Clinical and laboratory observationsEfficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room
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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2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionEuropean Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth
2021, ResuscitationCitation Excerpt :Recent, large-scale observational studies confirm that approximately 85% of infants born at term initiate respiration spontaneously; 10% will respond to drying, stimulation, opening the airway and/or applying CPAP or PEEP, approximately 5% will breathe following positive pressure ventilation. Estimates of intubation rates vary between 0.4% and 2%; <0.3% receive chest compressions and approximately 0.05% adrenaline.10–16 Several maternal and fetal pre- and intrapartum factors increase the risk for compromised birth or transition and the need for resuscitation.
The authors declare no conflicts of interest.