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epinephrine, it should be delivered via IV route as soon as vascular access is
established.
Epinephrine
Epinephrine is indicated when the infant’s HR remains less than 60/min, despite
adequate ventilation with 100% oxygen and coordinated chest compressions (see
Table 9.10 for dosing). It may be administered via an umbilical venous catheter, a
peripheral IV, an IO line, or the ET tube and repeated every 3 to 5 minutes. IV
epinephrine should be administered as rapidly as possible and followed by a 1mL normal saline flush. High-dose epinephrine is not recommended and may
cause harm.
TABLE 9.10
MEDICATIONS FOR NEONATAL RESUSCITATION

Volume Expansion
Volume expansion is indicated when the infant’s HR has not responded
adequately to other resuscitative measures or if blood loss is suspected. Isotonic
crystalloid (normal saline, lactated Ringer’s) or blood may be administered
intravenously in 10 mL/kg aliquots for volume expansion. Rapid infusion of
volume expanders should be avoided in premature infants given association with
IVH. Albumin-containing solutions are not recommended because of cost, limited
availability, risk of infection, and potential increased mortality.
Glucose
Hypoglycemia in the neonate is associated with increased risk for brain injury and
adverse outcomes with hypoxic-ischemic events. Therefore, the administration of
IV glucose infusion should be considered as early as is practical after initial
resuscitative measures. The goal of glucose infusion should be to maintain
euglycemia.

Other Medications
ED stabilization should focus on basic resuscitation interventions outlined above.
Other medications such as buffers, narcotic antagonist, vasopressors, or surfactant