Adrenaline, also known as epinephrine, is a powerful hormone and neurotransmitter used as a last-resort emergency medication during neonatal resuscitation in Nigerian maternity units. When a newborn fails to respond to effective positive pressure ventilation and coordinated chest compressions, the heart rate often remains critically low, usually below 60 beats per minute. At this stage, myocardial function is severely depressed due to profound hypoxia and acidosis. Adrenaline is introduced to stimulate the heart, restore adequate coronary perfusion pressure, and increase the force and rate of cardiac contractions. Because it is a high-alert drug, it demands extreme precision in calculation and administration to avoid dangerous complications in a tiny, fragile newborn.
Administering adrenaline to a neonate is a serious decision requiring strict adherence to international resuscitation guidelines. Midwives and doctors do not use it for routine birth asphyxia where simple stimulation and bag-mask ventilation suffice.
Failing to ensure adequate lung expansion before giving adrenaline is a common error in delivery rooms. If the alveoli remain filled with fluid and unventilated, adrenaline cannot save the infant because the heart lacks oxygen to respond.
Getting the dose wrong with neonatal adrenaline can easily cause fatal hypertension or heart rhythm disorders. Midwives must use the correct concentration and delivery route every time.
| Parameter | Recommended Specification |
|---|---|
| Concentration | 1:10,000 (which means 0.1 mg per mL) |
| Intravenous / Intraosseous Dose | 0.01 to 0.03 mg per kg of body weight |
| Endotracheal Dose (if IV/IO is delayed) | 0.05 to 0.1 mg per kg (higher dose required) |
| Preparation | Always dilute 1 mL of 1:1,000 adrenaline with 9 mL of normal saline to achieve the 1:10,000 strength |
Adrenaline acts directly on alpha and beta-adrenergic receptors distributed throughout the cardiovascular and respiratory systems. Stimulating beta-1 receptors in the heart increases the heart rate (positive chronotropy) and the strength of heart muscle contractions (positive inotropy). Simultaneously, its action on alpha receptors causes peripheral blood vessels to constrict. This constriction redirects limited blood flow away from less vital organs and concentrates it toward the brain and coronary arteries. While this lifesaving response restores blood pressure, it also significantly increases the heart's workload and demand for oxygen.
Because adrenaline is a potent vasoactive drug, mistakes in calculation or administration can lead to severe harm. Midwives must double-check calculations with a colleague whenever time permits. Rapid intravenous pushing of undiluted or incorrect concentrations can trigger dangerous ventricular arrhythmias, severe hypertension, or intracranial hemorrhage, especially in fragile preterm babies whose brain blood vessels are exceptionally delicate. Regular monitoring of the heart rate and blood pressure response following administration is mandatory to guide subsequent doses and evaluate the effectiveness of the resuscitation effort.