Chapter 54: Neonatal & Newborn Pharmacology

For infants born at lesser than thirty-seven weeks of gestation, the focus is on managing Respiratory Distress Syndrome (RDS), which occurs due to underdeveloped lungs and a lack of natural surfactant. To address this, healthcare teams administer exogenous surfactants such as beractant, calfactant, or poractant alfa via an intratracheal route. These substances, derived from bovine or porcine sources, lower surface tension in the air sacs to prevent lung collapse. The administration is a complex, multidisciplinary task requiring precise positioning of the infant to ensure gravity-assisted distribution and careful monitoring for side effects like bradycardia, cyanosis, or oxygen desaturation. For healthy, full-term neonates, the curriculum outlines three standard interventions: erythromycin ophthalmic ointment to prevent blindness from potential exposure to chlamydia or gonorrhea, phytonadione (vitamin K) injections to prevent life-threatening hemorrhagic disease since newborns lack the necessary gut bacteria for synthesis, and the Hepatitis B vaccine series. Nursing responsibilities are critical across all stages, including conducting Apgar assessments, maintaining airway patency, monitoring vital signs, and providing essential education to parents regarding informed consent and the long-term benefits of neonatal immunizations.