Epinephrine, volume expanders, naloxone, and sodium bicarbonate have never really been studied in newborns but may be considered as a last resort. The umbilical vein provides ready access. Intraosseous administration can also be considered.
If the baby simply doesn’t respond, with no heartbeat for 10 minutes after 10 minutes of resuscitation efforts, consider stopping the interventions. Some parents prefer to withhold resuscitation altogether if the infant is unlikely to survive long, especially in cases of extreme prematurity, chromosomal abnormalities, or anencephaly.
"If you’re not sure whether resuscitation is indicated or not, it’s much better to err on the side of trying," Dr. McCullough said. "You can always discontinue support after speaking with parents."
Dr. McCullough has no relevant conflicts of interest.