A newborn receiving resuscitation has a heart rate of 40 bpm that persists despite effective bag and mask ventilation with 100% oxygen and 60 seconds of coordinated chest compressions. Which drug, dose and route should be used next?

• A Adrenaline 0.1 mg/kg (1:1,000) via endotracheal tube
• B Adrenaline 0.01 to 0.03 mg/kg (1:10,000) via umbilical venous catheter ✓
• C Atropine 0.02 mg/kg via umbilical venous catheter
• D Sodium bicarbonate 2 mEq/kg via umbilical venous catheter

Explanation

The drug of choice for a heart rate persistently below 60 bpm despite adequate ventilation and compressions is adrenaline at 0.01 to 0.03 mg/kg of the 1:10,000 concentration, preferably through an umbilical venous catheter, repeated every 3 to 5 minutes. The intravenous route is preferred because tracheal absorption is unreliable and the higher 1:1,000 concentration is not recommended. Bicarbonate is reserved for documented metabolic acidosis after resuscitation is established.

Reference: Textbook of Neonatal Resuscitation (NRP), AAP/AHA, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.