From the Guidelines
For pediatric symptomatic bradycardia, the initial push pressor dose is atropine 0.02 mg/kg, with a minimum single dose of 0.1 mg and a maximum single dose of 0.5 mg for a child, which can be repeated every 5 minutes to a maximum total dose of 1 mg for a child, as recommended by the Pediatrics journal in 2008 1. The dose of atropine for pediatric symptomatic bradycardia is crucial for effective management.
- The initial dose of 0.02 mg/kg is based on the patient's weight, ensuring that the minimum single dose is not less than 0.1 mg and the maximum single dose does not exceed 0.5 mg for children.
- The dose can be repeated every 5 minutes, with a maximum total dose of 1 mg for children, allowing for titration based on clinical response.
- It is essential to note that atropine is used in the context of symptomatic bradycardia, particularly when oxygenation and ventilation are not effective in treating hypoxia-induced bradycardia, as stated in the study 1.
- Epinephrine, as mentioned in other contexts, is also a critical medication in pediatric resuscitation but is specifically indicated for cases where oxygen and adequate ventilation are not effective in the treatment of hypoxia-induced bradycardia, with dosing guidelines provided separately.
- The choice between atropine and epinephrine depends on the underlying cause of the bradycardia and the clinical scenario, with atropine being particularly useful in cases of increased vagal tone or primary AV block.
- The study 1 provides comprehensive guidelines for the management of pediatric emergencies, including the use of atropine for symptomatic bradycardia, emphasizing the importance of appropriate dosing and administration routes.
From the FDA Drug Label
2.3 Pediatric Dosage Dosing in pediatric populations has not been well studied. Usual initial dose is 0.01 to 0.03 mg/kg. The initial push pressor dosing for pediatric symptomatic bradycardia with atropine (IV) is 0.01 to 0.03 mg/kg 2.
- Key points:
- Dosing has not been well studied in pediatric populations.
- The dose should be titrated based on heart rate, PR interval, blood pressure, and symptoms.
From the Research
Initial Push Pressor Dosing for Pediatric Symptomatic Bradycardia
- The initial push pressor dosing for pediatric symptomatic bradycardia is not explicitly stated in the provided studies.
- However, according to the study 3, the emergency treatment of bradycardia depends on its hemodynamic consequences, and if the heart rate is <60 beats per minute with poor perfusion despite effective ventilation with oxygen, it may be treated with chest compressions, epinephrine through IV or endotracheal tube.
- The study 4 mentions that early bolus epinephrine administration during pediatric cardiopulmonary resuscitation for bradycardia with poor perfusion was not associated with survival outcomes, but it does not provide specific dosing information.
- The American Heart Association (AHA) Pediatric Advanced Life Support (PALS) guidelines, mentioned in the study 5, recommend interventions such as oxygen, chest compressions, epinephrine, and atropine for pediatric bradycardia, but the specific dosing for push pressor is not provided.
Recommended Interventions
- The studies suggest that the choice of therapy for pediatric bradycardia depends on the patient's degree of hemodynamic instability 3, 5.
- Atropine may be beneficial in cases of bradycardia due to vagal stimulation or primary A-V block 3, 6.
- Epinephrine and isoproterenol may be considered for continuous infusion if bradycardia persists or responds only transiently to initial treatment 3.
- Transcutaneous pacing may be planned for emergency treatment of bradycardia 3.