During neonatal resuscitation, intravenous adrenaline is indicated because the heart rate remains below 60 bpm despite effective ventilation and chest compressions. Which of the following correctly states the recommended dose, concentration and preferred route?

• A 0.1 to 0.3 mg/kg of 1:1000 solution via endotracheal tube
• B 0.01 to 0.03 mg/kg of 1:10,000 solution via umbilical venous line ✓
• C 0.01 mg/kg of 1:1000 solution via intraosseous needle as first choice
• D 0.1 mg/kg of 1:10,000 solution via umbilical venous line

Explanation

The recommended adrenaline dose in neonatal resuscitation is 0.01 to 0.03 mg/kg of the 1:10,000 concentration, given preferably through an umbilical venous catheter and repeated every 3 to 5 minutes. The 1:1000 concentration carries a tenfold overdose risk and must be diluted before use. The endotracheal route gives unreliable absorption and is used only while vascular access is being established. Option D represents ten times the correct dose and would be dangerous.

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

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