You arrive at a residence at 112 East Schweppe Street, where a father has just delivered his 34-week gestation daughter. The umbilical cord is still intact and the newborn, who has a weak cry, has cyanosis to the face, neck, and trunk. After quickly evaluating the newborn for signs of meconium, you perform the initial steps of resuscitation.

1. What are the initial steps of newborn resuscitation?

After completing your initial interventions, you perform a quick assessment of the newborn’s cardiopulmonary status (Table 1). The mother, who is being comforted by her husband, tells you that this is her first baby.

Table 1  Rapid Cardiopulmonary Assessment

Airway and Breathing	Airway is patent (after suctioning); respirations, normal rate but irregular; adequate tidal volume
Heart Rate	90 beats/min and regular
Color	Peripheral and central cyanosis

2. When is management indicated for this newborn?

Following 30 seconds of treatment, you reassess the newborn and note that respirations have become shallow. Additionally, the newborn’s heart rate is 50 beats/min and its trunk is becoming increasingly cyanotic. Your partner prepares for additional treatment.

3. How will you manage this newborn now?

The appropriate management is continued for the newborn. In addition, steps are taken to preserve the newborn’s body heat. After 30 seconds of additional treatment, you reassess the newborn (Table 2). The mother, who remains conscious and alert, has been placed on 100% oxygen via nonrebreathing mask.

A back-up crew of two paramedics arrives to provide assistance. Despite effective resuscitative efforts, the infant remains bradycardic and hypoxic. You and your partner agree that epinephrine is indicated. With difficulty, one of the assisting paramedics establishes a 26-gauge IV in the infant’s antecubital vein. Blood is also obtained for a blood glucose reading.

Table 2  Newborn Reassessment

Airway and Breathing	Intubated; ventilated at a rate of 40-60 breaths/min
Heart Rate	60 beats/min, weak and regular
Color	Peripheral and central cyanosis

4. What is the appropriate dose and route for epinephrine in this newborn?

Following the administration of epinephrine, you reassess the newborn and find that her heart rate has increased to 90 beats/min. Chest compressions are therefore discontinued; however, positive-pressure ventilations are continued. An assisting paramedic advises you that the newborn’s blood glucose reading is 40 mg/dL.