A newborn receives effective positive pressure ventilation for 30 seconds, after which the heart rate remains 45 bpm. What is the NEXT step in resuscitation?

• A Increase FiO2 to 1.0 and reassess after another 30 seconds
• B Intubate the trachea and continue positive pressure ventilation alone
• C Administer adrenaline intravenously through an umbilical venous catheter
• D Begin chest compressions coordinated with ventilation at a 3:1 ratio ✓

Explanation

When the heart rate stays below 60 bpm despite 30 seconds of effective ventilation, chest compressions must begin, coordinated with ventilation at a 3:1 ratio (90 compressions and 30 breaths per minute). Adrenaline is indicated only if the heart rate remains below 60 after at least 30 seconds of coordinated compressions and ventilation. Simply raising FiO2 delays a time-critical step, since inadequate perfusion, not oxygen content, is the limiting factor.

Reference: Textbook of Neonatal Resuscitation (NRP), American Academy of Pediatrics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.