During neonatal resuscitation, a provider begins coordinated chest compressions and positive pressure ventilation because the heart rate remained below 60 bpm despite 30 seconds of effective ventilation. What is the correct compression to ventilation ratio and the total number of events per minute?

• A 5:1 ratio, 90 events per minute
• B 15:2 ratio, 120 events per minute
• C 3:1 ratio, 120 events per minute ✓
• D 30:2 ratio, 100 events per minute

Explanation

Neonatal bradycardia is almost always due to hypoxia, so the NRP recommends a 3:1 compression to ventilation ratio, giving approximately 90 compressions and 30 ventilations, a total of 120 events per minute. The paediatric adult-style ratios such as 15:2 or 30:2 prioritise perfusion over oxygenation and are not used in the delivery room. Compressions are delivered on the lower third of the sternum to a depth of about one third of the anteroposterior chest diameter.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.