Use of high-dose epinephrine and sodium bicarbonate during neonatal resuscitation: is there proven benefit?

Clinics in Perinatology
Myra H Wyckoff, Jeffrey M Perlman

Abstract

For adults and pediatric age patients, high-dose intravenous epinephrine was recommended if standard-dose epinephrine failed to achieve return of spontaneous circulation. More recent trials suggest that high-dose epinephrine is not beneficial and may result in increased harm. There are no randomized clinical studies of high-dose versus standard-dose intravenous epinephrine in neonates. Routine use of high-dose epinephrine during neonatal resuscitation cannot be recommended. Although sodium bicarbonate has been used during neonatal resuscitation, the only randomized controlled trial of its use during brief neonatal resuscitation showed no benefit. Sodium bicarbonate infusion during neonatal cardiopulmonary resuscitation (CPR) has several known and potential side effects. The use of sodium bicarbonate infusion should be discouraged during brief CPR. Whether sodium bicarbonate is beneficial for infants who require prolonged CPR despite adequate ventilation is unknown.

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Citations

Sep 3, 2013·Seminars in Fetal & Neonatal Medicine·Vishal S Kapadia, Myra H Wyckoff
Jun 18, 2008·Journal of Perinatology : Official Journal of the California Perinatal Association·M Escobedo
Dec 9, 2009·Advances in Pediatrics·Maria J Mandt, Lara D Rappaport
May 30, 2008·Seminars in Fetal & Neonatal Medicine·Jonathan Wyllie, Susan Niermeyer
Jun 23, 2007·Resuscitation·Peter Raupp, Charles McCutcheon
Apr 29, 2015·Maternal Health, Neonatology and Perinatology·Payam ValiSatyan Lakshminrusimha
Dec 5, 2018·Minerva pediatrica·Megan O'reilly, Georg M Schmölzer
Apr 17, 2019·Children·Payam ValiSatyan Lakshminrusimha
Oct 2, 2019·Hospital Pediatrics·Kate D BruneGary M Weiner
May 17, 2017·Frontiers in Pediatrics·Vishal S Kapadia, Myra H Wyckoff
Jun 21, 2018·Paediatric Drugs·Roberto AntonucciLaura Cuzzolin

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