Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room.

Full Abstract

OBJECTIVE:
Given the paucity of information regarding endotracheal epinephrine for newborn resuscitation, the objectives of this study were:
(1) to determine the frequency of endotracheal epinephrine use in newborns in the delivery room, and (2) to determine whether the previously recommended dose of 0.01 to 0.03 mg/kg of endotracheal epinephrine is effective in establishing a return of spontaneous circulation.

PATIENTS AND METHODS:
A retrospective review was conducted for all neonates who received > or = 1 dose of epinephrine in the delivery room between January 1999 and December 2004. Infants who received > or = 1 dose of endotracheal epinephrine in the delivery room during resuscitation were included in the study population whether or not they survived to be admitted to the NICU. Exclusion criteria included lethal congenital anomalies, delivery outside the hospital, and missing medical charts.

RESULTS:
Of 93,656 infants, 52 neonates (0.06%) received epinephrine in the delivery room, 5 of whom met exclusion criteria. Of the remaining 47 infants, 44 (94%) received the first dose via the endotracheal tube. Only 14 (32%) of 44 achieved return of spontaneous circulation after endotracheal tube administration of epinephrine. Of the 30 remaining infants, 23 (77%) had return of spontaneous circulation with intravenous epinephrine after initially failing endotracheal tube epinephrine. There were no differences in clinical characteristics between newborns who responded to endotracheal tube versus intravenous epinephrine except for a lower blood glucose on NICU admission (52 vs 113 mg%).

CONCLUSIONS:
Endotracheal epinephrine is frequently used when intensive resuscitation is required in the delivery room. The previously recommended endotracheal epinephrine dose of 0.01 to 0.03 mg/kg is often ineffective. Higher endotracheal doses will likely be needed to improve efficacy. A prospective study is needed to determine the best endotracheal epinephrine dosing regimen. Until such information is available, intravenous administration should be the preferred route of delivery.

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Author information

Author/s: Barber, Chad A (CA); Wyckoff, Myra H (MH);

Affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.

Journal and publication information

Publication Type: Journal Article

Journal: Pediatrics (Pediatrics), published in United States. (Language: eng)

Reference: 2006-Sep; vol 118 (issue 3) : pp 1028-34

Dates: Created 2006/09/04; Completed 2006/09/29;

PMID: 16950994, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adrenergic Agonists - administration & dosage
Asphyxia - prevention & control
Blood Circulation - drug effects
Cardiopulmonary Resuscitation - methods
Delivery Rooms
Dose-Response Relationship, Drug
Epinephrine - administration & dosage
Female

Associated Chemicals: Adrenergic Agonists (0) ; Epinephrine (51-43-4)

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