From the Research
The Neonatal Resuscitation Program (NRP) increased the recommended epinephrine dose to 0.02 mg/kg to improve outcomes during neonatal resuscitation, based on evidence suggesting that this dose leads to better return of spontaneous circulation and improved survival rates, as supported by the most recent study 1. This higher dose is now recommended for both intravenous (IV) and endotracheal (ET) administration in newborns requiring resuscitation who do not respond to effective ventilation and chest compressions. The change was based on evidence from a randomized trial in term newborn lambs, which found that a dose of 0.03 mg/kg epinephrine with a 3 mL/kg flush volume was associated with the highest return of spontaneous circulation (ROSC) rate and fastest time to ROSC 1. Key points to consider when administering epinephrine in neonatal resuscitation include:
- The dose: 0.02 mg/kg is the recommended dose, although the study by 1 suggests that 0.03 mg/kg may be more effective
- The route: both IV and ET administration are recommended, with IV being the preferred route due to more predictable absorption
- The flush volume: a flush of 3 mL/kg is recommended to ensure delivery of the epinephrine to the lungs when administered via the ET route Epinephrine works by causing peripheral vasoconstriction, which increases diastolic blood pressure and coronary perfusion, while also enhancing myocardial contractility and heart rate through beta-adrenergic effects, as discussed in the study by 2. The higher dose is particularly important for ET administration since absorption through this route is less predictable and generally less effective than IV administration, as noted in the study by 3. When administering epinephrine via the ET route, it should be followed by a flush of normal saline to ensure delivery to the lungs, as recommended by the study by 1.