Elsevier

The Journal of Pediatrics

Volume 185, June 2017, Pages 232-236
The Journal of Pediatrics

Clinical and laboratory observations
Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room

https://doi.org/10.1016/j.jpeds.2017.02.024Get rights and content

A retrospective examination is presented of intravenous vs a lower (0.03 mg/kg) and higher (0.05 mg/kg) dose of endotracheal epinephrine during delivery room cardiopulmonary resuscitation. Repeated dosing of intravenous and endotracheal epinephrine is needed frequently for successful resuscitation. Research regarding optimal dosing for both routes is needed critically.

Section snippets

Methods

Parkland Memorial Hospital is a large county hospital in Dallas, Texas, with approximately 11 000-16 000 deliveries a year over the past decade. Since 1989, Parkland has had a dedicated neonatal delivery room resuscitation team whose purpose is to attend high-risk deliveries to resuscitate and stabilize newborn infants. The team consists of a senior pediatric resident or a neonatal nurse practitioner, a neonatal nurse with special training in delivery room resuscitation, and a neonatal

Results

During the 8.5-year study period, there were 114 367 births at Parkland Hospital. Of these, 56 infants (0.05%) received epinephrine in the delivery room (Figure). Baseline characteristics of infants who received initial ET vs initial IV epinephrine in the delivery room are found in the Table. The 2 groups were similar in all respects including birth weight, gestational age, sex, mode of delivery, Apgar scores, time to first epinephrine dose, umbilical cord arterial gas values, and incidence of

Discussion

Despite a significant lack of evidence to support optimal dosage and efficacy of IV and ET epinephrine in the newborn, its use in neonatal resuscitation remains accepted practice. This study demonstrates that the currently recommended doses for both IV and ET epinephrine frequently needed to be repeated before ROSC was achieved. The vast majority of newborn infants who achieved ROSC did so after receiving an IV dose of epinephrine. Furthermore, the overall total dose of epinephrine received

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    The authors declare no conflicts of interest.

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