Journal of Perinatology | 2021
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\u2009mg/kg or intravenous [IV] dose of 0.01–0.03\u2009mg/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\u2009mg/kg or 1\u2009ml/kg of 1\u2009mg/10\u2009ml epinephrine in a 5\u2009ml syringe for ET administration. For IV epinephrine, we suggest preparing an initial dose of 0.02\u2009mg/kg or 0.2\u2009ml/kg of 1\u2009mg/10\u2009ml epinephrine in a 1\u2009ml syringe. A dose of 0.02\u2009mg/kg enables use of a 1\u2009ml syringe for a wide range of birth weights from 500\u2009g to 5\u2009kg. The use of a color-coded syringe may decrease errors in dose preparation.