Nrp 8th edition epinephrine dose

Review

. 2021 Jul;41(7):1769-1773.

doi: 10.1038/s41372-021-01032-7. Epub 2021 Mar 12.

Affiliations

  • PMID: 33712718
  • DOI: 10.1038/s41372-021-01032-7

Review

What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room?

Payam Vali et al. J Perinatol. 2021 Jul.

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 mg/kg or intravenous [IV] dose of 0.01-0.03 mg/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 mg/kg or 1 ml/kg of 1 mg/10 ml epinephrine in a 5 ml syringe for ET administration. For IV epinephrine, we suggest preparing an initial dose of 0.02 mg/kg or 0.2 ml/kg of 1 mg/10 ml epinephrine in a 1 ml syringe. A dose of 0.02 mg/kg enables use of a 1 ml syringe for a wide range of birth weights from 500 g to 5 kg. The use of a color-coded syringe may decrease errors in dose preparation.

© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.

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References

    1. Redding JS, Pearson JW. Evaluation of drugs for cardiac resuscitation. Anesthesiology. 1963;24:203–7. - DOI
    1. Weiner GM, Zaichkin J. Textbook of Neonatal Resuscitation (NRP). 7 ed. Elk Grove Village, IL: American Academy of Pediatrics; 2016. p. 326.
    1. Barber CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics. 2006;118:1028–34. - DOI
    1. Halling C, Sparks JE, Christie L, Wyckoff MH. Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room. J Pediatr. 2017;185:232–6.
    1. Hudak ML. Epinephrine for Neonatal Resuscitation: the Limits of Knowledge. Pediatrics. 2020;146:e2020019968.

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