A term neonate receiving positive pressure ventilation through an endotracheal tube undergoes 60 seconds of coordinated chest compressions and ventilations. The heart rate is still 40 bpm. What is the MOST appropriate next step?

• A Increase FiO2 to 1.0 and continue compressions for another 60 seconds
• B Give a fluid bolus of 20 mL/kg normal saline
• C Administer sodium bicarbonate 2 mEq/kg intravenously
• D Administer adrenaline 0.01 to 0.03 mg/kg intravenously as 1:10,000 solution via umbilical venous catheter ✓

Explanation

When the heart rate remains below 60 bpm after at least 60 seconds of effective ventilation and coordinated compressions, intravenous or intraosseous adrenaline is indicated at 0.01 to 0.03 mg/kg of the 1:10,000 solution, preferably through an umbilical venous catheter. Sodium bicarbonate is reserved for documented metabolic acidosis during prolonged arrest and is not a resuscitation drug of first choice. A fluid bolus is given only when blood loss or shock is suspected.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.