During neonatal resuscitation, a newborn has received effective positive pressure ventilation and 60 seconds of coordinated chest compressions. The heart rate is still 45 bpm. Umbilical venous access has been secured. Which drug, dose and route is MOST appropriate next?

• A Epinephrine 0.1 to 0.3 mL/kg of 1:1000 solution intravenously
• B Normal saline bolus 20 mL/kg intravenously
• C Sodium bicarbonate 2 mEq/kg intravenously
• D Epinephrine 0.01 to 0.03 mg/kg of 1:10,000 solution intravenously ✓

Explanation

When the heart rate stays below 60 bpm despite ventilation and compressions, intravenous epinephrine at 0.01 to 0.03 mg/kg using the 1:10,000 dilution is given, preferably through an umbilical venous catheter. Option A uses the 1:1000 concentration intended for intramuscular use outside the delivery setting and would deliver a tenfold overdose intravenously. Volume expansion with saline is reserved for suspected blood loss or shock, and bicarbonate is not a first-line resuscitation drug.

Reference: Cloherty and Stark's Manual of Neonatal Care, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.