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An infant who appears to be of normal size is noted to be lethargic and somewhat limp on the warmer after birth. The mother is 28 years old, and this is her fourth delivery. The pregnancy was uncomplicated, with normal fetal monitoring prior to delivery. Labor was rapid, with local anesthesia and intravenous meperidine (Demerol) administered for maternal pain control. Which of the following therapeutic maneuvers is likely to improve this infant’s condition most rapidly?

Question Category:
Correct Answer:
Administration of naloxone (Narcan)
Description:
In the description provided, the most likely cause of the neonatal depression is maternal analgesic narcotic drug administration. While controlling the pain of the delivery in the mother, use of narcotics can result in depression of the newborn via crossing of the placenta. The appropriate first step in the management of this infant (after managing the ABCs of airway, breathing, and circulation) is the administration of naloxone, 0.1 mg/kg, IM, IV, or endotracheal. The other possibilities are unlikely, given the clinical information provided.
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