For a 3-day-old premature infant with a heart rate of 50/min, what medication would be most appropriate?

• A. Administer dopamine HCl
• B. Administer 0.2 mg Atropine sulfate
• C. Administer subcutaneous epinephrine 1:10,000
• D. Administer racemic epinephrine

Answer: (B)

In the case of a 3-day-old premature infant exhibiting bradycardia with a heart rate of 50 beats per minute, atropine sulfate is often utilized as it can effectively address symptomatic bradycardia. In pediatrics, especially among neonates, atropine works by creating vagolytic effects that can help to increase heart rate.

Notably, bradycardia in neonates can be associated with various underlying causes such as respiratory issues or neurological conditions, making it crucial to manage the heart rate to maintain cardiovascular stability. Atropine is typically indicated in these situations because it enhances heart activity by blocking the effects of the vagus nerve on the heart.

Furthermore, the use of other medications listed in the choices would not be appropriate in this specific scenario. For instance, dopamine would be more applicable in cases where there is a need to support circulation rather than primarily addressing a low heart rate. Epinephrine is generally reserved for more severe life-threatening situations, particularly in cardiac arrest scenarios or anaphylactic reactions. Racemic epinephrine is utilized to relieve upper airway obstruction or stridor but is not appropriate for managing bradycardia.

Thus, administering atropine sulfate is the most suitable choice for effectively increasing the heart rate