Epinephrine is a natural catecholamine which affects Alpha and Beta receptors. Beta I receptors are going to stimulate the heart activity to increase the ejection factor. It also stimulates Alpha II receptors with cause bronco dilation which should aid in expanding the lung tissue which as we know has been constricted up to the point of delivery.

Epinephrine will also increase cerebral perfusion along with a boost of glucose for the brain function.

 

Past guidelines Newborn Resuscitation recommended that initial doses of epinephrinebe given through an endotracheal tube because the dose can beadministered more quickly than when an intravenous route must be established. But animal studies that showed a positive effect of endotracheal epinephrine used considerably higher doses than what are currently recommended, and the one animal study that used currently recommended doses given endotracheally showed no effect. Given the lack of data on endotrachealepinephrine and the efficiency of an Easy IO, the IV route should be used as soon as venous accessis established.

 

The recommended IV dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended because animal  and pediatric studies show increased hypertension, decreased myocardial function, and worse neurologic function after administration of IV doses in the range of 0.1 mg/kg. If the endotracheal route is used, doses of 0.01 or 0.03 mg/kg will likely be ineffective. Therefore, IV administration of0.01 to 0.03 mg/kg per dose is the preferred route.While access is being obtained, administration of a higher dose(up to 0.1 mg/kg) through the endotracheal tube may be considered, but the safety and efficacy of this practicehave not been evaluated. The concentration of epinephrine foreither route should be 1:10 000 (0.1 mg/mL). Epinephrine of a 1:1000 concentration should never be used in the resuscitation efforts of a newborn.

 

Upon successful resuscitation efforts it is imperative that glucose level be monitored in the newborn. A side effect of the epinephrine is that it boosted the glycogen output and increased metabolism. Be prepared to administer dextrose of 10% solution at 2mL/Kg.

 

Another use for epinephrine after successful resuscitation is as Racemic Epinephrine to be nebulized after extubation. Soft tissue trauma from being intubated can cause edema in the upper air way and compromise respiratory efforts. It is believed that this will reduce the swelling by vasoconstriction in the soft tissue as in the same treatment for croup.

 

The bottom lines is that with only 1% of the births needing aggressive resuscitation efforts, there is not enough consistent data available from in hospital resuscitation efforts to warrant changing any of the current guidelines established by AHA.