Adenosine Administration for Neonatal SVT

Dosing Protocol

The American College of Cardiology recommends an initial dose of 0.1 mg/kg (100 mcg/kg) as a rapid IV bolus for newborns with SVT, followed by 0.2 mg/kg if the first dose fails, up to a maximum of 0.3 mg/kg (300 mcg/kg) 1
The initial pediatric dose is higher than the adult starting dose of 6 mg, reflecting the higher doses needed in children 1

The American Heart Association recommends administering adenosine as the most rapid IV push possible, immediately followed by a rapid 5-10 mL saline flush 1, 2

Adenosine has an overall cardioversion success rate of 72-88% for all SVT types, with a success rate of 79-96% for AV node-dependent SVT 1
The American College of Cardiology recommends adenosine as the drug of choice (Class I recommendation) for supraventricular tachycardia 2, 3

Continuous rhythm monitoring during therapy is essential to evaluate the effect of interventions, according to the American Heart Association 2

The American College of Cardiology warns against using adenosine for wide-complex tachycardia (QRS >0.09 seconds) unless confirmed to be SVT, as it carries significant risk if the rhythm is actually ventricular tachycardia 4

The American Heart Association recommends attempting vagal stimulation first, such as applying ice to the face without occluding the airway, unless the patient is hemodynamically unstable 2
For refractory SVT, procainamide has higher success rates than amiodarone with equal adverse effects, according to the American College of Cardiology 1
Synchronized cardioversion is preferred for unstable patients or when pharmacologic therapy fails, according to the American College of Cardiology 1
The American Academy of Pediatrics warns against using verapamil in infants due to multiple reports of cardiovascular collapse and death 1