A term neonate has HR 80/min and is apneic at 1 minute of life despite adequate drying, stimulation, and positioning. Positive pressure ventilation (PPV) with 21% O₂ is started. After 30 seconds of PPV, HR is 55/min. What is the NEXT step per NRP 2022 guidelines?
- A Increase O₂ to 100% and continue PPV for another 30 seconds
- B Begin chest compressions immediately at 3:1 (compression:ventilation) ratio
- C Intubate the trachea and administer surfactant
- D Check for ventilation correction steps (MR SOPA), then begin chest compressions if HR remains <60/min ✓
Explanation
Per NRP 7th edition (2022) guidelines, if PPV is being given and HR does not rise above 100 bpm by 30 seconds, the first step is to evaluate and correct ventilation by checking ventilation correction steps (MR SOPA: Mask adjustment, Reposition airway, Suction mouth/nose, Open mouth, increase Pressure, Alternative airway). Effective chest rise must be confirmed before escalating. If HR is <60/min after corrective ventilation steps are confirmed effective (for another 30 seconds), THEN begin chest compressions at a 3:1 ratio (90 compressions:30 breaths per minute) with 100% O₂. Immediately starting chest compressions before confirming adequate ventilation is incorrect; inadequate ventilation is the most common reason for failure to respond.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.