After 30 seconds of PPV, if heart rate is less than 60, what should you do?

• A. Initiate chest compressions
• B. Continue PPV
• C. Place on side and observe
• D. Start chest radiograph

Answer: (A)

When resuscitating a newborn, oxygenation and circulation both matter, and you monitor the heart rate after initiating ventilation. If the heart rate remains below 60 beats per minute after about 30 seconds of effective positive-pressure ventilation, the perfusion is inadequate and you must start chest compressions. Chest compressions generate circulatory flow to improve blood delivery to the brain and heart, which ventilation alone cannot achieve when perfusion is too low. Once you begin compressions, you coordinate them with ventilations (in neonates typically a 3:1 compression-to-ventilation pattern) and continue monitoring for an improvement in heart rate above 60. The other actions—the continued ventilation without addressing perfusion, simply watching from the side, or obtaining a chest radiograph during ongoing resuscitation—do not actively restore circulation and are not appropriate steps in this scenario.