therapy are rarely given in ED phase of care Sodium Bicarbonate Bicarbonate therapy may contribute to respiratory acidosis and a worsening intracellular acidosis, which may actually impair myocardial and cerebral function In prolonged resuscitations, after establishment of adequate ventilation, bicarbonate may be given to treat documented metabolic acidosis or hyperkalemia using arterial blood gases and serum chemistries to guide administration Use 0.5-mEq/mL (4.2%, half-strength) solution to decrease effects of hypertonicity Little research data exist to support the choice of other buffers, such as tris(hydroxymethyl) aminomethane (THAM), for documented metabolic acidosis; practitioners may use this to reduce the occurrence of hypernatremia Naloxone Hydrochloride Naloxone is a narcotic antagonist that reverses narcotic-induced respiratory depression Naloxone is not recommended for the initial resuscitation attempts in the newly born The focus of the resuscitation remains the same, providing adequate respiratory support to correct abnormalities in ventilation and circulation Naloxone given to the newborn of a mother suspected of narcotic addiction may precipitate acute narcotic withdrawal and seizures Atropine Atropine is not recommended for acute neonatal resuscitation as vagal stimulation does not cause bradycardia in neonates Furthermore, many investigators believe that the vagally mediated bradycardia response to hypoxia is a valuable reflex to guide resuscitative efforts and should not be pharmacologically abolished by atropine Artificial Pulmonary Surfactant Newborns who require intubation due to the respiratory distress associated with insufficient surfactant production may benefit from replacement therapy with an artificial surfactant product Prematurity of less than 35 weeks is the most common indication for surfactant use Replacement surfactant is delivered to the pulmonary bed via an ET tube Use of surfactant in the ED should be done in consultation with a neonatologist Antibiotics