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Related Experiment Video

Updated: Oct 1, 2025

A Swine Model of Neonatal Asphyxia
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Inadequate Bioavailability of Intramuscular Epinephrine in a Neonatal Asphyxia Model.

Sara K Berkelhamer1, Payam Vali2, Jayasree Nair3

  • 1Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.

Frontiers in Pediatrics
|March 10, 2022
PubMed
Summary

Intramuscular epinephrine is ineffective for newborn resuscitation during severe birth asphyxia due to poor absorption. This route may pose risks after circulation returns, but could be explored for less severe cases.

Keywords:
asphyxiaepinephrineintramuscularlow-resourceneonatalresuscitation

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Area of Science:

  • Neonatal resuscitation
  • Pharmacokinetics
  • Perinatal medicine

Background:

  • Intrapartum-related events cause over 500,000 newborn deaths annually, primarily in low-resource settings.
  • While asphyxia reduction strategies exist, novel approaches are needed to further decrease newborn mortality.
  • Current resuscitation guidelines recommend intravenous, intraosseous, or endotracheal epinephrine, requiring advanced skills and equipment.

Purpose of the Study:

  • To evaluate the bioavailability and efficacy of intramuscular (IM) epinephrine administration in asphyxiated newborns.
  • To determine if IM epinephrine is a viable, accessible alternative for neonatal resuscitation in compromised infants.

Main Methods:

  • Fetal lambs underwent cesarean delivery, followed by asphyxiation via umbilical cord occlusion for 5 minutes.
  • Intramuscular epinephrine (0.1 mg/kg) was administered after initial resuscitation efforts (ventilation and chest compressions).
  • Plasma epinephrine concentrations were serially measured using ELISA to assess absorption.

Main Results:

  • Plasma epinephrine levels did not significantly increase after IM injection during asphyxia.
  • Delayed epinephrine absorption was observed in half of the lambs after the return of spontaneous circulation (ROSC).

Conclusions:

  • Intramuscular epinephrine administration is inadequate during severe birth asphyxia, suggesting ineffectiveness for critically compromised newborns.
  • Late absorption post-ROSC raises concerns about potential adverse effects.
  • Further research into the bioavailability and efficacy of IM epinephrine in cases of less profound asphyxia is warranted.