In neonatal resuscitation, a heart rate remains below 60 bpm after 30 seconds of ventilation. What is the next step?

• A. Provide bag-valve-mask ventilation
• B. Begin chest compressions
• C. Delay ventilation
• D. Stimulate and rub

Answer: (B)

When a newborn’s heart rate stays below 60 beats per minute after about 30 seconds of effective ventilation, the priority becomes supporting circulation. Chest compressions are started to raise cardiac output and improve perfusion to the brain and heart, since ventilation alone hasn’t restored adequate circulation. In neonatal resuscitation, perform chest compressions in combination with ongoing ventilation at a 3:1 ratio—roughly 90 compressions and 30 breaths per minute. Use the recommended neonatal technique (two fingers on the sternum for a single rescuer, or two-thumb-encircling hands for two rescuers) and compress about one-third of the chest depth. Continue CPR until the heart rate rises above 60 bpm or until you achieve a stable rhythm with advanced care. Delaying ventilation or relying on stimulation alone doesn’t address the critical need for circulation when the heart rate remains very low.