Use of adrenaline and atropine in neonatal resuscitation

One hundred and five infants treated with adrenaline or atropine, or both, as part of resuscitation on 124 occasions were studied retrospectively. Adrenaline was administered to 98 infants, in 40 of whom it was in combination with atropine, and seven infants received atropine alone. Twenty infants were treated solely on the delivery unit, 81 on the neonatal medical unit, and four in both places. Twelve infants treated on the delivery unit and 13 treated on the neonatal unit survived. Follow up studies showed that 13 infants were handicapped with nine severely handicapped. Extreme prematurity, the need for early or repeated resuscitation using these drugs, particularly for episodes of collapse without a clear precipitating cause, and asystole rather than bradycardia were associated with a worse outcome. Evidence is accumulating to support a view that the use of these drugs for resuscitation at birth and in the first week of life of extremely preterm infants may be inappropriate.