When an infant is treated, and if his heart rate remains less than 80 beats per minute even after an external cardiac massage, which of the following should be given to him?

1. A

   sodium bicarbonate

2. B

   adrenaline

3. C

   Sodium chloride

4. D

   potassium bicarbonate

Appeared in: UP CHO - 10 September 2021

Explanation

• Adrenaline (Epinephrine) is the drug of choice for persistent severe bradycardia (heart rate < 60 bpm) in a newborn, as per Neonatal Resuscitation Program (NRP) guidelines.
• It is administered when the heart rate does not increase despite effective positive-pressure ventilation and 60 seconds of coordinated chest compressions.
• Adrenaline acts as a cardiac stimulant, increasing heart rate, myocardial contractility, and peripheral vasoconstriction, which helps restore circulation.
• The recommended route is intravenous (via an umbilical vein catheter) or intraosseous, as it provides the most reliable and rapid effect.

Why Other Options Were Wrong

• Option A: Sodium bicarbonate is not a first-line drug in neonatal resuscitation. Its routine use is discouraged because it can cause adverse effects like hypernatremia and fluid shifts in the brain.
• Option C: Sodium chloride (as normal saline) is a volume expander, not a cardiac stimulant. It does not directly increase the heart rate.
• Option D: Potassium is strictly contraindicated in this situation. Administering potassium can be cardiotoxic, leading to severe arrhythmias or even cardiac arrest.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological interventions in neonatal resuscitation as background academic context rather than a clinical decision trigger.
• Nurses on a delivery or neonatal unit must be proficient in the NRP algorithm to respond effectively to a non-breathing or bradycardic infant.
• Rapid and correct intervention is critical. Delays in starting appropriate steps, including medication administration, can lead to hypoxic-ischemic brain injury or death.
• What if the infant's heart rate was 90 bpm but they had poor respiratory effort? In that case, the priority would be to continue or improve positive-pressure ventilation (PPV) to support breathing. Chest compressions and adrenaline would not be indicated as the heart rate is above the 60 bpm threshold.

How to Approach the Question

• First, identify the patient and clinical situation: a newborn infant undergoing resuscitation.
• Analyze the specific clinical finding: the heart rate is less than 80 bpm even after chest compressions. This signifies a failure to respond to standard resuscitation measures.
• Recall the steps of the Neonatal Resuscitation Program (NRP) algorithm in sequence.
• Recognize that after effective ventilation and chest compressions fail to raise the heart rate above 60 bpm, the next step is pharmacological intervention.
• Identify the primary medication used for persistent bradycardia in the NRP algorithm, which is adrenaline (epinephrine).
• Evaluate the other options to confirm they are incorrect for this specific indication (e.g., volume expanders for hypovolemia, buffers for acidosis, or contraindicated substances).

Concept Tested & Keywords

• Concept Tested: Pharmacological interventions in neonatal resuscitation.
• Stem keywords: infant, heart rate, less than 80 beats per minute, external cardiac massage
• Lead-in keywords: which of the following
• Clinical cues: The key cue is an infant with persistent bradycardia (HR < 80 bpm) even after receiving chest compressions, indicating a failure to respond to initial resuscitation steps and the need for medication.

Question ID

QcAO0DwRMv-yzzMLZ5dnUa

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1080-1082

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 124-126