Effective positive pressure ventilation resolves transition problems for most newborns, and it is uncommon for newborns to require epinephrine during resuscitation. Neonatal resuscitation should not progress to chest compressions or medication administration until adequate ventilation has been established.   

Infants requiring epinephrine have severely depressed myocardial perfusion leading to ineffective cardiac contractions. Poor cardiac function may be caused by prolonged compromised oxygenation or severe acidosis. Newborns with acute blood loss (vasa previa, intrauterine trauma, cord disruption, and cord compression) are also at high risk for needing compressions and medications since their cardiac output may be insufficient. These high-risk babies may also need volume expansion. 

A route of administration must be established before giving epinephrine or volume expanders. The preferred route is via the umbilical venous catheter, but the intraosseous route is an acceptable alternative.