A 28-week preterm neonate weighing 980 g is born. After cord clamping and warming, the baby has no spontaneous respiration, HR 55/min, and central cyanosis. Initial ventilation with T-piece resuscitator is performed. After 30 seconds of PPV, HR is 68/min. What is the MOST appropriate next step?
- A Continue PPV and reassess after another 30 seconds
- B Begin chest compressions at 3:1 ratio with PPV
- C Check mask seal, airway positioning, and consider MR SOPA maneuvers before deciding on chest compressions ✓
- D Administer surfactant immediately via endotracheal tube
Correct answer: C. Check mask seal, airway positioning, and consider MR SOPA maneuvers before deciding on chest compressions
Explanation
When PPV fails to improve HR above 60/min, the immediate step before initiating chest compressions is to ensure ventilation is effective using the MR SOPA maneuvers (Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Airway alternative). Ineffective ventilation is the most common reason for failure to respond. Chest compressions are indicated only when HR remains below 60/min despite adequate ventilation for 30 seconds.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.