What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room?

The neonatal resuscitation program recommends a wide dose range of epinephrine for newborns who receive chest compressions (endotracheal tube [ET] dose of 0.05-0.1 mg/kg or intravenous [IV] dose of 0.01-0.03 mg/kg), which presents a challenge to neonatal care providers when attempting to determine t...

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Bibliographic Details
Published in:Journal of perinatology 2021-07, Vol.41 (7), p.1769-1773
Main Authors: Vali, Payam, Weiner, Gary M, Sankaran, Deepika, Lakshminrusimha, Satyan
Format: Article
Language:English
Subjects:
Blood pressure
Catheters
Dosage
Dosage and administration
Epinephrine
Heart rate
Intravenous administration
Methods
Neonatal intensive care
Neonates
Newborn babies
Pediatric research
Pediatrics
Pharmacokinetics
Resuscitation
Syringes
Veins & arteries
Ventilators
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Summary:The neonatal resuscitation program recommends a wide dose range of epinephrine for newborns who receive chest compressions (endotracheal tube [ET] dose of 0.05-0.1 mg/kg or intravenous [IV] dose of 0.01-0.03 mg/kg), which presents a challenge to neonatal care providers when attempting to determine the optimal initial dose. Dosing errors are common when preparing epinephrine for neonatal resuscitation. Based on animal data, we suggest preparing 0.1 mg/kg or 1 ml/kg of 1 mg/10 ml epinephrine in a 5 ml syringe for ET administration. For IV epinephrine, we suggest preparing an initial dose of 0.02 mg/kg or 0.2 ml/kg of 1 mg/10 ml epinephrine in a 1 ml syringe. A dose of 0.02 mg/kg enables use of a 1 ml syringe for a wide range of birth weights from 500 g to 5 kg. The use of a color-coded syringe may decrease errors in dose preparation.
ISSN:0743-8346
1476-5543
DOI:10.1038/s41372-021-01032-7