A term neonate receiving bag-and-mask positive pressure ventilation for 60 seconds still has a heart rate of 48 bpm. The airway position and seal have been checked and chest movement is adequate. What is the NEXT step in resuscitation?
- A Start chest compressions coordinated with ventilations at a 3:1 ratio ✓
- B Increase the oxygen concentration to 100% and reassess after another 60 seconds
- C Administer intramuscular adrenaline 0.1 mL/kg of 1:10,000 solution
- D Intubate the trachea solely to deliver surfactant
Correct answer: A. Start chest compressions coordinated with ventilations at a 3:1 ratio
Explanation
After at least 30 seconds of effective ventilation, a heart rate below 60 bpm mandates chest compressions at a 3:1 ratio (90 compressions and 30 breaths per minute), compressing one third of the anteroposterior chest diameter. Adrenaline is given only if the heart rate remains below 60 despite coordinated compressions and ventilation, so option C is premature. Increasing oxygen alone does not address the failing circulation, and surfactant has no role in bradycardia during active resuscitation.
Reference: Textbook of Neonatal Resuscitation (NRP), 8th, AAP/AHA ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.