A term neonate at 1 minute of life has heart rate of 50 bpm despite adequate positive pressure ventilation for 30 seconds. The next step is:
- A Begin chest compressions at a 3:1 compression-to-ventilation ratio ✓
- B Administer IV epinephrine immediately
- C Apply CPAP and observe for 2 more minutes
- D Intubate and then give chest compressions at 15:2 ratio
Correct answer: A. Begin chest compressions at a 3:1 compression-to-ventilation ratio
Explanation
Per NRP (Neonatal Resuscitation Program) guidelines, chest compressions are indicated when heart rate remains below 60 bpm despite 30 seconds of effective positive pressure ventilation. The compression-to-ventilation ratio for neonatal resuscitation is 3:1 (not 15:2 used in pediatric cardiac arrest) to maximize oxygenation. Epinephrine is given only if HR remains <60 bpm after 60 seconds of coordinated CPR. CPAP is not appropriate in this emergency situation.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.