title: Medications in neonatal resuscitation: epinephrine and the search for better alternative strategies.
abstract: Epinephrine remains the primary vasopressor for neonatal resuscitation complicated by asystole or prolonged bradycardia not responsive to adequate ventilation and chest compressions. Epinephrine increases coronary perfusion pressure primarily through peripheral vasoconstriction. Current guidelines recommend intravenous epinephrine administration (0.01-0.03 mg/kg). Endotracheal epinephrine administration results in unpredictable absorption. High-dose intravenous epinephrine poses additional risks and does not result in better long-term survival. Vasopressin has been considered an alternative to epinephrine in adults, but there is insufficient evidence to recommend its use in newborn infants. Future research will focus on the best sequence for epinephrine administration and chest compressions.
authors.affiliation: Department of Pediatrics, St. Joseph Mercy Hospital, 5301 East Huron River Drive, Ann Arbor, MI 48106, USA. weinerg@trinity-health.org
authors.forename: Gary M
authors.initials: GM
authors.lastname: Weiner
authors.forename: Susan
authors.initials: S
authors.lastname: Niermeyer
mesh_terms: D001238:Asphyxia Neonatorum / Q000188:drug therapy*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005316:Fetal Distress / Q000188:drug therapy*; D006323:Heart Arrest / Q000188:drug therapy*; D006336:Heart Massage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012151:Resuscitation / Q000379:methods*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine