Medication use in neonatal resuscitation

The American Heart Association has published guidelines for medication use in neonatal resuscitation. These recommendations should not, however, be regarded as standards or as the final word on resuscitation in neonates. Little work has been performed to justify these recommendations directly; therefore, it was necessary to make recommendations by extrapolating from studies not specifically designed to answer questions concerning the neonate. For example, the optimum dose of epinephrine administered either intravenously or endotracheally in a neonate with hemodynamically significant bradycardia is simply not known. The American Heart Association guidelines were made with reasoning based on the information available, even though the information is tangential. Similarly, since no data exist to document the benefit of NaHCO3 and some data would suggest harmful effects, its routine use is discouraged. Fertile areas for research exist to define better the optimum doses of epinephrine required in newborn resuscitation and to further delineate the importance and safety of rapid reversal of acidosis in newborn resuscitation.