If the heart rate remains <60 after CPR and vascular access in neonatal resuscitation, what is the next step?

• A. EPINEPHRINE 1:10,000 0.01 mg/kg IV/IO q3-5 min
• B. 0.1 mg/kg ETT q3-5 min
• C. Administer calcium
• D. Defibrillate

Answer: (A)

When a newborn’s heart rate remains below 60 beats per minute after CPR and obtaining vascular access, the next step is to give epinephrine at 0.01 mg/kg (1:10,000) IV or IO, every 3–5 minutes. Epinephrine helps restore and improve perfusion during CPR by increasing coronary and cerebral perfusion pressures through vasoconstriction, which supports return of spontaneous circulation and a growing heart rate.

The endotracheal route dose (0.1 mg/kg) is not the preferred approach when IV/IO access is available, because IV/IO administration provides more reliable and rapidly reached effects. Calcium is not routinely given in this situation unless there’s a specific electrolyte disturbance or another clear indication. Defibrillation is not indicated here, since the scenario involves persistent bradycardia/asystole, not a shockable rhythm like ventricular fibrillation or pulseless VT.