A term neonate delivered by emergency caesarean section for cord prolapse is limp at birth with a heart rate of 50 bpm. No spontaneous respirations are noted. After 30 seconds of positive pressure ventilation (PPV) with room air, heart rate remains 50 bpm. The next step according to NRP 2020 guidelines is:
- A Continue PPV and increase FiO2 to 100%
- B Intubate and administer adrenaline 0.1 mg/kg IV
- C Begin chest compressions at 3:1 ratio and increase FiO2 to 100% ✓
- D Begin chest compressions and administer sodium bicarbonate
Correct answer: C. Begin chest compressions at 3:1 ratio and increase FiO2 to 100%
Explanation
Per NRP 2020, if heart rate remains below 60 bpm after 30 seconds of effective PPV (with a rise in chest confirmed), chest compressions are initiated at a 3:1 ratio with ventilation and FiO2 is increased to 100%. Adrenaline is indicated if heart rate remains below 60 bpm after a further 60 seconds of compressions plus PPV. Sodium bicarbonate is not recommended routinely in acute resuscitation. Intubation is recommended prior to compressions if not already done.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.