During neonatal resuscitation, a newborn's heart rate remains below 60 bpm despite 30 seconds of effective positive pressure ventilation with chest movement. Chest compressions are begun. What is the correct compression to ventilation ratio and the target heart rate at which compressions can be stopped?

• A 3:1 ratio, stop when heart rate is above 60 bpm ✓
• B 15:2 ratio, stop when heart rate is above 80 bpm
• C 3:1 ratio, stop when heart rate is above 100 bpm
• D 30:2 ratio, stop when heart rate is above 60 bpm

Explanation

NRP recommends coordinated chest compressions and ventilations at a 3:1 ratio, delivering about 120 events per minute (90 compressions and 30 breaths) to favour ventilation, since asphyxia is the usual cause of bradycardia in newborns. Compressions are stopped once the spontaneous heart rate exceeds 60 bpm, after which PPV alone continues while the rate recovers further. The adult ratios 15:2 and 30:2 do not apply to newborns.

Reference: Textbook of Neonatal Resuscitation (NRP), AAP/AHA, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.