A term neonate remains bradycardic with a heart rate of 45 bpm despite 30 seconds of effective bag mask ventilation followed by 30 seconds of coordinated chest compressions. Umbilical venous access has been obtained. What is the most appropriate next drug and dose?
- A Adrenaline 0.01 to 0.03 mg/kg of 1:10,000 solution intravenously ✓
- B Adrenaline 0.1 mg/kg of 1:1000 solution intravenously
- C Atropine 0.02 mg/kg intravenously
- D Calcium gluconate 100 mg/kg intravenously
Correct answer: A. Adrenaline 0.01 to 0.03 mg/kg of 1:10,000 solution intravenously
Explanation
Adrenaline is indicated when the heart rate stays below 60 bpm after effective ventilation and compressions. The intravenous dose is 0.01 to 0.03 mg/kg of the 1:10,000 concentration, given through the umbilical vein and repeated every 3 to 5 minutes. The distractor uses the 1:1000 preparation at ten times the safe dose, a classic prescribing error. Atropine and calcium have no role in neonatal bradycardia of asphyxial origin.
Reference: Textbook of Neonatal Resuscitation (AAP/AHA NRP), 8th ed.
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Written and medically reviewed by the StethoPrep medical team.