Neonatal bradycardia: treatment

Neonatal bradycardia is defined as a decrease in heart by 30 bpm from baseline. Regarding neonatal resuscitation, bradycardia is concerning when the heart rate is less than 100 bpm. The primary cause of neonatal bradycardia is hypoxia. Other causes of bradycardia in this age group include hypothermia, hypovolemia, and pneumothorax, head injury, and medications.

The treatment of neonatal bradycardia starts by evaluating the airway. The airway should be open and the neonate should be spontaneously ventilating. If they have any evidence of labored breathing or if their heart rate is less than 100 bpm, positive pressure ventilation should be provided. If the heart remains below 100 bpm, ventilation should be reassessed and measures to improve ventilation should be initiated. These measures include adjusting the face mask, repositioning the head, suctioning the mouth, and using a jaw thrust technique with positive airway pressure to open mouth. The neonate may require endotracheal intubation if ventilation and oxygenation is inadequate despite these maneuvers.

If the heart rate corrects itself and remains above 60 but below 100 bpm, measures to ensure adequate oxygenation and ventilation should continue.If the heart rate decreases below 60 bpm despite adequate oxygenation and ventilation, begin chest compressions. If the heart remains below 60 bpm after 30-45 seconds of effective chest compressions, epinephrine 10 mcg/kg (0.01 mg/kg of 1:10,000 solution) should be administered intravenously. This may be repeated every 3-5 minutes. The dose of intratracheal epinephrine is 50-100 mcg/kg (0.05-0.1 mg/kg of 1:10,000 solution). Reassess the heart rate one to two minutes after administration of epinephrine.