Medication administration during neonatal resuscitation
THE CONTEXT
The passage describes vascular access, epinephrine administration, and indications for volume expansion in newborn resuscitation.
Preferred access and emergency tracheal administration
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The umbilical vein is the preferred route for medications; intracardiac injection has no role.
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Insert a 3.5 Fr or 5 Fr umbilical catheter just deep enough to obtain free blood flow.
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If venous access cannot be obtained in an intubated newborn, epinephrine may be administered through the trachea. Absorption through the tracheobronchial tree is erratic.
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For tracheal administration, inject the drug into the endotracheal tube using a syringe or 5 Fr feeding tube, then disperse it into the lungs using positive-pressure ventilation.
Epinephrine indication and administration
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Adrenaline is indicated when heart rate remains below 60 after 30 seconds of adequate ventilation and 60 seconds of effective ventilation with chest compressions.
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The epinephrine dose is 0.2 mL/kg, with a range of 0.1–0.3 mL/kg, of a 1:10 000 dilution prepared as 1 mg in 10 mL of saline.
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Follow the intravenous bolus with 3 mL of saline to flush the drug into the central circulation.
Volume expansion
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Normal saline or Ringer’s lactate is indicated as a volume expander when the neonate has a history of blood loss or signs of shock.