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

Abstract

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.

Fig. 1. Suggested initial endotracheal and intravenous (IV) epinephrine doses using 5 ml and 1 ml syringes, respectively.

The use of color-coded syringes may decrease errors in dose preparation. The advantages and disadvantages of the current recommended IV epinephrine dose range of 0.01–0.03 mg/kg used during neonatal resuscitation.