During neonatal resuscitation, a term newborn remains bradycardic with a heart rate of 40/min despite 60 seconds of effective positive pressure ventilation and coordinated chest compressions. The correct next drug, route and dose are:

• A Adrenaline 0.01 to 0.03 mg/kg via umbilical venous catheter ✓
• B Atropine 0.02 mg/kg via endotracheal tube
• C Sodium bicarbonate 2 mEq/kg via umbilical venous catheter
• D Calcium gluconate 100 mg/kg via umbilical venous catheter

Explanation

When the heart rate stays below 60 per minute despite adequate ventilation and compressions, adrenaline 0.01 to 0.03 mg/kg of the 1:10,000 solution is given intravenously through an umbilical venous catheter, the preferred route. Endotracheal adrenaline is unreliable in absorption and reserved until IV access is secured. Bicarbonate is not recommended during resuscitation in the delivery room, and neither atropine nor calcium forms part of the neonatal resuscitation algorithm for bradycardia.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.