A term neonate remains apneic with a heart rate of 45 bpm despite 30 seconds of correctly delivered positive pressure ventilation with visible chest rise. What is the NEXT step in resuscitation?
- A Continue positive pressure ventilation alone and reassess after another 30 seconds
- B Administer intravenous epinephrine through an umbilical venous catheter
- C Begin chest compressions coordinated with ventilation at a 3:1 ratio ✓
- D Intubate the trachea and administer surfactant
Correct answer: C. Begin chest compressions coordinated with ventilation at a 3:1 ratio
Explanation
Chest compressions are indicated when the heart rate remains below 60 bpm after at least 30 seconds of effective positive pressure ventilation. The compression to ventilation ratio in neonates is 3:1, giving roughly 90 compressions and 30 breaths per minute. Epinephrine comes only after compressions have failed to raise the rate above 60 bpm, so option B is premature. Surfactant addresses lung disease, not bradycardia.
Reference: Cloherty and Stark's Manual of Neonatal Care, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.