If the baby's heart rate is less than 100 after the previous steps, what should you do?

• A. Start positive pressure ventilation (PPV)
• B. Initiate chest compressions
• C. Give supplemental oxygen only
• D. Call for help and wait

Answer: (A)

Ventilation is the priority when a newborn’s heart rate is under 100 after the initial steps. A heart rate below 100 usually signals inadequate oxygenation due to poor breathing, so the next action is to initiate positive pressure ventilation to improve both breathing and oxygen delivery to the lungs and blood. Use a bag–mask to provide effective ventilation, aiming for a good chest rise at about 40–60 breaths per minute.

Giving oxygen alone won’t fix the underlying ventilation problem, and delaying action to call for help or wait would let hypoxia continue. Chest compressions are reserved for when the heart rate drops below 60 after you have established effective ventilation. By starting PPV now, you address the cause of the bradycardia and support the baby’s recovery.