A 28-week preterm neonate is born via emergency caesarean section. At 1 minute, the infant has a heart rate of 55 bpm, minimal respiratory effort, and is limp. After initial steps of resuscitation for 30 seconds there is no improvement. What is the NEXT most appropriate step?
- A Begin chest compressions
- B Administer IV epinephrine immediately
- C Start positive pressure ventilation (PPV) ✓
- D Intubate and administer surfactant
Correct answer: C. Start positive pressure ventilation (PPV)
Explanation
In neonatal resuscitation, after the initial steps (drying, stimulating, positioning, clearing airway), if HR is <100 or breathing is inadequate, the next step is positive pressure ventilation (PPV), not chest compressions. Chest compressions are only initiated if HR remains <60 bpm after 30 seconds of effective PPV. Epinephrine is used only if HR remains <60 after 30 seconds of coordinated CPR. Surfactant is a separate intervention for RDS, not part of immediate resuscitation sequence.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.