If the neonate is apneic or has a heart rate below 100, what is the recommended action?

• A. Chest Compressions Only
• B. Positive Pressure Ventilations at 40/min
• C. Do Nothing
• D. Warm Infant Only

Answer: (B)

When a newborn is apneic or has a heart rate below 100, the priority is to restore ventilation and oxygenation. Positive pressure ventilation delivers air into the lungs, supports gas exchange, and often helps the heart rate to rise toward normal. The recommended pace is about 40 breaths per minute, using a good seal and ensuring visible chest rise. This approach directly addresses the breathing and oxygenation issues that are causing the low heart rate.

If, after a brief period of effective ventilation (typically about 30 seconds), the heart rate remains very low (below 60), you would escalate to chest compressions while continuing ventilation. Do nothing or warming alone would not correct the underlying problem right away, and giving chest compressions without first providing ventilation is not appropriate when the infant is not breathing adequately or has a low heart rate.