Differences in Epinephrine Concentration in Newborns

This difference relates to both physiologic context and evidence-based dosing in the neonatal versus pediatric population. In neonatal resuscitation, the preferred route for epinephrine is intravenous or intraosseous, using 0.01–0.03 mg/kg of 1:10,000 (0.1 mg/mL). When ETT administration is required because vascular access is not yet available, 1:10,000 is also used, but at a higher dose (0.05–0.1 mg/kg) to compensate for poor pulmonary absorption (AHA, 2021). This concentration is maintained because it aligns with neonatal pharmacologic safety data and reduces the risk of dosing errors during a critical low-weight resuscitation.

In pediatric cardiac arrest (VSA), ETT epinephrine was historically delivered as 1:1,000 (1 mg/mL), reflecting early studies that used higher concentrations to achieve adequate absorption through the larger pediatric airway and the relatively higher tolerance for catecholamine doses in this group. While IV or IO routes remain preferred, when ETT administration is necessary, the 1:1,000 concentration is used to achieve sufficient systemic uptake in the absence of reliable absorption data for lower concentrations in older children (AHA, 2020; ILCOR, 2021).

In summary, the newborn concentration reflects neonatal-specific safety and absorption research, whereas the pediatric VSA concentration is based on historical pharmacokinetic data and airway size considerations. Both practices aim to deliver an effective but safe dose given the patient’s physiology and available routes during resuscitation.

References
American Heart Association. (2020). Part 4: Pediatric Basic and Advanced Life Support (2020 AHA Guidelines for CPR & ECC). Circulation.
American Heart Association. (2021). Part 5: Neonatal Resuscitation (2020 AHA Guidelines for CPR & ECC). Circulation.
International Liaison Committee on Resuscitation (ILCOR). (2021). 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation.