In the Neonatal Resuscitation Program (NRP) algorithm, after 30 seconds of effective positive pressure ventilation with 21% oxygen in a term neonate with no spontaneous respirations and heart rate 55 bpm, what is the next step?
- A Chest compressions at 3:1 ratio with PPV; increase FiO2 to 100% ✓
- B Continue PPV; increase FiO2 to 100% and start chest compressions
- C Intubate immediately and give adrenaline
- D IV dextrose for possible hypoglycaemia
Explanation
Per NRP 2020/IAP NRP guidelines, if effective PPV for 30 seconds results in heart rate <60 bpm, chest compressions are initiated at a 3:1 compression:ventilation ratio (90 compressions + 30 breaths per minute = 120 events/min), and oxygen should be increased to 100% (FiO2 1.0). Adrenaline is given only after 30 seconds of coordinated chest compressions + PPV if HR remains <60 bpm. Intubation is preferred when initiating compressions to optimise ventilation. The 3:1 ratio (instead of 15:2 used in adults) prioritises ventilation because neonatal arrest is almost always of respiratory origin.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.