In neonatal resuscitation using the NRP algorithm, which of the following findings would prompt a provider to deliver positive pressure ventilation after initial steps of warmth, stimulation, and clearing of airway?
- A Heart rate of 110 bpm with labored breathing and SpO2 of 94% in room air
- B Heart rate of 88 bpm with apnea or gasping after initial steps ✓
- C Heart rate of 120 bpm with cyanosis in a vigorous term infant
- D Heart rate of 95 bpm with normal respiratory effort but mild central cyanosis
Correct answer: B. Heart rate of 88 bpm with apnea or gasping after initial steps
Explanation
Per the NRP algorithm, PPV is indicated when the neonate has: apnea/gasping, or heart rate <100 bpm despite initial stabilization steps. A heart rate of 88 bpm with apnea clearly meets both criteria. Options A, C, and D describe neonates with HR ≥100 bpm, where supplemental oxygen via free-flow oxygen or CPAP is the initial step, not PPV. The threshold for PPV is HR <100 bpm, not 90 or 95 bpm, making option D incorrect as well since the neonate has normal respiratory effort.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.