During neonatal resuscitation, the heart rate remains 35 bpm despite 60 seconds of well-coordinated chest compressions and ventilations. What is the correct drug, route and dose?

• A Adrenaline 0.1 mg/kg intramuscularly into the thigh
• B Adrenaline 0.01 to 0.03 mg/kg intravenously through the umbilical venous catheter ✓
• C Sodium bicarbonate 2 mEq/kg intravenously through the umbilical vein
• D Adrenaline 0.05 to 0.1 mg/kg via the endotracheal tube as the first-line route

Explanation

After compressions fail to raise the heart rate above 60 bpm, adrenaline 0.01 to 0.03 mg/kg of 1:10,000 solution is given intravenously, preferably through an umbilical venous catheter, and may be repeated every 3 to 5 minutes. The higher endotracheal doses (0.05 to 0.1 mg/kg) are recommended only if intravenous access cannot be established, since absorption via the airway is unreliable. Bicarbonate is not part of the initial drug sequence.

Reference: Textbook of Neonatal Resuscitation (NRP), American Academy of Pediatrics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.