Epinephrine Administration for Neonatal Bradycardia

Rationale for Epinephrine

• The American Heart Association recommends epinephrine as the first-line vasoactive agent for neonatal cardiac arrest with persistent bradycardia, as it is the only medication indicated when adequate ventilation and chest compressions have failed to increase the heart rate to ≥60 bpm in a newborn 1, 2
• The International Consensus on Cardiopulmonary Resuscitation also recommends epinephrine as the first-line vasoactive agent for neonatal cardiac arrest with persistent bradycardia 4, 5

Dosing and Administration

• The recommended dose of epinephrine is 0.01-0.03 mg/kg, which should be administered intraosseously as soon as possible, ideally within 5 minutes of starting chest compressions 1, 2, 5
• The dose should be repeated every 3-5 minutes if the heart rate remains <60 bpm, using the same IV/IO dose 5

Alternative Routes and Medications

• Naloxone is not a first-line resuscitation medication, but may be considered after successful resuscitation if there is documented maternal opioid use within 4 hours of delivery and persistent respiratory depression despite adequate ventilation 1
• Sodium bicarbonate is not recommended for routine administration in neonatal cardiac arrest, but may be indicated for specific situations like documented hyperkalemia or sodium channel blocker toxicity 5