoethylglycinexylidide

Subcutaneous

(SC)

SC

2–5 mg/kg SC

None

Mild swelling, bruising, and bleeding

at site of injection. Systemic

toxicity in neonate after inadvertent lidocaine

intravascular

injection during

Dorsal Penile

NerveBlock.q

Available with epinephrine (vasoconstrictor) for select procedures

(e.g., suture).p

Examine labels closely—avoid error.

Consider adding sodium bicarbonate to

buffer to ↓ pain or warming vial prior

to injection to body temperature.

Use SC (without EPI) for ring or nerve

blocks.

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